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Volume 17 No 2 | March 2021

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

PRACTISING CLINICAL MEDICINE UNDER A MASK AND AT A DISTANCE Utilising Available Technologies, Developing New Ones

Also Featured in this edition

Te Aho o Te Kahu:

The State of Cancer in New Zealand 2020

College Fellows Honoured

Life as a Clinical Radiologist in Rural and Regional Settings

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Editor’s Pick 5 7

A Message from the President

Cancer Australia Advises the Formation of a National Lung Cancer Screening Program

College Actions on the Australian Medical Council’s Accreditation Report

RANZCR2021: It’s Time to Reconnect

A Message from the CEO

8 10 14 17

Te Aho o Te Kahu: The State of Cancer in New Zealand 2020

Practising Clinical Medicine Under a Mask and at a Distance College Fellows Honoured Life as a Clinical Radiologist in Rural and Regional Settings: What’s the Reality?

Targeting Cancer: Raising Awareness and Reaffirming Commitments to Patients

What are your thoughts?

30 33 35 40

Congratulations to Dr Scott Carruthers: FRO Indigenous Health Prize

TAR: Hard Work Continues ‘Behind the Scenes’ From the Faculty of Clinical Radiology Clinical Radiology Trainee Matters

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

45 47 49 50

Impressive Results in a Difficult Year Radiation Oncology Trainee Matters Scoping Out the Future for IR and INR MBA and MCNZ Changes to CPD

53 55 57 58

From the Faculty of Radiation Oncology

New Zealand Branch News

Have Your Circumstances Changed since July 2020? Great Savings and Rewards for Members Australian Branch News

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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Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editor Lindy Baker

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

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Introduction

A Message from the President Switching Focus to Avoid Medical Workforce Myopia Dr Lance Lawler

In the tumult of the last year, it would be understandable for anyone to have overlooked the significance of Prof Brendan Murphy's move in July from the highly-visible, advisory post of Australia's chief medical officer (CMO) to his near-invisible and decidedly un-advisory role as secretary of the Australian Department of Health. As the first medical doctor to hold the top administrative job in Australia's healthcare system since 1983, he brings to the post a rare familiarity with the everyday realities of our medical workforce and trainees. His new job also puts him in the unusual position of implementing the new national medical workforce strategy he helped to scope and steer as chair of the Medical Workforce Reform Advisory Committee (MWRAC) and adviser to the previous departmental secretary. At the time of writing, we have yet to see the finalised strategy, as endorsed by Australia's health ministers, but we have a decent sketch of what it is trying to achieve. This is a major update of the government policies underpinning investment in the country's medical workforce—the first such strategic review for 15 years—and it affects every one of us. In presenting the ‘scoping framework’ for the new strategy in 2019, Prof Murphy intimated that the medical milestones and technologies of the last century had helped to lengthen our lives. But with rising life expectancies

we have become an ageing population poorly served by a health system best suited to managing acute illness in early and midlife, not the ‘multiple, long-term’ chronic conditions common to later life. Murphy saw a partial solution in a shift in planning priorities from specialist to general medicine. ‘Access to an expert in a single condition is welcome, but may not meet [the patient's] needs if that expert cannot advise on how the recommended interventions affect their other conditions,’ he wrote. A close reading of the scoping framework MWRAC produced in 2019 reveals what the committee sees as its highest priorities in health reform, at least in terms of what stakeholders were telling Murphy and the strength of supporting evidence. The ‘big three’ issues, unsurprisingly, relate to distribution, supply and continuity of care. They are (i) inequality of access to health care in rural areas; (ii) ‘supplierinduced demand’ due to oversupply in certain specialties (the examples given are in cardiology and gastroenterology); and (iii) fragmentation of care resulting from a trend towards more specialisation. The proposed solutions raised by MWRAC were many. They included various measures to develop a ‘generalist mindset’ among medical students and young doctors, a review of entry requirements for training programs and ‘how they encourage subspecialisation,’ and

the establishment of a joint planning commission to determine medical school and specialist college training numbers. The raft of suggestions recently won broad support from the AMA and the Australian College of Rural and Remote Medicine (ACRRM). In particular, the ACRRM has welcomed recognition of the ‘need to address growing overspecialisation and workforce over-supply in many specialist areas.’ Suffice to say the new workforce strategy represents a ‘shot across the bow’ of the medical colleges, including the College, and a sharp reminder that we do not have absolute authority over specialist pathways. There are many powerful stakeholders in this debate and we would ignore the arguments of the generalists at our peril. The medical workforce ecosystem— medical schools, specialist colleges, training organisations and regulators— shares the same environment. An individual focus by our College or any other stakeholder on maintaining professional standards among its graduates and Fellows, while vital, is on its own, a failure to see the bigger picture. We must lift our eyes up, join the debate on what society wants of us and, as Prof Murphy put it, ‘respond to changes and needs in the wider system.’

Volