TRG Imaging is the second largest private radiology provider in NZ, delivering high quality patient care through a network of North Island clinics.
We offer: AUCKLAND NORTHLAND
• An opportunity to work with a progressive radiology provider;
• Work/life balance (evenings and weekends are yours);
• The choice of where you live... anything from city chic to rural tranquility;
• An MSK Fellowship programme;
• Access to develop your MRI sub-specialty skills on our fleet of modern high tech equipment;
• Further training opportunities and attendance at international conferences;
• Career progression;
• Shareholding opportunities;
• Locum opportunities so you can experience what it’s like here before you make the decision to move.
We are seeking Radiologists with:
• the right capabilities;
• the right attitude; and
• the right workplace cultural fit.
You will join our unique team of professionals dedicated to exemplary patient care and positive working environments where everyone is valued and recognised for their contribution.
We measure our successes and learnings through IANZ accreditation and Net Promoter Score process.
We are well respected in the marketplace and are known for our brand and what it represents.
We place culture at the heart of our success and work continuously to build and maintain the right workforce.
Trusted – we have a direct relationship with seven different District Health Boards, plus are entrusted with contracts from all private medical insurers and Government healthcare agencies.
Sustainability is a responsibility TRG Imaging is passionate about.
Our Vision is to be the recognised leader in the delivery of medical imaging services through quality imaging, patient experience; referrer relationships; and engaged employees.
5 8 A Joint Message from the President and CEO
A Vision for Digital Health in Clinical Radiology in Australia
13
Have your circumstances changed since July 2019?
The Impact of a Research Mentor: an Interview with Dr Ashu Gupta
The Rouse Travelling Fellowship – the exchange of information never stops
The Anne G. Osborn International Outreach Professorship
What are your thoughts?
Training and Assessment Reform
Recertification and Continuing Professional Development in New Zealand
The Role of the College in Trainee Selection
The Growing Importance of CT Guided Lung Biopsies
Raising Awareness to Increase Access to Life-Saving Cancer Treatment
InsideRadiology
From the Faculty of Clinical Radiology
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
Interventional Radiology Committee Update From the Faculty of Radiation Oncology
teaching visit to cancer centres in Cambodia and Vietnam Particle Therapy Group
Have you moved recently?
Log into the MyRANZCR portal and ensure your contact details are up to date at www.myranzcr.com
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The microscope of imaging for intricate IR procedures
In 2020, as we are all aware, the COVID-19 situation has commanded the attention and the resources of the healthcare system as it continues to escalate globally.
The College’s highest priority is to ensure the health and safety of our members, staff and patients. Radiologists and radiation oncologists are a precious health resource and will be critical in fighting the epidemic and supporting the health system.
We will periodically be providing you all with updates on actions the College is taking to mitigate risks and ensure your safety and the safety of your patients at this time.
As you are already aware, the College has formed a COVID-19 College Taskforce whose role it is to coordinate a whole-of-College response to the COVID-19 outbreak that effectively mitigates the risk to you, your patients, the College, and College staff.
The Taskforce aims to ensure that the College’s response encompasses all key precautions, information and professional support that you and our patients expect.
As previously communicated, the Taskforce members are:
• Dr Meredith Thomas, Chief Censor Faculty of Clinical Radiology (exofficio)
• Dr Yaw Chin, Chief Censor Faculty of Radiation Oncology (ex-officio)
• Adj Clin Prof Stacy Goergen, Chair Safety and Quality Committee Faculty of Clinical Radiology
• Dr Lisa Sorger, Councillor Faculty of Clinical Radiology
• Prof Liz Kenny, Councillor Faculty of Radiation Oncology
• Dr Johann Tang, Councillor Faculty of Radiation Oncology
• Prof Alan Coulthard, Director nominated by the Board
• Dr Sharyn MacDonald, Chair Australian and New Zealand Society of Thoracic Radiology (ANZSTR) and New Zealand representative
• Ms Natalia Vukolova, RANZCR CEO (Chair)
• Ms Lucy Hutton, RANZCR Senior Media and Communications Officer
The Taskforce meets regularly and will continue to communicate its decisions and provide information via direct email to you and on the College website. The College will support governments’ containment efforts in minimising the spread and flattening the disease curve over time.
The College Board of Directors, on the advice of the College’s COVID-19 Taskforce, made the difficult decision to defer all College examinations in Series 1, 2020. The risk of candidates acquiring COVID-19 is low, but real and increasing. All College events that cannot be delivered in an online format will be cancelled. Where events, examinations or courses are cancelled, the College will refund participant fees. We continue to monitor the situation closely and the College is communicating directly with anyone who is affected. You will also see changes to 2020 planning reflected in these pages.
College members come to the exams and College events from all key health facilities across Australia and New Zealand, and overseas. Clinical radiologists and radiation oncologists play a critical role in the health system and the risk of so many of you, and your colleagues, potentially requiring quarantine for at least two weeks would be devastating to vital health services. We have also decided to close the Sydney and Wellington College offices to minimise the potential risk of our exposure to COVID-19 which the health system is gearing up to respond to. The staff will continue to work remotely and have shown great professionalism in this exercise, already delivering successfully managed rapid-response virtual workshops.
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1. ViewRay internal data on file (as of 1 May 2019) 2. Zoberi et al. First Ever Magnetic Resonance Image Guided Radiation Therapy for Accelerated Partial Breast Irradiation: Early Results of a Single Institution’s Prospective Experience. ASTRO 2016 (Wash U) Results from this case study are not predictive of future results. 3. International Agency for Research on Cancer. World Health Organization (2018). GLOBOCAN (2018), http://gco.iarc.fr 4. Rudrah et al. Using adaptive magnetic resonance image-guided radiotherapy for treatment of inoperable pancreatic cancer. Cancer Medicine, 2019; 1-10.The Taskforce is also focusing on developing advice on access to personal protective equipment (PPE). The Taskforce felt strongly that the College needed to advocate (together with stakeholders) on PPE that is required by radiology practices. An evidence-based statement has been developed for that purpose. The Taskforce believes, based on the Singaporean experience, that in a situation of scarcity our members may miss out on critical PPE without the College’s advocacy. This advocacy has and will continue to take place across both the Australian and New Zealand governments. Further updates will be provided as this work continues over the coming time.
The Taskforce has reviewed and collated emerging literature and evidence on the role of radiology in COVID-19 detection and management. Australia and New Zealand continue to see patients presenting with respiratory disease either suspected or known to be due to the virus. Radiologists play a key role in diagnosis of disease and the College is providing emerging literature and evidence relevant to the profession on our website which will function as a key point of reference.
Normal appropriate use criteria for imaging patients presenting with an acute respiratory illness should be applied. CT should not be used for routine screening for COVID-19 disease. As with other causes of acute lung injury, it has a role in the evaluation of patients for potential complications.
Further detailed resources are currently available on our website, these will continue to be updated regularly. We would like to thank all College members for their work in reviewing these resources thus far. Separate communiques will be circulated when new resources are uploaded for your reference.
We encourage you to continue closely monitoring updates from the Australian and New Zealand Governments and follow the advice of your local Health Departments.
This is an evolving situation. The College will continue to communicate any significant developments via direct email and through our website at www.ranzcr.com/our-work/coronavirus.
Last but not least, we also fundamentally encourage you to take care of yourselves and everyone around you equally well. We look forward to a time when we can review the challenges faced by the professions in this moment, when we can step back and assess the relative strengths and weaknesses across the healthcare eco-system, when we can to continue to support and advocate for the work of our members in both ordinary and extraordinary circumstances.
Kind regards
Dr Lance Lawler and Natalia Vukolova RANZCR President and CEOunnecessary imaging where a patient’s previous images are not available due to imaging being completed in other jurisdictions or networks.
The College has a clear vision for how Australia can harness the benefits of digital technologies and improve the quality of care for patients who need radiology services. As depicted in the accompanying image, the College’s focus in digital health centres around five key priorities:
• the establishment of an eReferral system
• access to historic images
• standardised terminology
• development of imaging guidelines,
• the managed roll-out of artificial intelligence (AI).
Over the past decade, Australia has invested significant funds into attempting to harness and facilitate the adoption of digital healthcare. The commitment to this issue is outlined in the National Digital Health Strategy, created by the Australian Digital Health Agency, which states that every healthcare provider will be able to communicate via secure digital methods by 2022.
Work continues to ensure that a clear plan is in place to achieve this goal and the College is uniquely positioned to be a leader on this issue. The advanced technology used in clinical radiology means that our members have always embraced new developments and technologies to improve patient care and facilitate best-practice service delivery.
The College has been active in the digital health space for several years and has worked with governments and their agencies to improve outcomes for patients. For example, the College is leading the way in setting standards and ethical principles for AI. Most recently,
we contributed to the Australian Digital Health Agency’s Interoperability Program consultation, and continue to share our vision for digital health with government ministers and other stakeholders, to name just a few initiatives.
Continuing to be a pioneer in digital health is a priority for the Faculty of Clinical Radiology Council in 2020. Our aim is to ensure that patients and doctors have access to all relevant healthcare information, to enhance patient safety and reduce duplication of imaging, waste and costs.
Digital health provides numerous opportunities for providing better informed, quality care and improving access, particularly for those in regional and remote areas. Better transfer of and access to digital information promises to ensure that timely and more clinically relevant information is available for the clinical radiologist providing the service, the treating medical practitioner and others subsequently involved in a patient’s care. Within clinical radiology there is also the potential to reduce
The College strongly supports the adoption of eReferral in in clinical radiology to improve how clinical and administrative information is exchanged between healthcare providers. A repository model is preferred where a referral is automatically transmitted to a secure virtual database and is then accessible to any provider the patient chooses. Before getting started on a solid foundation, it is imperative that standardised terminology is developed and agreed upon. This will simplify referrals to radiology and create a stable foundation for other digital health priorities.
Healthcare providers need easy, secure and timely access to patient information, including images and reports. Currently independent data repositories across health care settings are poorly linked and not adequate to provide a seamless experience for patients who invariably attend for care across multiple settings. For example, patients frequently attend for care across public and private providers, community clinics and hospitals, and across jurisdictions.
The availability of historic images and reports would reduce duplicate imaging occurring because of the lack of interoperability in Australia’s healthcare system. Making historic images easily available and accessible across providers would also likely reduce out-of-pocket costs for patients.
Patient care would also benefit from the introduction of imaging guidelines. These guidelines would increase appropriateness of referrals, enhance patient safety, provide educational opportunities and feedback to referrers on the suitability of the selected imaging modality. To be effective, the College has recommended that clinical decision support (CDS) must be digitally integrated into the workflow of clinicians.
AI presents many opportunities for a more efficient and accessible healthcare
system. While it may be some time until the technology is clinically appropriate and safe for patients, it is important for the College to continue positioning itself as a leading player in the application of AI in healthcare.
Last year, the College became the first professional peak body to develop Ethical Principles for AI in Medicine and we are currently in the closing stages of finalising a set of professional standards for the use of AI in clinical radiology and radiation oncology. We must continue to be pioneers in this space and work with stakeholders to help them recognise the potential and risk of AI and the integral role it could play as digital health and interoperability projects progress.
The College is stressing the need for an agreed vision for digital health in clinical radiology, as taking a projectspecific approach will result in further
interoperability challenges. It is also vital that due regard is given to data security, patient privacy, workability, and the needs of health practitioners using the system.
At its heart, digital health strives to connect healthcare providers and clinicians across all environments to provide a seamless experience and quality care for patients. As technology continues to advance at a rapid rate, it is vital that the digital health solution is properly considered and implemented effectively.
If you have further questions about digital health in clinical radiology please contact Melissa Doyle, Executive Officer at the College at melissa.doyle@ranzcr.edu.au
Medical Imaging
Original Article: The cost to perform uterine fibroid embolisation in the Australian public hospital system
Corresponding author: Dr Warren Clements, Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, Vic., 3004, Australia.
Introduction Uterine fibroids have the potential to cause morbidity, and there is a substantial cost to both the healthcare system and society. There is support for minimally invasive intervention, and uterine fibroid embolisation (UFE) is an established cost‐effective option for women wishing for an alternative to surgery. There is a lack of local Australian costing data to compliment use in the public hospital system, and we offer a costing analysis of running a public hospital service.
Methods We reviewed the costs for 10 sequential uterine fibroid embolisation cases, by assessing the direct and indirect hospital costs.
Results The total cost of providing a uterine fibroid embolisation service using our model in a public hospital including initial outpatient assessment, procedure costs, overnight hospital ward stay and outpatient follow‐up is $3995 per admission.
Conclusion Using our model, the overall cost to perform this procedure is low, and lower than prior estimates for surgical alternatives. We encourage government and regulatory bodies to support UFE through guidelines and remuneration models, and encourage more public Australian interventional radiology departments to offer this service.
Point of View: The Incidental finding and the false‐positive paradox
Corresponding author: Clinical Associate Professor Lloyd Ridley, Department of Radiology, Concord Hospital, Hospital Road, Sydney, NSW 2139, Australia.
I read with interest the article in the recent article in JMIRO by Ha et al.1 on the outcomes of incidental findings during planning CT for transcatheter aortic valve implantation (TAVI). The authors identified 59 with incidental findings described as being of non‐immediate clinical significance, and 6 with findings of immediate clinical significance out of their cohort of 265 patients. Follow‐up demonstrated 7 patients had cancer and 23 had benign disease. A total of 35 were not investigated further. Thus, for those with a confirmed result, the number of false positives was more than triple the number of true positives.
Review Article: Comparison of accuracy and long‐term prognosis between computed tomography‐based and magnetic resonance imaging‐based brachytherapy for cervical cancer: A meta‐analysis
Corresponding author: Dr Linlin Liu, Department of Radiotherapy, The Second Hospital of Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun, Jilin Province 130041, China.
High‐dose‐rate brachytherapy (HDR‐BT) has been shown to play an important role in the treatment of cervical cancer patients. The aim of this systematic review and meta‐analysis was to compare the dose parameters and long‐term effects of MRI‐based, CT‐based and hybrid imaging (MRI/CT)‐based volumetric planning. A systematic search was conducted to identify the clinical studies of BT treatment on cervical cancer patients. After study selection, a total of 13 clinical studies were enrolled for further analysis. No obvious differences were observed among the treatment parameters and the patients included. In detail, no significant difference was observed among these three techniques of volumetric planning in the parameters of high‐risk clinical target volume (HR‐CTV), total dose of D90 or mean fraction dose of D90. Meanwhile, MRI‐based planning was superior to CT‐based treatment in the total dose D2cc to organs at risk (OAR) for the bladder, rectum and sigmoid. Furthermore, no significant difference was observed among MRI‐, CT‐ or hybrid‐based treatments with the mean fraction dose D2cc to OAR for the bladder, rectum or sigmoid. In conclusion, MRI provides good anatomical delineation of the relevant HR‐CTV and OAR, and performed better in the analyses of dose parameters compared with CT. At least one MR image is required to assess the tumour extension, with clinical findings and MRI information facilitating much more accurate CT‐based contouring.
Review Article: Magnetic resonance‐guided radiation therapy: A review
Corresponding author: Dr Stephen Chin, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK. Magnetic resonance‐guided radiation therapy (MRgRT) is a promising approach to improving clinical outcomes for patients treated with radiation therapy. The roles of image guidance, adaptive planning and magnetic resonance imaging in radiation therapy have been increasing over the last two decades. Technical advances have led to the feasible combination of magnetic resonance imaging and radiation therapy technologies, leading to improved soft‐tissue visualisation, assessment of inter‐ and intrafraction motion, motion management, online adaptive radiation therapy and the incorporation of functional information into treatment. MRgRT can potentially transform radiation oncology by improving tumour control and quality of life after radiation therapy and increasing convenience of treatment by shortening treatment courses for patients. Multiple groups have developed clinical implementations of MRgRT predominantly in the abdomen and pelvis, with patients having been treated since 2014. While studies of MRgRT have primarily been dosimetric so far, an increasing number of trials are underway examining the potential clinical benefits of MRgRT, with coordinated efforts to rigorously evaluate the benefits of the promising technology. This review discusses the current implementations, studies, potential benefits and challenges of MRgRT.
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
Nominations and applications for the College’s range of awards, honours and Fellowships are now open. These are available to recognise outstanding service by members to their professions, and to support members to further their knowledge and expertise by travelling overseas.
APPLICATIONS CLOSE 6 APRIL 2020
The Gold Medal is the highest accolade to be given by the College. It honours a Fellow who has rendered outstanding service or benefactions to the development, teaching or practice of clinical radiology or radiation oncology in Australia, New Zealand or Singapore.
The Roentgen Medal is awarded to Fellows who have made a very valuable contribution to the College over a significant period of time.
Life Membership is awarded to Fellows over the age of 65 who have made an unusually significant contribution to their field or the College.
An Honorary Fellowship recognises individuals who have contributed to the advancement of clinical radiology or radiation oncology and allied sciences, either through original research or by special services to the College.
This award recognises members who have demonstrated outstanding longterm commitment, participation and leadership in training and education in radiation oncology.
This award recognises members who have demonstrated outstanding longterm commitment, participation and leadership in training and education in clinical radiology.
The Sally Crossing Award for Consumer Advocacy acknowledges outstanding commitment of consumers involved in health care advocacy. The award honours the memory of the late Sally Crossing AM, in recognition of her exceptional contributions to advocating for cancer patients.
For more information, to nominate someone or to apply, visit www.ranzcr.com/college/ grants-and-awards or email gaps@ranzcr.edu.au
To apply, nominate someone you know, or find out more visit ranzcr.com/college/grants-and-awards or email gaps@ranzcr.edu.au
In light of the rapidly evolving COVID-19 outbreak the College's overseas Fellowships are subject to change. If you have any questions or concerns regarding the Fellowships or your application please contact Hannah Barton, Project Officer, Research, Grants, Awards and Prizes on gaps@ranzcr.edu.au
This Fellowship enables a clinical radiology or radiation oncology member up to six years post-Fellowship to further their knowledge by studying abroad for between three and 12 months. It is supported by a grant of AU$20,000 from The Baker Foundation.
This Fellowship supports a Fellow more than five years post-Fellowship for a period of intensive or overseas study (three to 12 months) or for attendance at an international short course (two weeks to one month) with a grant of AU$30,000.
In 2020, this Fellowship is available for a Clinical Radiology Fellow from New Zealand to attend the Annual Scientific Meeting in Melbourne. The Fellow is also expected to visit and present in their field of interest in three training centres in Australia, with the support of an AU$8,000 grant.
This scholarship is available to support trainees who identify as being of Aboriginal, Torres Strait Islander or Maori heritage during their studies. Six individual annual scholarships of up to AU$5,000 each are available, to be used towards expenses for educational activities.
South Coast Radiology requires a dynamic and personable Radiologist (AON/DWS welcome to apply) to join us with a desire to participate in all modalities and basic interventional procedures. South Coast Radiology part of the Integral Diagnostics group is a rapidly growing diagnostic imaging provider with 12 practices on the Gold Coast and Tweed region as well as practices in Mackay and Toowoomba. We are seeking a full time Radiologist looking to escape the cold weather and head to beautiful Mackay. Nestled on the banks of one of Australia’s rare blue water rivers, kilometres of coastline, enjoy the relaxed lifestyle Mackay has to offer.
• Must meet standards with RANZCR, AHPRA and Medicare Accreditation.
• Suitable for DWS/AON
• Ability to maintain credentials under hospital’s or site of service provision credentialing process.
• Experience in General Radiology, MRI, CT, Fluoroscopy, Mammography & Ultrasound
• Excellent communication skills
• A desire to work in a collegiate and collaborative work environment using advanced imaging technology and infrastructure systems, including state-of-the-art modalities, PACS and integrated RIS
An attractive s alary package including relocation support is on offer and will be commensurate with experience and skills.
We understand that, during the course of your career, there may be times when your personal circumstances change. Whether you’re reducing your work hours, taking a break from practice entirely, or moving overseas to pursue a new opportunity, we encourage you to inform the College, as you may be entitled to a reduced rate of membership fees.
Fellows and Educational Affiliates
Going on extended leave, parental leave, or experiencing health issues that will stop you from working for 6–12 months? You may be entitled to a reduced membership fee.
To apply, email the College at members@ranzcr.edu.au providing evidence such as an employer letter or medical certificate, the date you will be taking your leave and intended date of return to practice.
Taking a break for longer than 12 months? You can apply each year for an extension of your break-in-practice rate, up to a maximum of three years.
Please note, members that are on a break-in-practice are still required to submit their pro rata CPD points, for further information please contact cpd@ ranzcr.edu.au.
If you are taking a break in training (including parental leave) you may be eligible to a reduced rate on your membership and training fees. You must submit a request for break in training through the Trainee Information Management System (TIMS) for approval, in order to be eligible to apply for a reduced fee.
Part-time
Fellows and Educational Affiliates
Are you practising 20 hours or less per week? If so, you may be entitled to a reduced rate of your membership subscription, provided you inform the College in writing of your part-time status, attaching evidence such as an employer letter or contract.
If you then return to full-time practice, please ensure you inform the College.
Student Members
If you are training part-time at 0.65 FTE or less, you may be entitled to a reduced rate of your membership subscription.
You must report all changes of your training status (full-time/part-time) through the Trainee Information Management System (TIMS) in order to be eligible for a reduced rate of fees.
Moving overseas?
If you are moving away from Australia or New Zealand, you too may be entitled to a reduced membership rate. * Simply update your home and work address on the MyRANZCR member portal and email members@ranzcr.edu. au with the date you intend to move and an expected return date (if you have one).
If/when you move back to Australia or New Zealand please ensure you update your details on the member portal.
*Applies to Fellow members only
We’re here to help you
Each of our members, and their personal circumstances, are unique. So, if you have questions or need further information please do not hesitate to contact the College:
Fellows and Educational Affiliates
Contact the membership team today at members@ranzcr.edu.au or +61 2 9268 9777, or check out the fees page on our website for more information and the latest RANZCR Fees Policy.
Student Members
Refer to the Interrupted and Part-time Training Policy on the College website or contact the Specialty Training Unit at radtaa@ranzcr.edu.au for clinical radiology students and ronctaa@ranzcr.edu.au for radiation oncology students. Useful links and documents
Membership fees page: www. ranzcr.com/college/membership/ fees
Fees Policy: www.ranzcr.com/ documents/4296-ranzcr-feespolicy/file
Interrupted and Part-Time Training Policy: www.ranzcr.com/ documents/4525-interrupted-andpart-time-training-policy/file
Please note: Fee reductions can only be applied for the current or future financial year; and cannot be applied for fees billed in a previous financial year.
How long have you been a research mentor?
I have been a research mentor for approximately five years.
What motivated you to apply?
I had been supervising radiology registrar projects since I started as a consultant in 2008. Applying for this role was a way of formalising what I had already been doing.
I enjoy research as it adds to clinical practice and provides professional satisfaction. When you look at a radiograph, you’re helping just one person, but when you do research it’s like getting into a helicopter and looking at thousands of patients from up above. It gives you a different perspective and can help you see better ways of doing things, that may improve clinical care and efficiency.
What kind of level of commitment/time does the role require?
This would depend on the structure of the training program (single hospital vs. inter-hospital) and the number of trainees that each individual research mentor might be supervising and the local research culture. The support provided for a research mentor to supervise projects may differ between smaller and larger hospitals. In WA specifically I have good support from my colleagues and the
registrars are well informed about the project 1 and 2 processes. I do not have dedicated time for this role and fit it in within my reporting list, catching up with registrars between cases.
What have you learnt from being a research mentor?
Research has highs and lows. There will be times when you look at your data and you will realise that it is incomplete or contaminated by a confounding variable or the ethics application is rejected or requires revision. There will be other times though that you look at the data and realise that it is ground-breaking and could improve clinical practice. Perseverance is important no matter what the project throws at you. The journey can be exciting.
Have there been any challenges or hurdles? If so, how have they been overcome?
I think research is synonymous with challenges and failures.
The first step is to identify a topic. The best research projects are formulated when you’re reporting a film and you don’t quite understand something, so you ask a colleague who doesn’t know the answer either and then you look it up on your computer and even Google doesn’t know. That’s when you know you’ve stumbled across something that could improve clinical practice.
The next step is finding a supervisor to help you, with both the technical skills and soft skills to navigate the project. Subsequently, regulatory approval is required such as through an ethics committee. Having obtained regulatory approval, one needs to conduct the project. Performing or obtaining assistance with statistical analysis can be challenging. When the statistics are complete one needs to write an article for submission or presentation at a conference.
At each one of those steps there can be challenges, but there can also be triumphs along the way.
What have you found most valuable about being a research mentor?
I find supervising projects rewarding. When a registrar encounters a hurdle, there is almost always a solution and it is great to be able to help the registrar to overcome the hurdle.
What has been one of your achievements while being a research mentor?
Within WA, we created a website to match registrars with supervisors and projects which was housed on our training website. Initially we found the website was used well, however given our small community in WA and our training program is networked we found that registrars tended to develop their own contacts. In a larger state though where there are a lot more people and the training is not inter-hospital, this sort of website would be invaluable, particularly for trainees at smaller sites where research opportunities may not be as accessible.
Why should other College members consider becoming a research mentor?
Being a research mentor adds another dimension to your professional life. It provides intellectual challenges and interpersonal challenges in bringing out the best in the registrar and the other people involved in the project. The outcome to all of this is that you are given the opportunity to change how you do things within your department and change clinical practice to provide a better patient outcome.
Dr Shoba Ratnagobal Royal Perth HospitalFor more information on becoming a research mentor visit www.ranzcr. com/current-opportunities
I am deeply honoured and grateful to have been chosen for the Rouse Travelling Fellowship 2019.
The Rouse Travelling Fellowship has been established as a vehicle for the continuing exchange of information and ideas between clinical radiologists and radiation oncologists of Australia and New Zealand and honours the memory of the late Edgar Rouse, an early College benefactor. The Fellowship enables a Fellow from Australia or New Zealand to attend and present at the College’s annual scientific meeting in the other country, and to visit and present in their field of interest in that country.
I was humbled to receive this fellowship from Dr Lance Lawler, president of RANZCR in the annual ceremony at the annual scientific meeting in Auckland in October 2019 in the presence of so many other award recipients, distinguished radiologists, and new Fellows from all over Australia and New Zealand, with so many of them being at the frontiers of radiology knowledge, experience and skills. It was a great experience for me both to meet and to catch up with so many colleagues that night. I was enlightened by many valuable and fascinating clinical and research tips they shared. It turned out that I did not even have to wait for the commencement of this travelling fellowship for information exchange opportunities to arise. I was amazed how naturally inclined and willing radiologists were to share what they knew.
Thanks to the RANZCR ASM organising committee for giving me an opportunity to give a half hour presentation on ‘Advanced CT iterative reconstruction and its value’ during the scientific meeting, enabling me to share with conference attendees the indications, techniques and limitations of ultra-low dose CT at a radiation dose comparable to plain radiography.
I also took this opportunity to mention briefly how AI would help reduce CT radiation doses in the future.
I returned to New Zealand in November last year. I was grateful to so many radiologists there, in particular, Dr Rhian Miranda, Dr Graeme Anderson and Dr Jash Agarval, who facilitated my visits at their departments at Auckland District Hospital, Middlemore Hospital and North Shore Hospital.
I was so thrilled and delighted to have met so many eminent radiologists and enthusiastic trainees during these hospital visits. It was a highlight to see various departmental and workflow arrangements.
During these visits, I gave two presentations on ‘Imaging of extramedullary haematopoiesis in typical and atypical locations’ and ‘Musculoskeletal conditions in Chest Imaging’ at Auckland District Hospital, and another two presentations on ‘Advanced CT technologies in Chest and Abdominal Imaging’ and ‘Radiology Research’ at North Shore Hospital.
I enjoyed the inspirational discussions amongst radiologists and trainees after each of these presentations. In addition, North Shore Hospital was in a pristine location by the seaside, I was astonished by the outstanding views from the lecture room during the presentations.
I had a great learning opportunity at Middlemore Hospital by sitting in on the biggest chest radiology meetings I have ever seen, which took place in a full lecture theatre. I also attended their academic research meeting which was on anti-fibrotic drugs in interstitial lung fibrosis. Further, Dr Graeme Anderson was very enthusiastic in sharing with me all the interesting cases on soft tissue sarcomas.
I am very grateful to our College for this prestigious and meaningful Rouse Travelling Fellowship that has enabled me to visit different centres and meet so many radiology colleagues and trainees in New Zealand. The experience was tremendous: not only to share my areas of interest with radiology friends in New Zealand, but also to learn from their experiences and techniques. The meetings and discussions with colleagues in New Zealand were inspirational and thought provoking.
These mutual sharing and information exchanges did not stop here. It was only the beginning. I aim to go back to visit more New Zealand centres in future as radiology knowledge and new techniques are constantly evolving!
Prof Ken Lau met Drs Graeme Anderson and Jennifer Donald at Middlemore hospital and was thrilled to be shown a collection of interesting soft tissue sarcomas.
For more information on how to apply for the Rouse Travelling Fellowship please visit: ranzcr.com/college/grants-and-awards or email gaps@ranzcr.edu.au
l Maximum allowable course based live and library cases for ANZ credentialing.
l RANZCR accredited for 117.5/67 CPD points (Level A/Recertification).
l Officially sponsored and endorsed by GE Healthcare for more than10 years.
l Live scanning at second highest global recruiting site in SCOT-HEART study.
l Unrivalled venues: MASTERS at Zest, Point Piper and RECERTIFICATION at ICC, Darling Harbour.
3 Day Recertification Course
For more information and online registration log on to: www.aicct.com.au or contact us at: info@aicct.com.au
The Qscan Group’s growing national network offers Radiologists opportunities for career development and earning potential. By partnering with our doctors, we encourage individual professional aspirations and provide market competitive, flexible avenues to join our team.
Why join the Qscan Group?
• Career opportunity customised in line with your skillsets and ambitions;
• The ability to be part of a supportive and strong collegiate doctor network;
• The very latest in cutting-edge technology;
• Assured access to a broad clinical case mix including tele-reporting which can provide flexibility or additional hours to expand your earning potential.
We currently have opportunities for Radiologists, Nuclear Medicine Physicians and Dual-Trained Radiologists for various regions across Australia. Flexible workloads including private practice, public hospital work and teleradiology are available.
Qscan Fellowships are also available including:
• Hybrid Fellowship - 12 months;
• Sub-specialty Fellowship programmes (Musculoskeletal, Body Imaging, Cardiac/Thoracic imaging, Breast imaging and Paediatric);
• Dedicated Nuclear Medicine/PET sub-speciality Fellowship.
Your employment offer with Qscan can include:
• Above market-rate remuneration package;
• Significant sign-on bonus;
• Equity opportunities;
• Relocation assistance.
For more information or a confidential discussion please call our Qscan General Manager, Matthew Bellairs on 0412 939 200 or email matthew.bellairs@qscan.com.au
The Anne G. Osborn Outreach Professorship which is offered by the American Society of Neuroradiology (ASNR) is a unique opportunity to learn and share knowledge across borders. It is a volunteer program available to senior members of the ASNR who are interested in teaching in developing countries. It is not a traditional visiting professor program but is an outreach program where the costs of the activities are shared between the
ASNR member, the ASNR, and the host organisation in the receiving country. The main objective of the program is to facilitate the exchange of knowledge and techniques, and to teach. I was absolutely delighted to get an email notification from Dr Bruno Policeni, ASNR International Collaboration Committee Chair, informing me that I was selected to be the Anne G. Osborn ASNR Outreach Professor to Ethiopia for 2019.
It gave me an amazing opportunity to visit Ethiopia and was particularly exciting for me as this was the first time ASNR had chosen someone outside North America. I flew to Addis Ababa, Ethiopia in early April 2019 and spent about three weeks in the radiology department in the Black Lion (Tikur Anbessa) Specialized Hospital, School of Medicine, College of Health Sciences, Addis Ababa University. This is the main tertiary teaching hospital in the
country with about 700 beds and has attached medical, nursing and pharmacy schools. The radiology department has a busy ultrasound service and has two CT scanners and one Philips MRI scanner. Unfortunately, the MRI scanner was not in service, therefore patients were sent to St. Pauls Hospital nearby for MRI studies. I spent most of my time at Tikur Anbessa Hospital, at the neurology faculty lecture theatre at Zewditu Memorial Hospital and a short visit to Wudassie Radiology Centre. Dr Tesfaye Kebede is the Chair of Radiology, Dr Abebe Mekonnen is Head of the Neuroradiology Division and Dr Tequam Debebe is the Dean of the Medical School. I had a warm welcome from the faculty on first day when I was introduced to other neuroradiology colleagues and had my hospital tour and orientation on the same day, finishing off with the best coffee.
The radiology department is fully subspecialised into different faculties with digital PACS in the reading room. Every day I was picked up by gracious hosts—hospital staff or attending clinicians—and dropped home safely
to the hotel. The neuroradiology department is very well organised with attending faculty and has neuroradiology Fellows in training. The faculty and Fellows are very well trained with most of them educated in the US at Emory University. Dr Abebe Mekonnen was my host for the site and I can’t thank him enough for his hospitality and care, I never felt out of place and was regularly updated about lecture schedules and teaching plans.
Understanding the impact of CNS tuberculosis and discussing some phenomenal cases with Dr Mekonnen and his colleague Dr Saleh made me realise that I would never have seen cases such as these otherwise; it was a great learning experience for me, providing a wealth of knowledge. I really enjoyed the case discussions and was impressed by the variety of cases and disease spectrum in Ethiopia, very different to what I see at my practice here in Australia.
My day would start early in the morning with Tomoca coffee, the aforementioned best coffee in the
world, on board for an 8 am lecture and second lecture at 1.30 pm after lunch. Both lecture sessions were well attended by neuroradiology and other radiology faculty and residents (registrars). I gave almost 16 lectures on various topics in neuroradiology and head and neck imaging with some case discussions and pertinent teaching points. I also attended neurosurgery case conferences and other clinical meetings. Every afternoon after lectures until six or seven o’clock in the evening was spent with residents teaching and reviewing live workstations cases. I saw almost every manifestation of CNS tuberculosis and some other unusual infections including HIV, schistosomiasis etc. I quickly learnt that paediatric neurology cases of brain stem and spinal cord lesions are not always gliomas and astrocytomas but also tuberculomas or schistosomiasis granulomas.
All the residents, Drs Aga and Frewoini, the faculty, and Fellows went out of their way to help me and make my stay comfortable. I would particularly like to thank chief resident Dr Aga for helping me out. They were my local guides who I got to know extremely well and heard some of their inspiring stories of hardships they had to go through to get into medical school and training programs.
I also had the honour of speaking at the National Neurosurgery Conference halfway through my visit. Different
charitable organisations and local government are involved in tackling the problem of spinal dysraphism and this was a real eye opener. I gave three lectures at the conference and was hosted by Dr Abenezer Tirsit.
I had a great mix of teaching, learning, cultural and culinary experiences. There was one fine evening where folk dances from different provinces of Ethiopia took place and it was a holistic and cultural experience. I had opportunity to relish in some of the best Ethiopian food and delicacies, my favourite being injera, a local flatbread and shiro, a chickpea stew. Soon after came the farewell dinner at an Indian restaurant, it was difficult to say goodbye as I quickly realised that the visit was about to finish soon.
I am extremely grateful to the American Society of Neuroradiology (ASNR) for organising and facilitating the program, and to Prof Anne Osborn for supporting this incredible outreach professorship to promote neuroradiology throughout the world. Meeting this legend in neuroradiology at RSNA and at a few other conferences has really enriched me and getting a personal thank you note from Prof Osborn after finishing the professorship gave me an immense sense of fulfilment and I was really humbled by the gesture. This teaching experience has been one of a kind; I will cherish the memories for the rest of my life.
This trip gave me a flashback to the Rouse Travelling Fellowship I did through our College in New Zealand in 2012. I have made friends and colleagues for life in both. I hope to set up a more constant and robust online teaching platform for the residents as they really appreciate every moment of teaching. This experience was so special to me that it has influenced my life in a particularly positive way. There is a constant urge to go back for another visit which I will do in near future.
A/Prof Sandeep Bhuta NeuroradiologistAfter a few years of hard work, we are pleased to see the Training and Assessment Reform (TAR) project has come to fruition. We are indebted to all Fellows, Educational Affiliates, Trainees, other medical specialists, educationalists, consumers and College staff who have dedicated their time and provided invaluable advice and contribution to this project.
The training programs will be launched in December 2020 for New Zealand trainees, and February 2021 for Australian and Singaporean trainees.
Both specialities now have a more structured and streamlined curriculum with learning outcomes that are in line with current and contemporary practice. We recognised the importance of emphasising intrinsic roles and have continued to be guided by the CanMEDS Framework, incorporating the roles of medical expert, communicator, collaborator, leader, health advocate, scholar and professional.
The College recognises the increasing importance and ongoing relevance of understanding the cultural determinants of health and values/belief systems of Aboriginal, Torres Strait Islander and Māori populations of Australia and New Zealand.
There is a new focus on cultural competency and cultural safety where trainees are not just taught about the "other" but encouraged to explore and reflect on their own views and biases and how these could affect their decision-making and health outcomes. It is important to acknowledge and address their own biases, attitudes, assumptions, stereotypes and prejudices that may affect the quality of the care they provide.
In recognition of the increasing role of Artificial Intelligence (AI) in both specialities, and with the assistance of the College’s Artificial Intelligence Committee, we have incorporated AI learning outcomes in both curriculums, with an expectation of frequent review and updating in this rapidly evolving field. A list of learning resources has been developed to complement the learning outcomes.
Both Faculties have developed an assessment framework that is aligned with the learning outcomes. The workbased assessment tools are designed to be used frequently, in a range of work-based situations, by a range of supervisors. Timely and constructive feedback will be provided frequently, which will contribute significantly to trainee learning, with an expectation of improved performance and reducing supervision requirements over time as the trainee gains more experience. Tracking over time will allow an assessment of progression and provide opportunities for early and targeted intervention when required.
Trainees will be expected to initiate work-based assessments, although clinical supervisors and DoTs will have oversight and may suggest areas where a trainee would benefit from additional experience and review.
A number of structured learning activities have been developed to assist with trainees' learning, while being manageable in terms of workload for both trainees and trainers.
Summative examinations will be held in Phase 1 and Phase 2, with a requirement of a passing standard to progress to the next phase of training (in addition to completion of all other
training requirements). Changes have been made to Phase 1 and Phase 2 examinations, to ensure they are more fit-for-purpose, better aligned to learning outcomes and complementary to work-based assessments. More information will be provided in the coming months.
We are confident the enhanced training programs will ensure we produce highly skilled practitioners in the fields of clinical radiology and radiation oncology, to provide optimal patient care.
During March and April, the College will undertake stakeholder consultation for both training programs. Please take this opportunity to review the documents and provide feedback and any suggestions for improvement. All feedback will be considered by the College, before we finalise the training programs.
With the TAR implementation now in full swing, lots of educational and training activities will be conducted this year.
Between February to April, key clinicians and College staff who have been involved in developing the training programs are visiting networks/training sites, to provide trainees, clinical supervisors and Directors of Training with details of all the changes. Please liaise with your Training Network Director or Education Support Officer, or Ms Faeha Tashkeel, Project Officer, TAR Implementation at faeha.tashkeel@ranzcr.edu.au if you need more information about the event at your network/site.
We encourage everyone who is involved with the delivery of training and teaching to attend these sessions. This is also an opportunity for you to provide feedback and make suggestions for improvement
in order to ensure the training programs are able to achieve the desired outcome at network/site level.
As we have communicated previously, the Trainee Information Management System (TIMS) will be replaced by a new fit-for-purpose system, called RANZCR ePortfolio, to support the delivery of enhanced training programs, to measure identified outcomes and allow tracking of trainee progression.
The College has decided that ALL current trainees will transition to the enhanced programs when they are implemented. This will allow all trainees to benefit from the new programs and avoid the need to operate two IT systems concurrently, reducing potential confusion. The College is in the process
of finalising the transition plan, and endeavors to minimise any disadvantage to trainees, and to allow some flexibility during the transition.
To expedite the transition, all trainees are asked to keep their relevant information and records under the current training programs up to date in TIMS, including details of training status, rotation, experiential training requirements, logbooks and work-based assessments. This will ensure that the data being transferred to the RANZCR ePortfolio is as accurate as possible. In the coming months, more information regarding the transition will be provided to ensure all members, particularly trainees, are well-informed and properly supported throughout the transition.
It is important that you read the information and keep abreast of changes shared with you through College communication channels, including the College website, e-newsletters, printed newsletters and direct correspondence.
If you would like more information or have any questions regarding the Training and Assessment Reform project, please visit the College website www.ranzcr.com/tar, or contact Mrs Legend Lee, Manager, Training Programs at the College at legend.lee@ranzcr.edu.au.
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In this College update to changes to your medical registration requirements we take the opportunity to shine a light on an important piece of work in New Zealand in the context of recertification and continuing professional development: cultural safety.
As you may be aware, the Medical Council of New Zealand (MCNZ) sets the requirements for the recertification of doctors practising medicine in New Zealand. The fundamental function is to protect the health and safety of the public by ensuring doctors are competent and fit to practise. This is done through setting standards of clinical and cultural competence and ethical conduct.
There are four current standards; medical care and prescribing, communication and consent, cultural safety, and conduct and professionalism.
MCNZ requires doctors to meet cultural safety standards. Cultural safety focuses on the patient and provides space for patients to be involved in decision-making about their own care and contribute to the achievement of positive health outcomes and experiences2
MCNZ have published a number of useful resources to assist doctors in meeting the standards. The “Statement on Cultural Safety3” outlines what cultural safety means, why it is important and the advancement from the cultural competence of doctors to cultural safety. Within the Statement cultural safety has been defined as the need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery and the effect on the quality of care provided.
MCNZ recognises that cultural safety benefits all patients and communities and has a central role in health equity. It is well-documented that Māori experience significant health inequity compared to the rest of the New Zealand population across most areas of health. MCNZ’s “He Ara Hauora Māori: A Pathway to Māori Health Equity4” is a useful resource for doctors and healthcare providers in supporting cultural safety and Māori health equity as clinicians have a responsibility to work toward eliminating health inequities. It is important for clinicians to read this in conjunction with the Statement on Cultural Safety.
Cultural safety requires doctors to reflect on how their own views and biases impact on their clinical interactions and the care they provide to patients and as such cultural safety, and a focus on health equity, must be embedded across, and within, all of the CPD categories: reviewing and reflecting on practice; measuring and improving outcomes; and educational activities/ continuing medical education (CME). This is illustrated in Figure 1.
As a new and emerging area for doctors to report against, the College is actively working with MCNZ to enable you to meet the recertification cultural safety standard and have the resources available for practical application in your workplace.
If you have any questions or concerns about the upcoming changes to your continuing professional development and recertification in New Zealand and/ or your Australian medical registration requirements, please send them to cpd@ranzcr.edu.au
References
1. https://www.mcnz.org.nz/registration/maintain-orrenew-registration/recertification-and-professionaldevelopment/
2. https://www.mcnz.org.nz/our-standards/currentstandards/
3. https://www.mcnz.org.nz/assets/standards/ b71d139dca/Statement-on-cultural-safety.pdf
4. https://www.mcnz.org.nz/assets/ standards/6c2ece58e8/He-Ara-Hauora-Maori-APathway-to-Maori-Health-Equity.pdf
Selection into the College training programs is a complex endeavour. It is paramount that the College’s selection processes are fair, robust and able to withstand external scrutiny. The College's selection policies, processes and outcomes should reflect best practice and must comply with the expectations set out by the Australian Medical Council (AMC) and the Medical Council of New Zealand (MCNZ).
Why is trainee selection so important?
Trainee selection is:
COMPLEX as it involves predicting future performance and assessing ethical and interpersonal behaviours.
COMPETITIVE and therefore should be merit-based and conducted in a consistent manner.
HIGH STAKES as there are an array of ramifications for all stakeholders.
Decisions affect the trainee, employing department and training network now and in the future. Decisions made on the skills, attributes and competencies targeted at the point of selection will influence how the specialty reproduces itself over time. Being future-focused and proactive is crucial, especially considering the increasing rate of adoption of emerging technologies such as AI and particle therapy. Successfully managing the impacts and challenges of these changes is vital to the future of our specialties and to how well our professions and workforce adapts to change over time.
The AMC in conjunction with the MCNZ assesses and accredits Australian and New Zealand providers of specialist medical training and their specialist training programs. The College must comply with these organisations’ Standards, which state that the College’s selection decisions must be underpinned by policies and principles. The College is also required to guarantee a robust and defensible system of selection of trainees.
The Standards stipulate that selection must be transparent, rigorous and fair, and that selection processes are evaluated in respect to validity, reliability and feasibility. The College needs to report on the consistent application of its selection policies across different training settings.
There are a range of AMC Accreditation Standards related to Indigenous health outcomes and workforce. One of these, AMC Standard 7.1.3, relates specifically to admission policies and selection: ‘The education provider supports increased recruitment and selection of Aboriginal and Torres Strait Islander and/or Māori trainees.’ As yet, the College has no formal mechanism to increase recruitment of Aboriginal, Torres Strait Islander and Māori doctors. Additionally, the AMC expects that “The education provider should facilitate opportunities to increase recruitment and selection of rural origin trainees and trainees from other under-represented groups” (AMC Notes for Standard 7.1).
Following our AMC re-accreditation assessment in 2019, improvements in the College’s selection processes are required, as well as an increase in the diversity of background, skills and/or experience of the trainees selected.
Unlike some colleges, where selection into the training programs is separate to recruitment for employment, selection at the College is synonymous with recruitment into accredited training positions.
In Australia, selection happens at the network level and the College is not directly involved in the selection of trainees. In New Zealand, the process is national, and the College is involved by providing coordination support and administrative assistance for recruitment and the central match.
Many Australian networks are largely controlled by their respective state government’s formal recruitment requirements.
Broadly speaking, the College’s role in selection can take one of three different approaches.
Influencing role: This is the current status for the College. This approach leaves selection processes and decisions to employer bodies and seeks to influence the outcome by setting guidelines for selection. While this seems like the easiest option for the College, we are not currently meeting AMC Standards for selection. On the surface it appears to be a low resource-intensive option. But this does not include the hidden costs of indirectly monitoring outcomes to meet AMC accreditation standards. Also, it does not allow the College any agency in shaping the future workforce.
Examples of colleges taking this approach include the Australian and New Zealand College of Anaesthetists (ANZCA) and the Royal Australasian College of Physicians (RACP).
Integrated role: This approach involves colleges agreeing (and compromising) with employers over selection requirements and conducting a joint selection exercise. This is arguably the best model from a trainee perspective but is one that is difficult to sustain in terms of decision-making. It can also be resource-intensive.
For example, the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) is currently employing this approach. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) established an integrated selection process but it has since been discontinued.
Independent role: This approach sees the college conducting its own selection processes, allowing a more strategic approach. Employers may opt to conduct their own process of selection (selecting from those selected) following this process.
Examples of this approach can be seen at RANZCP and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Employers may then choose to trust the selection as conducted by the college, as is the case with the Royal Australasian College of Surgeons (RACS). What’s next?
The College is forming a cross-faculty Selection Review Working Group to advise the Faculties of Clinical Radiology and Radiation Oncology on appropriate and robust (valid and reliable) selection approaches, processes and methods. Whatever changes are proposed, the College is committed to improving selection and needs to take a more active role in strengthening the entire process. This will allow us to comply with the AMC Standards and ensure that the clinical radiology and radiation oncology workforce will continue to meet community needs, exceed community expectations and improve patient outcomes over time.
Questions or comments?
If you would like to discuss this work please contact Madeleine d’Avigdor, Senior Projects Officer, Special Projects, via email on madeleine.davigdor@ranzcr.edu.au
This year’s Annual Scientific Meeting (ASM) in Auckland reinforced the continued importance of radiological guided lung biopsies. Dr Amy Lam (Princess Alexandra Hospital, Brisbane) found their radiologists are doing more lung biopsies despite the introduction of advanced bronchoscopic techniques.
Rather than being competitive, radiological biopsy and bronchoscopy are complementary—radiologists can biopsy peripheral lesions with a greater success (and potentially fewer complications) than bronchoscopy. This reverses for central lesions where bronchoscopy is generally preferred. One reason for the increase is the improved treatment options. Over half of non-small cell lung cancers (NSCLC) now have identifiable DNA mutations, many providing targets for new therapeutic drugs. Natural selection favours cells resistant to the initial agent (including transformation into small cell carcinoma) requiring rebiopsy to identify changes in targetable mutations. Biopsies are often required to characterise complications of therapy, including drug-related pneumonitis and pulmonary infections.
Those attending the lung biopsy session at the ASM were surveyed on their biopsy techniques (Table 1). The wide range of techniques highlights the heterogeneity of the literature. In many studies the complication rates (even in the intervention arm) are higher than the ‘best practice’ rates.
Whilst most articles focus on pneumothorax and/or chest drain insertion, these are usually not life threatening. The most common cause of death after lung biopsy is haemorrhage (for example, haemoptysis or haemothorax) followed by air embolism. A simple mnemonic as a checklist prior to accepting a lung biopsy was also presented at the meeting (Table 2).
One participant reported success with the use of the “Rocket Pleural VentTM” to manage post-biopsy pneumothoraces—a recently released device that can be inserted into the pleural space while still allowing the patient to be discharged home and return for removal of the device the following day. Future research needs to combine the techniques with reasonable evidence of benefit to ensure that the control group’s results approximate
best practice—thus allowing more meaningful assessment of interventions that are chosen to be studied. Those interested in participating in a multicentre study of techniques should contact the author on email: lloyd.ridley@health.nsw.gov.au.
“BIOPSY”
– BLEEDING (coagulation studies and medications).
– IMAGING (review imaging/ availability during the procedure).
– ORDER (includes post biopsy CXR).
– PERMISSION Able to consent (language, co-operation etc).
– SEDATION Acceptable cardiopulmonary function/ able to tolerate complication of biopsy.
– YONDER Aftercare (Advising patient of requirement for observation after biopsy and access to emergency care after discharge).
The campaign also collaborated with cancer agencies and other stakeholders including HealthInfoNet, Cancer Council NSW, the Australian Society for Medical Imaging and Radiation Therapy (ASMIRT) and the Radiation Therapy Advisory Group (RTAG) to spread awareness of radiation therapy as a vital cancer treatment across their social media accounts.
We would like to thank all our members who shared their #ICan&IWill commitments with us across social media in the run up to the day and on the day itself.
During February the Targeting Cancer campaign once again supported World Cancer Day and its #ICan&IWill campaign. The annual event on 4 February is a global initiative led by the Union for International Cancer Control (UICC). The day, which celebrated its 20th anniversary this year, raises worldwide awareness and aims to increase access to life-saving cancer treatment.
To mark World Cancer Day, Targeting Cancer undertook an advocacy campaign, sharing the importance of radiation therapy with all state and federal ministers and shadow ministers’ offices. Tasmanian Health Minister, Sarah Courtney, reiterated their government’s commitment to cancer services in a media statement on the day after their announcement in 2019 that $28 million has been committed to install four new linac machines across the state.
This year the UICC commissioned a global survey to form an up-to-date picture of the public’s experiences, views and behaviours around cancer. More than 15,000 adults across 20 countries were surveyed in what was the first multi-country public survey on cancer perceptions in a decade. Those surveyed in Australia said the most important actions governments should take in relation to cancer are making cancer services affordable (45 per cent), supporting research (32 per cent ) and ensuring equal access for everyone (30 per cent).
In response to the survey results, College President Dr Lance Lawler said, “These survey results demonstrate that making cancer services and treatment more affordable and accessible needs to be a priority.
We know that one in two cancer patients would benefit from radiation therapy at some time during their cancer experience. However, less than one in three patients in Australia and New Zealand will actually receive radiation therapy. This is due to many factors including access barriers, particularly in regional locations, and lack of knowledge about modern radiation therapy amongst patients and referrers. It is imperative that all patients who could benefit from it have timely access to radiation oncology services, regardless of location, ethnicity and other social factors.”
There are several cost factors that patients and their families need to think about when choosing the best treatment provider for them. These include direct costs which are those associated with treatment, and other indirect costs like travel, parking, accommodation and any allied health care that may be required.
To help answer some frequently asked questions, the College recently developed a helpful factsheet that includes a list of questions patients should ask their radiation therapy provider about the costs of treatment. In addition to covering the range of costs that patients should consider, the factsheet also explains the Medicare Safety Net, Medicare contributions and arrangements for concession card holders. The factsheet includes a handy list of questions that patients can take with them to their radiation therapy centre to talk through these considerations.
Targeting Cancer will continue to promote this important resource to patients and referrers through social media and by collaborating with external stakeholders.
We would like to thank the Economic and Workforce Committee for their efforts in developing the factsheet. The factsheet can be downloaded from the Targeting Cancer website at www.targetingcancer.com.au/faqs/whatyou-need-to-know-about-the-costs-ofradiation-therapy-in-australia/
Targeting Cancer’s advocacy efforts in the UK continued to step up in February as Chair of the Targeting Cancer Working and Advisory Group, Dr Lucinda Morris, and A/Prof Sandra Turner attended the Royal College of Radiologists (RCR) in London to facilitate a full-day workshop on advocacy for radiation therapy.
The workshop was attended by more than 20 clinical oncologists, radiation therapists and medical physicists from across the UK. As leaders in the oncology community, the participants are dedicated to raising the profile of radiation therapy to ensure cancer patients who would benefit do not miss out on this vital treatment.
The workshop kicked off with a brainstorm session on the current state of play in the UK, before development on a strategy to improve the profile of radiation therapy began.
Dr Morris said that the day was a great success and feedback from the RCR team and participants was extremely positive.
“We were able to make great progress in identifying current gaps and barriers in the UK environment, which are contributing to underutilisation of radiation therapy,” Dr Morris said. “On a personal note, it was a privilege to be able to share the experience Targeting Cancer has had in Australia and New Zealand with our UK colleagues. Both Sandra and I are confident that the valuable lessons learned here will provide useful guidance for the growing advocacy efforts in the UK.”
We are always looking for patients and clinicians to support our efforts to raise awareness of radiation therapy by sharing their stories and experiences. Reading and hearing their stories helps other cancer patients and their families and friends understand the experience of radiation therapy treatment. They are a powerful tool and offer valuable insight into the patient experience. Personal stories also create a shared sense of community and connection, lessening the isolation many patients may feel when faced with decisions about the best treatment options for them.
If you or your colleagues have any patients who may be willing to share their experiences with Targeting Cancer, please let us know by downloading the testimonial and image release form and returning it to faculty@ranzcr.edu.au
www.insideradiology.com.au
In Australia, it’s estimated that 60 per cent of people have less than adequate levels of health literacy1, which is a significant challenge in delivering health services.
Low health literacy is a risk factor for poor health. It can affect people’s ability to do things like navigate the health system, understand medical instructions, and seek support from health professionals. This can increase the risk of people needing emergency care, being hospitalised, mismanaging their medication and not understanding their disease or condition.
Low health literacy levels have been shown to impact the safety and quality of healthcare and contribute to higher healthcare costs. This is why InsideRadiology aims to deliver content in plain English to maximise the usefulness of the resource. If we are to cover 80 per cent of the population then we need to ensure our language is aimed at a readership with an average age of 12–14 years.
2019 was a great year for the site, with 1,702,170 visits. The Gadolinium Contrast Medium page attracted the highest volume of traffic with 138,513 sessions.
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.
1. Gadolinium Contrast Media
2. Interventional Radiology
3. Transvaginal Ultrasound
4. MRI
5. VQ Scan
6. Iodine Containing Contrast Medium
7. Coronary Artery Calcium Scoring
8. Bursal Injection
9. Saline Infused Sonohysterography
10. Varicose Vein Ablation
1. Angiography
2. Computed Tomography
3. Bone Mineral Density Scan
4. MRI
5. Gadolinium Contrast Media
6. Nuclear Medicine Bone Scan
7. Plain Radiography
8. VQ Scan
9. PET Scan
10. Transvaginal Ultrasound Visitor Locations
Trans-Tasman visitors account for 16 per cent of total activity on the site, with 46 per cent of visitors accessing the website from the US and 10 per cent from the UK. The majority of our target audience are accessing the site from large cities with eastern Australian capital cities responsible for over 65 per cent of Australian and New Zealand visitors, however there is still a steady stream of visitors from regional and remote locations.
InsideRadiology encourages its information partners, hospitals, and radiology practices to link directly to the InsideRadiology website so that staff, patients and referrers can access trusted information straight from their own website that can easily be printed into a fact sheet.
InsideRadiology will continuously update the items as part of an ongoing review strategy so that radiology sites have up-to-date information for their patients without the extra administration.
Referral to the website only accounts for 2.2 per cent of our total audience and 5.04 per cent of Australian visitors up from 3.3 per cent in 2018. In New Zealand; however, it accounts for 37.88 per cent, up nearly 12 percent from 2018. This demonstrates that direct linking currently is an extremely effective way to reach the InsideRadiology target audience in New Zealand.
Please help us promote InsideRadiology by following us on Twitter and Facebook (@InsideRadiology)
If you need further information please contact insideradiology@ranzcr.edu.au
References
1. Australian Bureau of Statistics (2006) Adult Literacy and Life Skills Survey, Summary Results, Australia)
2. Healthdirect Australia https://about.healthdirect. gov.au/improving-health-literacy
Promoting InsideRadiology in your professional networks. Recommending any topics that could be considered for inclusion. Share the InsideRadiology Video.
Supplementing
As you read this, we are going through the COVID-19 pandemic, something none of us have experienced in our lifetime. This will have a profound, and in many instances long-standing effect on people all around the world, with catastrophic health and economic impact.
This year has started with bushfires across Australia during summer with loss of life, livelihood and property. On the back of this now we are facing the unprecedented COVID-19 pandemic. As medical professionals we play a key role in providing leadership and support for the wider community. Please do your best to ensure that you also look after your own health, by managing fatigue and keeping well. Elsewhere in this edition you can read about the College’s response and ongoing actions around COVID-19, including the establishment of the COVID-19 Taskforce and advice in relation to the impact of COVID-19 on College activities.
Notwithstanding the challenges we face, it’s important that we take time to reflect on the great progress we made in 2019. Our advocacy work resulted in the Australian Government indexing CT, X-ray, mammography and ultrasound. We continue to seek greater transparency from the government in the allocation of MRI licences, however, it was pleasing to see patient access increase through the provision of additional licensed machines and new listings of obstetric MRI and liver MRI. The College also continued to be a leader in the AI space, and became the first professional peak body to
develop Ethical Principles for Artificial Intelligence in Medicine. AI will remain a priority this year as the College will publish its draft Standards of Practice for Artificial Intelligence and produce a position statement on the regulation of AI.
There are several other key areas which will present exciting opportunities for the radiology sector in the coming months, including digital health, theranostics and the New Zealand national election.
On digital health, the College is currently in the process of drafting a proposal for a Radiology Request Set. This document aims to standardise terminology used for radiology referrals. This piece of work will form the foundation for our priority e-health initiatives such as e-referral and access to historic images. If supported by government, the Radiology Request Set will be shared with members for consultation later this year.
The Theranostics Working Group is looking to develop a position statement on theranostics and will provide initial advice on the future direction that the College should take in this rapidly emerging field.
New Zealanders will go to the polls for the national election on Saturday 19 September and the College has begun its advocacy efforts ahead of this. The current government has progressed several of our 2017 priorities including the rollout of a national bowel cancer screening program and work to ensure that only practitioners registered with
the Medical Council of New Zealand are involved in the care of New Zealand patients. Following the College’s successful advocacy campaign during last year’s Australian federal election, where we obtained commitments to the support and funding of radiology from all major parties, the College will issue a similar survey to New Zealand’s major parties. Our focus will be on digital health solutions, workforce and equitable access to quality services.
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The College has been proactive in engaging with the MBS Review Taskforce to ensure that the vital role that interventional radiology plays in patient care is understood. We are keen to raise awareness of the value that interventional radiology brings to patients and funders with minimally invasive options that are associated with lower morbidity and mortality, reduced costs, reduced hospital in-patient stay and significant time savings compared to many other treatment options, such as open surgery.
Another major item on our agenda for 2020 is the clinical radiologist workforce. There are some significant challenges to consider regarding overall workforce growth and distribution, particularly to cover regional and rural areas, delivery of sub-specialist radiology services and changes to the role of the clinical radiologist that AI might bring. We will be engaging further with members on this important area through 2020 and I encourage you to contribute to these important discussions.
We will continue to advocate to governments in both jurisdictions to advance the recognition of our profession and support provided to patients and the broader healthcare sector.
If you have any questions or comments about this article please contact Kirsten Fitzpatrick, Project Officer, on fcr@ranzcr.edu.au
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As we move into the new decade, the focus of the Specialty Training Unit (STU) is very much on the implementation phase of the Training and Assessment Reform (TAR). Successful implementation will require close collaboration between the College staff, the Fellows and the trainees, and all are very busy ensuring that processes and policies are in place to enable roll-out in 2021. While new groups were created specifically to assist with development and delivery of the TAR, going forward responsibilities for implementation and evaluation will increasingly be moved to the standing committees to ensure a seamless implementation.
During the course of 2020, I would like to acknowledge the various committees within STU, the committee Chairs and members, as well as highlight some of the important work of the committees.
One of the key committees involved in TAR implementation is the CRCAC. I would like to welcome the new Chair of the committee, Dr Jash Agraval, recently appointed to a three-year term. This position brings with it the role of Deputy Chief Censor, and I am looking forward to working with Jash to deliver not only the new training program, but also the usual and core business of the committee. The committee is supported by Ms Faeha Tashkeel, Project Officer, TAR, and by Mrs Legend Lee, Manager, Training Programs.
CRCAC is an advisory committee to the Clinical Radiology Education and Training Committee. The responsibilities of the committee include development and monitoring of the curriculum, learning experiences, work-based assessments (WBAs) and research, ensuring alignment between curriculum and assessments, and evaluation of the training program.
The various members of the committee have assumed responsibilities for different portfolios aligned with the new training program, including competencies of early training, learning objectives, experiential training requirements, rapid film reporting, workbased assessments, and research. The new training program will be released for broad stakeholder consultation in March–April 2020, and CRCAC will take a lead role in reviewing and considering feedback around curriculum and WBAs. I would recommend all who are involved in training to review the documents and provide feedback.
Research remains a key component of our training program. As part of a recent review and revision of the College’s Recognition of Prior Learning (RPL) Policy, RPL in research was considered and it was determined that the following could be considered if they fulfilled the learning objectives of the research curricula:
• Previous PhD research in the medical field (completed no more than three years prior to the commencement of training)
• Previous Masters by Research in the medical field (completed no more than three years prior to commencement of training)
• Clinical radiology research commenced less than two years prior to commencement of training, completed during training and meeting research project criteria.
An application for recognition of prior learning must be made to the College between the time the applicant has obtained an accredited training position in the Clinical Radiology Training Program and up until six months after the applicant has commenced training. I would refer trainees to the Recognition of Prior Learning Policy for further details.
The research component of the curriculum has been comprehensively reviewed with the TAR, the major change being a move to a single research project, with the preferred sign-off being acceptance for peer review by a journal.
All trainees will also be expected to present their research at a local network or branch level, to give them the opportunity to develop oral presentation skills, as well as the opportunity to be considered for the Branch of Origin competition.
CRCAC will be working closely with other committees to ensure successful TAR implementation. Communication will be key. There is training network representation on the TAR Implementation Working Group to ensure that the specific needs and requirements of the different jurisdictions can be recognised and considered. Robust consultation and feedback will assist greatly with successful implementation.
•
• Equity participation model
Dr Jash Agraval Chair of CRCAC Deputy Chief Censor
During the first operational year of the Professional Practice Committee (PPC), the committee established itself within the Faculty of Clinical Radiology and began work on a number of key priorities.
2020 is primed to be busy for the committee, beginning with the first meeting of the year held in late February. The committee met to plan for the extensive list of projects it will be working on, all designed to provide guidance for the profession of clinical radiology and effective support for our members.
Members of the PPC have been working tirelessly to draft the Clinical Radiology Range of Practice. This document aims to assist in identifying the range of practice or types of procedures which a clinical radiology Fellow can undertake. A draft of the completed document was presented to the PPC in February, following approval by the committee members, stakeholder consultation will begin. This document will be of great importance to the profession of clinical radiology and I urge all members to take part in the consultation.
In November of 2019, the Medical Council of New Zealand released the recertification requirements for vocationally-registered doctors in New Zealand. This builds on existing systems and emphasises the value of
the activities; particularly those related to review and reflections of practice. Accredited CPD program providers (CPD homes) are expected to have the changes implemented by 1 July 2022. For members working in New Zealand, I strongly recommend looking at the Medical Council of New Zealand’s website to familiarise yourself with the changes. You can also direct questions to the College via email to professionalpractice@ranzcr.edu.au
The Medical Board of Australia released a public consultation on the Draft revised Registration standard: Continuing professional development in December of 2019. Earlier in 2019 a confidential stakeholder consultation took place, RANZCR provided a response based on feedback from the relevant committees; the PPC for Clinical Radiology and the PFEC for Radiation Oncology. Both committees were requested to provide feedback on the latest consultation which included changes in line with those recommended by RANZCR in the initial round.
The public consultation ended on 14 February. As developments come from the MBA, the PPC will work to implement the changes, as well as those from the MCNZ, and provide communication to the broader membership, enabling a seamless transition to the new program.
In late 2019, the Australian Government’s Dust Disease Taskforce released their interim advice to the Minister of Health. The taskforce identified five national actions to address issues related to the re-emergence of silicosis. These are:
1. Develop and implement a prevention strategy, with an initial immediate targeted education and communication campaign
2. Develop a national approach to understand the extent of occupational dust diseases in Australia through identification and capture of data, information collection and sharing
3. Apply a strategic approach to research to better understand accelerated silicosis with the ultimate aim of improving prevention and treatment options, this includes establishing a research collaboration platform across Australia to ensure resources are targeted, activities address identified research gaps and efforts are not duplicated
4. Develop national guidance on an approach to actively search for people at risk from respirable crystalline silica dust exposure at the workplace
5. Develop a strategic national approach to improve Australia’s ability to detect and rapidly respond to any future emerging occupational diseases of significance.
The College is still very much working at the forefront of this very important health issue. We will continue to keep members updated as new developments emerge.
Post-mortem imaging is a niche area of radiology which is growing in significance, not only in the forensic environment, but also at a hospital level and for paediatrics. The Post Mortem Imaging Working Group was formed late last year and held their inaugural meeting in December of 2019. Dr Mohamed Nasreddine was elected as chair to guide the work of the group, I congratulate him on his position and look forward to working with him and the working group members.
The major pieces expected to come from the working group are; a position statement ‘The role and value of radiologists in post mortem imaging’, a framework for Appropriate Training and Quality Assurance, Practice Standards, a legal guide and a section related to paediatrics.
I look forward to keeping the Faculty updated on the work this group develops.
Last year, the Faculty Council approved the consolidation of the Continuing Professional Development Committee (CPDC) into the PPC. I am very pleased to advise that the members of the CPDC agreed to serve the remainder of their terms on the PPC, with some electing to renominate following the conclusion of their term at the end of last year.
After assessing the high workload of the PPC this year, two new members have been approved to join the committee. It is encouraging to see the continued support of clinical radiology members to the committee, evidenced by the bolstered membership of volunteers who give their time to maintain the high standard of our profession.
I would like to wish all members of the College the very best for 2020, in their professional endeavours and personal lives. I know the College appreciates the tireless work of our volunteers; I would like to also thank you for your ongoing commitment to enhancing our profession.
Given the current climate of COVID-19, I would like to extend a word of thanks to our members who are working hard to provide health care services to their communities during this stressful time. I wish you all the very best in getting through this.
Yours sincerely,
A/Prof Dinesh Varma Chief of Professional PracticeIf you have any questions or comments about this article please contact Antonia Kunde, Project Officer, Standards, on cpd@ranzcr.edu.au
This difficult year for many of you has just become more unpredictable, but not unsurmountable, and I have every confidence that you will cross the final hurdles and become an excellent clinical radiologist.
I am immensely fortunate to be part of a superbly talented and hardworking clinical radiology trainees’ committee (CRTC) this year, including representatives from VIC (Surain Rajadurai and Caitlin Farmer), SA (Sophie Thoo), WA (Shoba Ratnagobal), NSW (David Ong and Leonard Tiong), QLD (Sarah Robertson) and NZ (Sarah Benson-Cooper). Outside of this year’s interrupted examinations process, some of the key areas we will be focusing on in 2020 include:
• Delivery of the trainee day program at the Melbourne 2020 ASM
• Advocacy and assistance for trainees who are experiencing difficulty
• Contribution to local branch committees and assistance with local training issues
The beginning of the year 2020 has been unprecedented. Starting with devastating bushfires across much of Australia, we now face another challenge as a global community in addressing the COVID-19 pandemic. The effects of vital measures during the pandemic will impact all industries, but perhaps none more than healthcare. Difficult decisions need to be made to best protect our colleagues, our families and our broader communities. Unfortunately, but not without much consideration and the community’s best interests in mind, it was decided to cancel the series one examinations. This was devastating to many of you. I know first-hand the level of academic, personal and emotional investment that goes into preparing for these examinations, having sat part two exams last year. The clinical radiology trainees’ committee (CRTC) and I have been in contact with the senior leadership of RANZCR and will be working to find the best solutions moving forward.
• Feedback regarding the new enhanced curriculum and assessment format, and assistance with the implementation processes
• Advocating for trainee-centred and optimised subspecialty pathways (e.g. interventional radiology, nuclear medicine)
• Contribution to the trainee selection working group
Finally, I encourage you all to take a proactive approach to consider how you personally can best prevent yourself from contracting or spreading the COVID-19 virus. As the situation evolves (hopefully for the best!), I’m optimistic that we will look back upon this period as a time when the broader healthcare community faced an immense challenge and responded with the determination and qualities that brought us to a career in medicine and radiology in the first place.
Much like your parents, we would love to hear from you more often! Please feel free to email the CRTC at clinicalradtc@gmail.com with your thoughts, questions, and feedback.
SUPPORT
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Helping to meet the needs of patients with prostate cancer and healthcare professionals through initiatives such as patient support materials and supporting educational activities. Zoladex is indicated for:1 Palliative treatment of metastatic ( M+ ) or locally advanced prostate cancer where suitable for hormonal manipulation. Adjuvant and neoadjuvant therapy in combination with radiotherapy for the management of locally advanced prostate cancer in men suitable for hormonal manipulation.
Before prescribing please review full Product Information available on request from AstraZeneca on 1800 805 342 or at www.astrazeneca.com.au/PI
PBS Information: Zoladex 10.8mg. Restricted benefit for locally advanced ( equivalent to stage C ) or metastatic ( equivalent to stage D ) carcinoma of the prostate.
Zoladex® 10.8 mg Implant ( goserelin acetate ) Minimum Product Information. Indications: Metastatic ( M+ ) or locally advanced prostate cancer; adjuvant and neoadjuvant therapy in combination with radiotherapy for locally advanced prostate cancer. Contraindications: Hypersensitivity to LHRH, LHRH agonist analogues or any components of ZOLADEX. Precautions: Not indicated for use in females or in children; patients with metastatic cancer at risk of developing ureteric obstruction or spinal cord compression - use of ZOLADEX should be carefully considered and monitored closely in the first month; injection site injury, including pain, haematoma, haemorrhage and vascular injury, care with patients of low BMI and/or receiving full anticoagulation medications; bone pain; serum testosterone concentrations may rise if implant is omitted or delayed; loss of bone mineral density; hyperglycaemia and increased risk of developing diabetes – periodically monitor blood glucose and/or glycosylated haemoglobin ( HbA1c ). Androgen deprivation therapy may result in prolongation of QT/QTc interval-consider benefits versus risks in patients with congenital long QT syndrome, congestive heart failure, frequent electrolyte abnormalities or taking drugs known to prolong the QT interval. Correct electrolyte abnormalities. Monitor for symptoms and signs of development of cardiovascular disease and manage appropriately. Effects on fertility – see full PI. Adverse reactions: Very common ( ≥10% ): decreased libido, hot flush, abnormal blood pressure, hyperhidrosis, erectile dysfunction, gynaecomastia, breast tenderness, paraesthesia, decreased bone mineral density; Common ( ≥1% to <10% ): impaired glucose tolerance, spinal cord compression, incontinence/urinary frequency ( post-radiotherapy ), rash, bone pain, arthralgia, injection site reaction, cardiac failure, myocardial infarction, increased weight, mood swings; For less common adverse reactions, see full PI. Dosage: One implant ( 10.8 mg ) injected subcutaneously into anterior abdominal wall every 3 months. Caution should be taken while inserting ZOLADEX into the anterior abdominal wall due to the proximity of underlying inferior epigastric artery and its branches. Use extra care when administering ZOLADEX to patients with a low BMI and/or who are receiving full anticoagulation medication. Date of first inclusion in the ARTG: 22 May 1996. Date of most recent amendment: 16 May 2017.
1. Zoladex 10.8 mg Approved Product Information. Zoladex® is a registered trademark of the AstraZeneca group of companies. Registered user AstraZeneca Pty. Ltd. ABN 54 009 682 311. 66 Talavera Road, Macquarie Park, NSW 2113. www.astrazeneca.com.au. For Medical Information enquiries: 1800 805 342 or medinfo.australia@astrazeneca.com. To report an adverse event: 1800 805 342 or via https://aereporting.astrazeneca.com. AU-5913, WL302306, April 2019
References:
Achieving recognition for interventional radiology (IR) and interventional neuroradiology (INR) as official clinical radiology specialties in Australia and New Zealand will involve a considerable amount of work across a wide range of areas. New specialties are approved by the Council of Australian Governments Health Council (CHC) on the recommendation of the Medical Board of Australia.
Acknowledgement of a new medical specialty under the National Law by the Australian Medical Council of Australia and the Medical Council of New Zealand requires the College to make a case for specialty recognition through a staged application process. A key component of this process is demonstrating clear public benefit, which includes evidence of:
• improved health outcomes
• safety of care
• safety and quality of service delivery
• access to health services
• cost-effectiveness of interventions.
To commence the work to support this application, the Standards Unit is hosting a health science intern to undertake a literature review and
scoping exercise to map the current available evidence for interventional radiology and interventional neuroradiology across these areas.
We are asking for your help. Are you involved in any research that could be considered for this review or know of any early studies that may be concluding this year? Or are there research papers you know of that meet one or more of the categories outlined above? Would you like to contribute to this critical work, or do you know others who could help? Please get in touch at www.interventional@ranzcr.edu.au
The next round of European Board of Interventional Radiology (EBIR) examinations are to be held at the IRSA ASM in Queenstown, 10 August. Prospective IR candidates are encouraged to apply. For more details, visit: www.cirse.org/education/ebir/ Note: please visit the IRSA and CIRSE websites to keep up to date with the latest information on the scheduled EBIR exam.
The Society of Interventional Radiology has published a position statement on ablation in renal cell carcinoma (4 February 2020) interventionalnews. com/kidney-cancer-ablation-sir/
The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) has launched an international accreditation system for interventional oncology, and in doing so has identified strategies to improve quality clinical practice. Further information can be found at www.iasios.org.
The General Medical Council (GMC) are introducing a framework for GMC regulated credentials, interventional neuroradiology (led by the Royal College of Radiologists) are one of five early adopters to evaluate this framework. www.gmc-uk.org/education/ standards-guidance-and-curricula/ projects/credentialing
Do you have any IR or INR articles you would like to contribute to future editions? Please email your interest to interventional@ranzcr.edu.au
We
I trust you and your families are safe as we move into 2020. In what is, without a shadow of a doubt, a challenging year for us all, I would like to acknowledge the difficulties we face and at the same time not neglect to pay tribute to the valuable contribution of our members and College staff in the last 12 months. While recognising that a great deal of our energies will be devoted to the global pandemic, I would like to reiterate that our priorities always lie with our patients and members. We will continue our advocacy for equitable access to sustainable and high-quality radiation therapy services for all our patients irrespective of geographic, cultural, linguistic and socioeconomic variations. The day-to-day business of the Faculty continues, we aim to ensure a robust Medicare Benefits Schedule (MBS), collaborate closely with the government and several other stakeholders, develop standards for our profession, and support our trainees and supervisors through the training and assessment reform. Most importantly, I am very pleased that we have truly begun our journey of reconciliation with a College wide strategy to address disparities in Indigenous health. We have a lot of work to do in this area and as we mark the twelfth anniversary of the National Apology, it is timely to commit to a sensitive and respectful approach to Closing the Gap.
One of the key pieces of work for the Faculty in 2020 continues to be the MBS Review. Centres will be invited by the federal Department of Health to collect prospective data over three months.
A few test centres are currently providing feedback on the readability of the new descriptors before they are sent out to all centres for data collection. Data will be used to model the new radiation oncology schedule. It is important that as many centres as possible participate in this exercise.
A significant amount of work has been put into updating the ‘regional centres’ position paper over the last few months by a small team of radiation oncologists, radiation therapists and medical physicists. I was heartened to see wide stakeholder engagement and I would like to thank all who provided feedback during the recent consultation phase. Feedback received on our documents helps make them stronger tools. This paper will continue to be used to ensure we maintain high-quality services to regional areas. The final version will be published on the College website following approval.
Cancer Council Australia, along with Breast Cancer Network Australia, CanTeen and the Prostate Cancer Foundation of Australia have developed standards for informed financial consent in cancer care.
The document can be downloaded from the Cancer Council Website (www.cancer.org.au/about-cancer/ patient-support/informed-financialconsent.html) and should be read by all members. Cancer Council are progressing work on developing a patient-friendly resource.
As the year commences, it is timely to remind centres about the benefits of offering GP education evenings. These evenings give us the opportunity to not only showcase what makes our profession so special, but also an opportunity to engage and network with our referrer base. I also urge you to actively engage with the local Aboriginal and Torres Strait Islander Health services and invite them to be part of the education evening. If you or your centre are considering holding an education evening this year or already planning an evening, please contact our Targeting Cancer team (tcinfo@ranzcr.edu.au) who are able to assist with suggestions for planning and providing resources.
The 2020 TROG ASM is fast approaching. The ASM brings together national and international researchers and provides an opportunity to hear what is happening in the research realm and to network with colleagues. For more information visit www.asm.trog.com.au/
Congratulations are in order for former Faculty of Radiation Oncology Dean, Prof Gillian Duschesne who became a Member in the Order of Australia (AO) in the Australia Day honours. A very deserving recipient of such an honour.
If you have any questions or comments about this article please contact Tan Nguyen, Project Officer, on faculty@ranzcr.edu.au
In 2015, then Minister for Health, the Hon Sussan Ley, announced the Medicare Benefits Schedule (MBS) Review as an opportunity to update the Schedule to reflect contemporary practice. The Schedule, with over 5,700 items, was identified as having potentially unsafe, outdated or obsolete services listed.
Several clinical committees were formed, providing advice on each area of the Schedule. This included the Oncology Clinical Committee, which had within its remit medical and radiation oncology.
A sub-group of the Oncology Clinical Committee was formed to review the radiation oncology items. This subgroup undertook a thorough review and recommended to the Oncology Clinical Committee that the existing schedule, with over 90 items, be significantly overhauled. As advised by the Faculty of Radiation Oncology’s MBS Review Working Group, a new complexitybased schedule was developed and put to the Oncology Clinical Committee in 2016. A waiting game began, with the Report from the Oncology Clinical Committee expected for an external consultation period.
It was not until mid-2018 that the consultation was announced—nearly two years after the proposed schedule had been developed. This was the first time that most stakeholders had seen the proposed schedule. Feedback was considered by the Oncology Clinical Committee before the final report, including recommendations to change the radiation oncology schedule, was presented to the MBS Review Taskforce.
Once approved by the Taskforce, the report and recommendations were sent to the Minister for Health, the Hon Greg Hunt, for approval.
Following Ministerial approval in early 2019 of the recommendations of the Oncology Clinical Committee, work commenced on an implementation plan. The Minister advised the Department of Health to work with the College on implementation.
The Faculty has been liaising with the Department of Health since then regarding the proposed changes and the steps leading to the implementation of the new schedule.
A data-gathering exercise is about to commence to help determine usage and pricing of the new items. This exercise will look at the billing practice of sites and determine, based on data and assumptions, the fees associated with the new item numbers.
Ahead of sites being contacted by the Department of Health and invited to collect three months of prospective billing data, a small sample of sites identified by the Department of Health, have been involved in reviewing draft guidance material that will be provided to sites as part of the prospective billing data collection.
Prospective data collection is a critical step in the process as the data will be used to inform the pricing of items in the new radiation oncology schedule, and therefore rebates for patients. The principle of the MBS Review is that any changes made to the Schedule are meant to be cost neutral. Sites contacted by the Department of Health
are strongly encouraged to participate in this data-gathering exercise.
Planning provides for the new schedule to be implemented from November 2021. The Faculty maintains that a pilot of the new item prices occurs ahead of implementation. That pilot would be the final opportunity to identify any unintended consequences of the changes—whether for patients, providers or the government.
Post-implementation will see the schedule being closely monitored and the Faculty will continue to work with the Department throughout this.
For further information contact Ms Shahin Begum, Manager, Economics and Analytics on shahin.begum@ranzcr.edu.au
In my inaugural report as Chief Censor, I would firstly like to express my sincere gratitude to the Faculty Council for giving me the privilege and honour to serve in this capacity. Secondly, I want to thank the outgoing Chief Censor, A/Prof Margot Lehman who, through her leadership and diligence, has worked tirelessly together with the Steering Committee and many volunteers over the last three years to deliver the enhanced training program following the recommendations of the ACER/Prideaux review. Very soon, the entire training program including the learning outcomes, work-based assessments, structured learning experiences and review feedback tools will be undergoing external stakeholder consultation. I am looking forward to this world-class training program being launched in 2021.
As a natural progression, the implementation phase of the training program is moving along swiftly with multiple training resources for clinical supervisors and information sessions for trainees in planning throughout the year. I would strongly encourage all Fellows and Directors of Training, in particular, to provide any constructive feedback necessary, especially in regard to its application and delivery.
One of the more significant changes affecting the way trainees progress through the training program is the assessment for progression from Phase 1 to Phase 2 training, and the eligibility to apply for Phase 2 examinations. Previously progression of Phase 2 training was automatic post the successful completion of Phase 1
examinations. The eligibility to apply for Phase 2 examinations on the other hand was remitted to the Directors of Training (DoTs). Due to the significance, complexity and ongoing need for increased independence of these decision-making processes, it was determined that both would now fall under the remit of the Network Portfolio Review Committee (NPRC), under the governance of the Network Governance Committee. This is intended to allow DoTs to remain at arm’s length from these decisions which can sometimes be difficult to make in the face of existing relationships.
In addition to the efforts put into the curriculum in the enhanced training program, there is significant work being invested into revising and refining of the Phase 1 and Phase 2 examinations processes and framework. I look forward to working closely and effectively with the Chief of Examinations, Dr Sean Brennan and the examination panels to operationalise this essential work. The aim of this revision is to deliver a more fit-for-purpose and flexible/ adaptable examination process, which will hopefully benefit both trainees and examiners alike.
All these endeavours have been aptly reflected in the inaugural 2019 National Medical Training Survey results which were made public on 10 February 2020. Over 9,000 doctors-in-training responded to the survey, with 3,510 of these being specialist non-GP trainees. Trainees from the Faculty of Radiation Oncology scored extremely high agreement scores in the areas of relevance of the training program,
understanding of training program requirements, communication of both the requirements of the training program and the changes that are occurring in the training program. The scores are very positive in that they are comparatively higher than many of the other trainees from other colleges surveyed. These results not only give us the impetus to persist with this essential work but also to strive to improve on the areas that have lower agreement scores.
My primary focus as Chief Censor in the first half of this year will be to visit and engage with Fellows who are involved in the training and assessment sphere, listening and working out potential issues. I hope that we can collaborate to find ways of supporting and equipping everyone adequately for the job at hand. I would be happy for anyone who wants to reach out to connect and engage with me regarding any aspect of radiation oncology training.
Dr Yaw Chin Chief Censor Faculty of Radiation OncologyIf you have any questions or comments about this article please contact Legend Lee, Manager, Training Programs, on rotraining@ranzcr.edu.au
Varian’s Bravos™ afterloader system is designed to streamline the highdose-rate (HDR) brachytherapy treatment process, from planning to delivery. Bravos integrates with the BrachyVision™ module in Eclipse™ treatment planning to create plans that deliver a high dose to the target with minimal impact on surrounding healthy tissues.
The Bravos system was installed at the UK-based Norfolk and Norwich University Hospital (NNUH) in 2018 as part of a new, specially built brachytherapy treatment suite that also includes a multi-purpose room for anesthesia and treatment, and a dedicated recovery area.
Prior to November 2018, NNUH used brachytherapy to treat only gynecological cancers. However, brachytherapy is well established as a treatment for localized prostate cancer. HDR brachytherapy offers a means to deliver hypo-fractionated dose escalation within the limits of normal tissue tolerances, helping to reduce the risk to healthy organs and improve disease control.1 Furthermore, recent studies indicate that adding HDR brachytherapy to a course of external beam radiotherapy (EBRT) can improve biochemical and survival outcomes.2
“The addition of Bravos has allowed us to start treating prostate patients with brachytherapy, as well as streamline the process for the gynecological patients,” explains Sam Worster, advanced practitioner in prostate brachytherapy at
NNUH. “Everything about the system is designed to help speed up treatments and improve patient safety—from the intuitive touchscreen to the machine’s easy maneuverability around the operating room to the built-in checklists. We typically treat patients on an outpatient basis in one day, so it’s important that the entire process is as efficient and seamless as possible,” he adds. “Treatment with Bravos technology can take anywhere from 20 to 40 minutes, depending on how many channels we use.”
Vicki Currie is the lead clinical scientist for brachytherapy in the NNUH Radiotherapy Physics department and leads the commissioning of Bravos and brachytherapy treatment planning, including set up, testing, and afterloader verification.
“We’re part of a multidisciplinary team that delivers treatments, ensures radiation protection is in place, transfers plans to the machine, and verifies that the dose is delivered safely and accurately,” she says. “Bravos has helped streamline the entire process as it fully integrates with treatment planning.”
The integration with treatment planning is also a huge plus for Katie Cooper, consultant radiographer for brachytherapy. “As we look at streamlining our workflows, the built-in software means we can reduce the use of treatment spreadsheets and further improve the efficiency of paperless processes,” Cooper explains. “Not only can we customize the brachytherapy checklist to include everything we need to make treatment safer, but there is also the potential to develop the way in which we record patient’s
treatments. The inclusion of electronic signatures ensures compliance with the Ionizing Radiation (Medical Exposure) Regulations (IR(ME)R).
“Developing the brachytherapy treatment suite was a joint effort with Varian,” Cooper says. “The training was excellent, and Varian has been very supportive in getting us off the ground and going. As more people are trained and the prostate service grows, we’re also looking at expanding to treat cancers of the esophagus, rectum, and skin. We’re optimistic that this will make a huge difference to patients in the area.”
Reference
1 Hoskin PJ et al. Randomized trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localized prostate cancer. Radiother Oncol. 2012 May;103(2):217-22.
2 Wedde TB et al. Ten-year survival after High-DoseRate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort. Radiother Oncol. 2019 Mar;132:211-217.
In 2010, Howard Brody challenged medical specialty societies in the US to create a list of ‘Top 5’ low-value, or potentially harmful medical tests or treatments that are over-used or mis-used (1). The American Board of Internal Medicine (ABIM) responded by introducing the Choosing Wisely® (CW) campaign, which is a health education initiative, engaging clinicians and patients in conversation about unnecessary non-evidence-based tests and treatments. The RANZCR Faculty of Radiation Oncology has also taken on the challenge and developed five radiation oncology specific CW recommendations (Table 1) in 2016, which is largely an adaptation of the ASTRO recommendations (2)
To ensure maximal impact of the CW campaign, its recommendation needs to focus on non-controversial evidence-based practice, and where there is reliable local data on the current variation from ‘wise’ practice— this is evident in the differences in the CW recommendations between countries. For example, the use of hypofractionated breast radiotherapy is already a standard of care in the UK, and hence it was not included in the UK Royal College of Radiologists CW recommendations (3). Similarly, given that extended radiation therapy fractionation schemes of more than 10 fractions for bone metastases is an uncommon practice in Canada, the Canadian CW campaign recommended not to use more than a single fraction radiation therapy for uncomplicated bone metastases (4)
It is also desirable if the CW recommendations are measurable, as it allows us to firstly identify if there is variation from ‘wise’ practice, and secondly offers opportunity to evaluate the impact of the CW campaign. Recent studies using administrative databases and registry-based datasets have
shown that there has been significant change in radiation oncology practice over time that is in line with the CW recommendations (5, 6)
At the same time, given the rapidly evolving evidence in radiation oncology, some of the recommendations may need to be revised, as it may not be in line with the contemporary evidence. For example, the recommendation not to routinely use extensive locoregional therapy in metastatic cancer setting may be considered obsolete now, with the accumulating level 1 evidence in different cancers favouring treatment of the primary tumour in the setting of metastatic disease.
We believe that the CW campaign provides us with a framework in our effort to minimise low-value care in radiation oncology practice. However, it is important to be aware that we need to tailor the recommendation to our local practice, and these recommendations will also need to be revisited and revised on a regular basis, as evidence in radiation oncology practice continues to evolve over time.
Reference
1 Brody H. Medicine's ethical responsibility for health care reform--the Top Five list. The New England journal of medicine. 2010;362(4):283-5.
2 American Society for Radiation Oncology. Five Things Physicians and Patients Should Question. [Available from: http://www.choosingwisely.org/ wp-content/uploads/2015/02/ASTRO-ChoosingWisely-List.pdf.
3 Choosing WIsely UK. Recommendations [Available from: http://www.choosingwisely.co.uk/i-am-aclinician/recommendations/.
4 Mitera G, Earle C, Latosinsky S, Booth C, Bezjak A, Desbiens C, et al. Choosing Wisely Canada cancer list: ten low-value or harmful practices that should be avoided in cancer care. Journal of oncology practice / American Society of Clinical Oncology. 2015;11(3):e296-303.
5 Ong WL, Foroudi F, Milne RL, Millar JL. Are We Choosing Wisely in Radiation Oncology PracticeFindings From an Australian Population-Based Study. International journal of radiation oncology, biology, physics. 2019;104(5):1012-6.
6 Ong WL, Evans SM, Evans M, Tacey M, Dodds L, Kearns P, et al. Trends in Conservative Management for Low-risk Prostate Cancer in a Population-based Cohort of Australian Men Diagnosed Between 2009 and 2016. Eur Urol Oncol. 2019.
1. Don’t initiate whole-breast radiation therapy as a part of breast conservation therapy in women age50 with early-stage invasive breast cancer without considering shorter treatment schedule
2. Don’t initiate management of low-risk prostate cancer without discussing active surveillance
3. Don’t routinely use extended fractionation scheme (>10 fractions) for palliation of bone metastases
4. Don’t routinely add adjuvant whole brain radiation therapy to stereotactic radiosurgery for limited brain metastases
5. Don’t routinely use extensive locoregional therapy in most cancer situations where there is metastatic disease and minimal symptoms attributable to the primary tumour
can contribute towards ongoing improvement of the radiation oncology training experience for all. The primary goal of the ROTC is to represent and advocate for all radiation oncology trainees. So, if you have any suggestions or ideas of how the ROTC can make things better, feel free to reach out to myself (weeloonong@cantab.net) or trainee representatives in your respective network.
including exams preparation courses, are currently under review, and updates will be provided accordingly.
Welcome to the new clinical year, especially to the first-year trainees who have come on board one of the most exciting and cutting-edge training programs! Firstly, I would like to thank the 2019 Radiation Oncology Trainee Committee (ROTC) whom I had the honour and opportunity to work with, for all their hard work over the last 12 months, especially with the Australian Medical Council reaccreditation process and in preparation for the Training and Assessment Reform (TAR) implementation.
I would also like to introduce the enthusiastic fresh faces in the ROTC for 2020, who will bring along new ideas, and hopefully as a group we
Unfortunately, we are now faced with a global outbreak of the novel Coronavirus (COVID-19). Amidst escalating concerns on COVID-19 in Australasia in the recent weeks, the College through the COVID-19 College Taskforce has made a difficult but necessary decision to defer the upcoming radiation oncology Phase 2 Series 1 clinical exams. This undoubtedly affects plans and arrangements in the post-exams period, and we as the ROTC deeply empathise with all our affected fellow trainees. However, the health and safety of everyone involved in the examination process (including exams candidates, examiners, administrative staff, and volunteer patients) is of key priority. Plans for other Collegerelated activities in the coming months,
Wee Loon Ong VIC/ TAS ROTC Chair, ASM Committee
Lyndsey Edwards WA ROTC Secretary
Chamitha Weerasinghe NSW-N Media and Profile Committee
Revadhi Chelvarajah NSW-S Radiation Oncology Education and Training Committee
James Gallo QLD Economic and Workforce Committee
Jeremy Khong SA/NT Quality Improvement Committee
Mollie Kain NZ Radiation Oncology Research Committee
Eileen O’Reilly NZ New Zealand Radiation Oncology Education
Gabrielle Metz (Ex-officio member) NSW TAR Implementation Working Group
COVID-19 aside, ROTC will continue to improve our communication with all trainees through our monthly eNewsletter. This is high on the ROTC priority list this year. We hope to continue to provide timely updates on ongoing workshops, as well as training and research opportunities. I am sure trainees who have attended the SMART workshop at the recent ‘virtual’ TROG ASM have found it to be an educational session. A major upcoming college event is the ASM in October; the deadline for abstract submission, as well as several other college research prizes/ grants, is in April.
Lastly, I hope for a great year ahead for all trainees in continuing to progress with contouring, improving on plan evaluation skills, preparing for exams, and working on research projects amongst other things. However, in the coming months, it is most important that everyone stays well, and practice necessary social distancing and hand hygiene, in our collective effort to ‘flatten the curve’!
Balancing the risk of side effects with the potential benefit of treatment is a big part of making decisions about treating any cancer. Over 21,000 new cases of prostate cancer are diagnosed each year across Australia and New Zealand, with surgery the most common treatment approach. More than a third of these patients will have high-risk features placing them at significant risk of their cancer returning.
The strategy of treating high-risk patients with radiation therapy soon after surgery (called adjuvant radiation therapy) has been shown in three large randomised trials to halve the risk of cancer returning, and is currently recommended by both European and American urological guidelines. An alternative approach is to use radiation therapy only if a rising PSA shows the cancer is active (called surveillance with salvage radiation therapy).
While adjuvant therapy provides benefits to some patients, it exposes males to risks of bladder and bowel problems and can compromise recovery of erectile functioning. If surveillance with salvage radiation therapy is as effective as adjuvant radiation therapy, many patients could be spared unnecessary treatment and possible side effects.
There has been considerable debate over the last decade on the optimal timing of post-operative radiation therapy for high-risk patients. The TROG 08.03 RAVES trials stands to help resolve this debate and could transform the way this issue is addressed across practices worldwide.
Launched in 2009, the RAVES trial is the first study in the world to address the role and timing of radiation therapy after surgery for prostate cancer within the context of giving radiation therapy in a standard way.
The phase III randomised clinical trial was led by Dr Maria Pearse from Auckland Hospital and A/Prof Andrew Kneebone from Royal North Shore Hospital, and involved enrolling 333 male patients from 32 radiation therapy centres across Australia and New Zealand. Patients were randomly allocated to receive radiation therapy within six months after surgery or to be observed and have radiation therapy if their PSA rose above 0.20 ng/ml. All received the same 64Gy dose and had symptoms, PSA and patient quality of life assessed.
The trial has shown surveillance with early salvage radiation therapy has similar rates of controlling cancer to adjuvant radiation therapy and is associated with fewer urinary problems. After five years of follow-up, 86 per cent of patients in the adjuvant radiation therapy arm were free from relapse measured by PSA tests, compared with 88 per cent in the salvage radiation therapy arm. The results were presented at the American Society for Therapeutic Radiation Oncology (ASTRO) ASM in Chicago in September 2019.
The next phase of analyses will look at side effects and quality of life, more effective ways to identify high-risk patients, and explore the relationship between radiation therapy delivery technique and risk of side effects.
Data will also be pooled with two similar trials in Britain and France for a combined analysis of over 2000 patients, providing enough patients to compare the two treatments in relation to survival. This trial was funded with grants from the New Zealand Health Research Council, Australian National Health Medical Research Council, Cancer Council Victoria, Cancer Council NSW, Auckland Hospital Charitable Trust, Trans-Tasman Radiation Oncology Group Seed Funding, Genesis Oncology Trust, Royal Australian and New Zealand College of Radiologists, Cancer Institute NSW, Prostate Cancer Foundation Australia, and Cancer Australia.
Intercontinental Hotel, Wellington
Professor Laurie A. Loevner Chief, Division of Neuroradiology Professor of Radiology, Neurosurgery, Otorhinolaryngology: Head & Neck Surgery, and Ophthalmology
University of Pennsylvania Health System
Philadelphia, USA
Associate Professor Bruno Giuffrè
University of Sydney at Northern Clinical School Radiology Department, Royal North Shore Hospital Sydney, Australia
Associate Professor Corinne Doll
Tom Baker Cancer Center President of Canadian Association of Radiation Oncology
Calgary, Canada
Key Dates
Registration Open: 9 April 2020
Abstract Submission Open: 9 April 2020
Abstract Submission Close: 28 June 2020
Early Bird Registration Close: 5 July 2020
www.ranzcr2020.co.nz
In May 2019, representatives from the Asia-Pacific Radiation Oncology Special Interest Group (APROSIG), together with representatives from the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) and the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT), visited cancer centres in Southeast Asia to provide two weeks of targeted training. The visit was funded by a RANZCR International Development Fund grant.
The team first visited Ho Chi Minh City Oncology Hospital (HCMCOH), the largest public cancer centre in Vietnam and flagship centre for the south of Vietnam. This visit followed up a previous tripartite visit in 2017 and aimed to provide education and training in the use of IGRT, given the department had just installed two new Varian TrueBeam machines. The teaching visit also aimed to build on the prior training provided by Australian Riding to The Top (RTT) volunteer, Mr Vu Hunyh who had been based there for eight years. The team consisted of radiation oncologists Dr Iain Ward, Dr Mei Ling Yap and Dr Shaun Costello, Range of Motion Project (ROMP) volunteer Dr Stéphanie Corde and RTT volunteer Mr Craig Opie.
The team provided lecturers on topics which had been identified by the HCMCOH team as key learning needs. These topics included principles of IGRT, quality assurance for IGRT and deep inspiration breath hold (DBIH). As well, the team spent time observing the clinics and planning/treatment practices of HCMCOH and were able to provide practical teaching. Since the May visit, there has been ongoing virtual support by the team members, including provision of advice for the start of the centre’s stereotactic brain program. This was followed by a return visit to the National Cancer Centre (NCC) in Phnom Penh, Cambodia, a recently built centre which our team has been collaborating with since 2016. During the past three years, volunteer Australian medical physicists and radiation therapists have spent from months up to a year each in Phnom Penh training Cambodian staff to help ensure a successful and safe start to the department. This visit aimed to observe the practices of the Cambodian centre which had, for the first time, been without Australian volunteer support for a period of five months and to provide targeted training. Dr Karen Lim (radiation oncologist) and Ms Brianna Minns joined the team for the Cambodian visit. The team observed that the NCC had established a solid foundation for the delivery of safe and accurate radiotherapy. Patient set-up and treatment processes were reliable, sophisticated 3D conformal treatment plans were being delivered and there was a strong quality assurance program. During their time there, the team also helped develop a framework for ‘Nursing transition to radiation therapy practice’, a 12-month training program which Ms Brianna Minns will help to implement during her upcoming RTT volunteer placement in late 2020. This program will be important, as there is no formal radiation therapy training
program in Cambodia and a number of nurses at the NCC have been identified to take on the role of an RTT without prior training. The radiation oncologists focused on helping to develop treatment guidelines and data collection sheets for breast, cervix and nasopharynx cancers. This will be consolidated when Dr Shaun Costello returns for a volunteer training stint later this year.
We would like to thank RANZCR for its continuing funding support through the IDF grant. If you are interested in becoming involved in Asia-Pacific training, please contact:
Mei Ling Yapmeiling.yap@health.nsw.gov.au
Iain WardIain.Ward@cdhb.health.nz
The Australian Bragg Centre for Proton Therapy and Research is on target to open in 2023, with site works now underway. Particle Therapy (PT) Special Interest Groups (SIG) are now established in RANZCR, ACPSEM, ASMIRT and most recently the TransTasman Radiation Oncology Group (TROG) as well. Working together, these groups will ensure that patients who will benefit most from proton therapy will be treated at the Centre from around Australia by a well-trained workforce according to agreed clinical protocols which include follow-up programs. There is considerable work to be done!
A survey of RANZCR members was conducted in September 2019 to assess the levels of understanding and perceptions of proton beam therapy (PBT), led by Dr Peter Gorayski. The response rate from members was low at 16 per cent overall, although not unusual for College surveys. Around three quarters of respondents reported that they did not have high-level confidence in the role of PBT with a similar number citing a lack of clinical data in the field, including randomised controlled trials. Two systematic reviews were conducted by RANZCR PTSIG members during 2019, led by Dr Eun Ji Hwang (the manuscripts are currently under review with JMIRO). The first updates the clinical evidence base for particle therapy, both proton beam and carbon ion therapy and the second examines toxicity as a separate focus. The reviews conclude that, at the very least, PT provides equivalent tumour outcomes compared to photon controls with evidence to support reduced morbidity and improved quality of life in a range of tumours such as head and neck cancer, paediatrics, sarcomas and gastrointestinal tumours. However, the quality of evidence overall is low. To be part of the international effort to improve this situation, it is imperative
that clinical trials in PBT in Australia are designed with appropriate comparators and take into account integration of PT’s pace of technological advancements.
Information about PT for the Targeting Cancer website is well-developed and should be online by the end of March. Together with publication of the systematic reviews, this will allow radiation oncologists to be better informed about PT.
The RANZCR SIG has received feedback on a Guidelines for Safe Practice of Particle Therapy and with revisions, aims to have this document endorsed by the end of March. The document describes facility considerations for patient care and physical requirements; the patient referral pathway; scope of practice at a PT facility and credentialing for radiation oncologists practicing in the field of PT.
PBT planning skills are in various stages of development at the four facilities in Australia with funded PT centres (The Bragg Centre) or with well-developed business cases—the National Particle Treatment and Research Centre on the Westmead precinct in Sydney, the Peter MacCallum Cancer Centre and Metro North on the Royal Brisbane and Women’s Hospital site. For the first time, teams of radiation oncologists, medical physicists and radiation therapists from the four centres will come together in March to compare treatment plans for four datasets. This will form the basis of a set of planning principles for PBT.
A workshop was held at the RANZCR offices in Sydney in August 2019 regarding the establishment of a national registry for particle therapy. The most likely solution will be a registry that acts as the platform for an agreed minimum data set to be collated and linked to other registries nationally and internationally, while keeping diagnostic images and radiation treatment plans at local facilities. It will almost certainly rely
on distributed-learning methods and allow benchmarking of PBT with other facilities and registries such as that of the European Particle Therapy Network and the Pediatric Proton Consortium Registry.
Three national symposia on PT have been held since November 2018, most recently in Brisbane in March 2019. The fourth symposium will be held at the Peter MacCallum Cancer Centre in June this year. The symposia have brought together clinicians, scientists and patient support and advocacy groups from across Australia with support of the Australian Nuclear Science and Technology Organisation (ANSTO), universities (Sydney, Wollongong), the South Australian Health and Medical Research Institute among many other organisations, emphasising the need for an ongoing national approach and recognising the potential for research and innovation including for physics and technology research, as well as clinical research.
If you have any queries about this update, please contact:
A/Prof Verity Ahern
Chair, Faculty of Radiation Oncology
Particle Therapy Special Interest Group at:
FROSIGS@ranzcr.edu.au
An exciting development over the past year has been the launch of the Australian and New Zealand Society for Paediatric Radiology website (anzspr.org). This website will provide information about our group, including the current executive, links to the ANZSPR annual conference, links to other paediatric radiological societies, information on Australasian Paediatric Fellowship programs and, in time, useful educational resources and some clinical guidelines.
Dr Helen Bird ANZSPR secretary helenb@adhb.govt.nzThis year’s ANZSPR conference was held in the South Island of New Zealand in the pretty village of Hamner Springs.
The scientific content was cutting-edge with several speakers from NZ and abroad. There was a full-day symposium on inflicted injury with speakers including Child Abuse specialist Dr Patrick Kelly ONZM, Dr Katherine Halliday from Nottingham in England and Dr Neil Stoodley, Neuroradiologist from Bristol, England. The other major topic was neonatal and fetal imaging including fetal MRI with Dr Beth Kline-Fath, Chief of fetal and neonatal imaging from Cincinnati US.
The social events were well attended with a fantastic welcome BBQ, and degustation meal with wine match for the conference dinner at the Hamner Springs Heritage Hotel.
The weather also joined the party with a dusting of snow on the final night to make the whole area look like a fairyland.
Dr Sonja Bastin Starship Hospital, AucklandThis year’s ANZSPR Annual Scientific Meeting will be held over three days from the 19 to 21 October 2020 at the Yarra Valley Lodge in the beautiful, tranquil surrounds of the Yarra Valley in Victoria, less than an hour’s drive from Melbourne city centre. The program will focus on paediatric body and oncology imaging, neuroradiology, chest and musculoskeletal imaging. Five eminent confirmed international invited speakers along with local speakers will deliver an array of state of the art presentations. The program will also incorporate a fetal neuroradiology workshop.
The social program will include a welcome reception and a conference dinner, with additional opportunities to sample some of the amazing food and wine that the Yarra Valley has to offer.
Invited speakers: Ethan Smith from Cincinnati, USA, paediatric body and oncology; Jerry Dwek from San Diego, USA, paediatric MSK; Paul Griffiths from Sheffield, UK, paediatric neuroradiology; Pedro Daltro from Rio de Janeiro, Brazil, paediatric chest; and Jacob Jaremko from Edmonton, Canada, paediatric MSK
Registration and abstract submissions will be open soon.
Dr Padma Rao Royal Children’s Hospital, MelbourneIn late 2019, RANZCR informed its affiliated societies that it was no longer able to provide financial and membership management services to the societies. The IRSA Executive spent many months preparing for the society to transition and on 1 November 2019 this transition period was completed and IRSA became fully operational as a standalone entity. IRSA would like to thank RANZCR for the many years of service support and we look forward to a continuing close relationship. We would also like to extend a big thank you to Ms Hilary Baldwin from RANZCR who has helped IRSA for many years.
The IRSA Executive has appointed new service providers to support the society, including a not-for-profit accounting firm, new secretariat support (with a strong background in our profession) and has developed a new members management system, database and website.
IRSA members can now pay their subscriptions through the IRSA website. Members are also able to manage their profile ensuring that IRSA has the most up-to-date contact details for each member.
For member support and engagement queries, please phone: +61 2 9158 7633 or email Bianca Heggelund at secretariat@irsa.com.au.
IRSA would like to take the opportunity to thank its members for their continued support and to outline the many great benefits of being an IRSA member in 2020.
We are pleased to announce that Society of Interventional Radiology (SIR) affiliate membership commenced for all
financial IRSA members from January 2020.
This affiliate membership will give IRSA members:
• Discounted registration fees for all SIR meetings
• Access to a dedicated society community and SIR membership directory access on SIR Connect
• Access to SIR’s secure ‘online discussion forum’
• Full access to the SIR cloud; an online library that offers a comprehensive collection of files relating to interventional radiology topics.
• Online access to IR Quarterly (IRQ), a magazine offering updates, stories, interviews and in-depth analysis of issues impacting the profession.
IRSA members will continue to receive affiliate Cardiovascular and Interventional Radiological Society of Europe (CIRSE) membership which gives members:
• Reduced congress fees
• Access to the CIRSE Library
• Online access to CVIR
• A reduced rate for CVIR print subscription
• Eligibility for EBIR examination
• Reduced fees for the CIRSE Academy courses
• Access to members lounge at the annual congress
• A print copy of IR News three times per year
• Eligibility to CIRSE corresponding fellow status after three years
• An invitation to the CIRSE members’ evening.
Other great benefits of IRSA membership include:
• IRSA ASM information, education opportunities and discount member registration rates
• Official society recognition
• Access to the latest patient
• Support, advice and resources from the society as needed.
Membership subscriptions for 2020 are now due. Please check your emails for details on how to access the new IRSA website and pay your fees. If you have any questions, please contact the IRSA secretariat at secretariat@irsa.com.au
The IRSA executive and ASM committee are constantly monitoring the situation regarding COVID-19. The situation is very fluid and changes daily. The ASM and EBIR exams are approximately 4–5 months away and at this stage the ASM and EBIR are still planned to run. Should any changes be made the IRSA membership will be advised accordingly at the earliest possible time. The ASM will be held from 11–13 August 2020 at the Crowne Plaza, New Zealand.
We are pleased to announce that the topic for the meeting is Venous Action and Intervention.
The confirmed international keynote speakers are Dr Robert Morgan (UK), Dr Scott Trerotola (US) and Dr Raman Uberoi (UK).
Early Bird Now Open: Take advantage now and get 10 per cent off the application fee for the EBIR examination taking place on 10 August at the Rydges Hotel, Queenstown, New Zealand.
The Early Bird Fee expires on 31 March. Applications are accepted on a first come, first served basis, so secure your place today!
Apply now at http://www.cirse.org/ebir
Dr Gerard Goh IRSA President2020 has begun, at the time of writing, the COVID-19 situation is evolving rapidly. Please look after yourselves, your families, your colleagues and your neighbours.
Kia Kaha.This year’s election has been announced for 19 September. The incumbent government has made some positive moves for our professions with the creation of the Cancer Control Agency, investment in linear accelerators (LINACs) and, not reported in the media, the creation of the National Radiology Collaborative Action Group (NRCAG).
For more discussion on the NZ election, please see over.
The creation of the NRCAG is the result of New Zealand’s health leadership understanding that radiology services and the imaging workforce has been struggling with demand growing well beyond capacity. The NRCAG has a healthy budget and two years to prioritise the issues and come up with solutions.
One meeting has been held with clinical representation from around New Zealand, including myself representing the College, as well as non-clinical representation from the Ministry of Health and the Cancer Control Agency.
The group:
• worked on confirming the terms of reference and representation
• discussed the big challenges facing imaging services including workforce (not just medical), technology, managing demand and appropriate referrals
• considered standards and guidelines (I'm sure use will be made of the documents that the College has already produced. We will make sure they are available.)
I will keep you updated regarding the NRCAG’s activities as things progress.
In December 2019, the Cancer Control Agency began operation under the leadership of Dr Diana Sarfati. The Clinical Cancer Council has now been established: Dr Claire Hardie is representing radiation oncology and Dr James Entwistle is representing radiology.
The final version of the Cancer Action Plan1 has been released. It remains broad in scope, focusing on equity, prevention and improved care overall. I wait optimistically to see what progress is made in 2020.
The annual recruitment round for College registrars in New Zealand (radiology and radiation oncology) opens on 1 April. This is not an April Fool’s joke. Last year saw a lower
number of applications for radiology. And we often see a disappointing number of applications for radiation oncology. Please encourage any promising house officers to apply, as we know radiology and radiation oncology are exciting careers, particularly for the tech-savvy. The expansion of AI will bring many exciting changes and we need enthusiastic young doctors.
The 2020 ASM for New Zealand is being held in Wellington at the Intercontinental from 7–9 August. I understand the program is nearly complete and will be ready to post online soon. I hope to see lots of members there. The ASM is always a good time to connect with other members and brush up on clinical knowledge.
The College is currently seeking people to fill some training roles in New Zealand, including a Training Network Director (radiation oncology) and a Network Training Director (radiology). Please contact nzbranch@ranzcr.org.nz or (04) 472 6475 for more information.
References
A core component of the College’s advocacy work relating to the 2020 NZ election will be to engage with members regarding the Faculties’ needs and then target the main political parties in order to seek commitments.
It is opportune to reflect on the College’s prior advocacy work and assess what the Government has delivered since the last election.
• The College asked for a review of the Health Practitioners Competence Assurance Act to ensure that equivalent professional standards and registration requirements are applied to telehealth and overseas practitioners.
Despite strong advocacy from the College, the HPCAA was amended without the inclusion of registration for overseas practitioners of telehealth. However, the College’s arguments attracted sufficient attention for the Minister of Health to press for an alternative solution. Recent discussion with the Ministry and the Medical Council of New Zealand indicate the likely implementation of an alternative to ensure that overseas medical practitioners that deliver care to New Zealand patients are registered.
• The College asked for political support for the national roll-out of the bowel cancer screening program.
Steady progress has been made towards this goal and the program will be fully rolled out across all District Health Boards (DHBs) by 2021.
• The College asked for investment in radiology departments, including both infrastructure and workforce,
to allow for the increased demand for imaging as a result of the bowel cancer screening program.
Progress has been made—a National Radiology Collaborative Advocacy Group has been created (based on RANZCR’s advice) with significant national representation and budget to investigate and develop solutions for a range of issues affecting imaging services in New Zealand. Dialogue has also continued with Ministry and Health Workforce regarding the recruitment and retention of clinical radiologists and how to expand the training program to meet the needs of the health system.
• The College asked for a review of the funding model for radiation oncology, to ensure it reflects modern best practice.
The creation of the Cancer Control Agency and purchasing of 12 linacs can be considered progress. Additionally, The Cancer Action Plan (final version released February 2020) states: “The Ministry and wider health sector will prioritise workforce, technology and treatment capacity for radiation oncology. We will review and update the National Radiation Oncology Plan 2017–2021 to ensure radiation oncology services are future proofed and sustainable.”
• The College asked for the development and implementation of a ‘Career in Radiation Oncology’ project to raise awareness of the specialty and attract more trainees.
This has not been achieved but engagement is ongoing with Health Workforce and the Ministry regarding investments in radiation oncologist training. Recent information received from Health Workforce indicates more investment in radiation oncology training is likely.
• The College asked for the establishment of at least six postspecialist radiation oncologist fellowship positions in New Zealand to support retention of new graduates.
There has been no movement regarding this goal, however discussions are ongoing.
Although the College’s specific goals haven’t necessarily been achieved over the last two years, there is progress and the current government has invested significant resources including:
• The 2018 Budget injected $750 million into health for capital projects—the biggest investment in health for a decade
• The Wellbeing Budget of 2019 included a rollout of the Bowel Screening Program to five more DHBs, and an additional $4.6 billion to the DHBs
• The Health and Disability Review led by Heather Simpson was announced in 2018. The final report is due in March 2020 and is expected to have significant implications for future planning.
The Branch’s committees will soon start to prioritise election asks for 2020. We welcome your input into the process. Please contact Megan Purves, Branch Manager, on nzbranch@ranzcr.org.nz if you have questions or issues you feel should be raised with NZ’s political leaders.
Before taking out Life or Income Protection insurance, you will naturally want to know how the cover compares to other products available. It can be difficult obtaining objective costeffective advice in relation to Life insurance.
In addition, most online comparison tools only compare price and there isn’t much about product features, let alone claims service.
One of the key points of confusion can centre around the difference between ’underwritten’ cover, which is assessed upfront, versus products that are not fully underwritten, where the assessment is made at the time of claim.
NobleOak provides fully underwritten insurance cover. This means that we ask a number of health, occupation and lifestyle questions upfront and sometimes require medical tests and details of your medical records, to allow us to properly tailor your cover. The costs associated with these requests are usually covered by NobleOak. This process does take slightly longer than cover that is not underwritten but results in far greater certainty about the risks we’re taking to insure you, and importantly, greater certainty for you at claim time when you may be going through a difficult time.
Competing covers that are not underwritten and assessed when you apply for cover, usually contain automatic exclusion clauses which apply to pre-existing medical conditions. In short, this means that any medical condition for which you are either currently being treated, or for which you have ever been treated by a doctor in the past, will be excluded from your
policy. Death caused by any of these conditions may result in a claim being declined.
Some insurance companies will exclude all pre-existing conditions from coverage, even though you may not have had treatment over the past 20 years. This is what’s known as a total preexisting exclusion clause (PEC).
These types of policies (that are not underwritten) often result in the Life insurance company performing a more detailed review at the time of a claim arising, and this process will nearly always delay payment of the claim.
Find out more about NobleOak’s comprehensive Life insurance and to unlock the RANZCR member offer, visit www.nobleoak.com.au/ranzcr or call our Life insurance agents on 1300 108 490 and mention ‘RANZCR’.
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, neurologists, cardiologists, neurosurgeons, researchers and medical physicists wanting to gain a better understanding of MRI.
25-26 July 2020
*T&C’s apply, consider the PDS. AFSL 247302 ABN 85 087 648 708 COURSE
Pullman Hotel Adelaide 16 Hindmarsh Square Adelaide, South Australia
For more information and to view the full program visit www.ncevents.com.au/events
In late July last year, the board of the 45-strong partnership-led Perth Radiological Clinic entered into a buy-in agreement with private equity firm Allegro to sell a 37 stake in their business. This was no little deal for the privately-owned radiological practice which has been doctor-owned and led for almost all its 71 years in business. PRC chair Dr Martin Blake is proud of a deal that he and his partners believe will bring security to PRC but also offers an exciting new model for doctor-owned practices to do business.
“We wanted to keep our partnership model but we also saw the benefit of being able to access the long-term benefits of capital by introducing new investment partners without diluting earnings and providing retiring partners an ability to unlock the value they had created without having to sell the whole business”
“Allegro worked with PRC for two years in 2011-12 while they undertook the restructure of the I-MED group and had representatives sitting on our board, so they clearly saw the attraction to our
doctor-based business model and our leadership team,” Martin said. Allegro has assembled a consortium of institutional investors comprising First State Super and the Accident Compensation Corporation of New Zealand who are large scale superannuation investors with long-term horizons and which opens a network of investment opportunities for PRC.
The investment is bespoke, in that the investment partner has interests aligned directly with the partnership and the business. There have also been 35 of the 45 doctor partners who have reinvested part of their capital back into Allegro’s investment vehicle.
“We have kept to the doctor partnership model and increased the market value of the company. There is now an easy path for retiring partners to extract some of the value they have created in their lifetime of being with the business without having to sell the farm.” “We continue to offer our associates the opportunity of partnership and have brought on two new partners this January. The partnership pathway
The information provided in this article is intended to stimulate general discussion, it does not necessarily represent the views of the College.
continues to be a means of wealth creation and an opportunity which we think attracts the best radiology talent available that the corporates can’t match”
“The investment partner along with the existing partners will get progressively diluted as more partners come into the business, so there will be a natural tendency for the investment partner to want to maintain their stake as doctors retire.”
“This has given us a retirement pathway for our doctors to leave in a way that doesn’t mean the remaining partners have to take on debt to pay out a retiring partner – it’s an area that can cause grief for a lot of businesses, and can cause some partnerships to stagnate.”
“We wanted to create an investment model that allowed private practices to stay in the hands of doctors and stay majority controlled. We have spoken to a number of the larger privately owned partnerships interstate and in New Zealand during this process, who have been similarly approached to
list or trade sale to unlock value, but we explained that we had a different model that can retain substantial doctor ownership and they have been attracted to what we’re doing.”
“The companies on the stock exchange have to have a growth story and generally this is by acquisition. We didn’t want to compete in that space and thought there had to be another way.”
“We have hosted a couple of radiology businesses over the past six months so they can see how our model actually works and it may be that in the future we end up building an investment network with these groups but that may not come to fruition and it’s certainly not our primary aim. Our prime focus is to see PRC doctors benefit from the Allegro investment with future clinical developments alongside sound business development.”
It is significant that 35 of the 45 doctor partners are reinvesting some of their proceeds into the Allegro investment entity. The partners see this as a means to diversify their investment while buffering the private PRC business from hungry listed companies.
“We don’t believe radiologists should think they need to sell out. With our model, businesses can retain majority doctor ownership and if they want to be part of our network we both can share our knowledge and systems for mutual gain. We are very happy with where we are going and will be delighted to share details with any interested groups”.
Martin.blake@perthradclinic.com.au
Allegro Statement:
“This investment has been designed to maintain the best elements of the doctor- and patient-centric service models blended with business expertise delivered through Allegro’s operating framework to enable the business to continue to attract and retain the best and most talented radiologists into the partnership.
Together, Allegro and PRC are looking to build a long-term sustainable and renewable investment model that could reshape not only investment into other doctor partnerships but other professional service businesses as well.” This is an abridged and reworded version of an article that appeared in Medical Forum Sept 19 produced with permission.
www.medicalhub.com.au/having-a-
Dr Martin Blake Chairman Perth Radiological Clinic"We wanted to create an investment model that allowed private practices to stay in the hands of doctors and stay majority controlled."
The Obstetrics and Gynaecology Special Interest Group (OGSIG) is the newest special interest group within RANZCR, officially ratified by the Faculty of Clinical Radiology in July last year.
I am honoured to serve as the inaugural Chair. The other members of the Executive are Dr Virginia Saxton (Victoria), Dr Lynne Brothers (Tasmania), Dr Rachael McEwing (Christchurch, NZ) and Dr Ekaterina Alibrahim (Victoria).
OGSIG has been formed to establish a network of RANZCR members who are interested in O&G imaging, and will provide ongoing support and expansion of this network. OGSIG will help promote best practice for the performance and reporting of O&G imaging in Australia and New Zealand. It will work closely with the Faculty of Clinical Radiology and other RANZCR committees. It will also assist with training of registrars and fellows and will have ongoing input into the curriculum and examinations. It will liaise with local and international organisations
such as The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australasian Society for Ultrasound in Medicine (ASUM) to ensure ongoing high standards and current policies. The Executive of OGSIG are planning to have annual meetings to help members keep up to date. This year, there was a planned OGSIG session embedded within the ARGANZ meeting in Brisbane which as you all know was unfortunately cancelled. There was going be a meeting of OGSIG members immediately prior to this session. We plan to hold this meeting at this year's ASM in Melbourne instead. Please come along to meet the Executive, and to have your say in what direction you would like OGSIG to take.
I would like to thank the Executive of the Abdominal Radiology Group Australia and New Zealand (ARGANZ), especially Dr Kirsten Gormly, who have been so supportive in allowing us to collaborate in this fashion.
We go beyond simply meeting training requirements:
l Maximum allowable course based live and library cases for ANZ credentialing.
l RANZCR accredited for 117.5/67 CPD points (Level A/Recertification).
l Officially sponsored and endorsed by GE Healthcare for more than10 years.
l Live scanning at second highest global recruiting site in SCOT-HEART study.
l Unrivalled venues - Now at Zest, Point Piper, Sydney.
2020 COURSE DATES:
5 Day Level A Course: 21st - 25th May 2020
3 Day Level A Course: 23rd - 25th May 2020
For more information and online registration log on to: www.aicct.com.au or contact us at: info@aicct.com.au
Looking to the future, we hope there will be an annual meeting to help members keep up to date in the fast-changing world of O&G imaging. At present, the meeting will be on Friday 26 March 2021. The content will be practical, in order to help radiologists report O&G at a high level on a day-to-day basis. We hope that there will be plenty to interest both the generalist and sub-specialist radiologists, and will aim to have talks which include ultrasound and MRI, in both gynaecology and obstetrics. We will provide more information as we confirm speakers, but please put this date in your diary.
In the meantime, please feel free to contact me if you have any queries regarding O&G imaging.
Dr Emmeline Lee emmeline@westernultrasound.com.au
A variety of research awards and grants are available in 2020 to support research projects and foster a culture of research at the College.
RANZCR research grants provide financial support for Fellows, Educational Affiliates and student members in clinical radiology and radiation oncology to conduct research. Grants are awarded for sums between AU$5,000 and AU$30,000.
Applications close 9 June 2020
This AU$1,500 prize recognises a clinical radiology trainee or junior Fellow who is the first author of a paper accepted for publication by JMIRO or another Medline Indexed peer-reviewed journal.
This AU$1,500 prize is awarded to a trainee who has written an exceptional trainee research requirement manuscript.
This AU$25,000 grant supports Fellows up to five years post-Fellowship and trainees post-Phase 2 exams to carry out significant research projects.
This is a 12 month position for Fellows up to two years post-Fellowship or trainees post-Phase 2 exams that provides clinical research opportunities at the Mount Vernon Cancer Centre in the United Kingdom.
This AU$2,000 prize will be awarded in the case of high-quality research in Indigenous Health in radiation oncology that is published in a peer-reviewed journal.
This AU$2,000 prize will be awarded in the case of high-quality research in Quality Improvement in radiation oncology that is published in a peer-reviewed journal.
Applications close 6 April 2020
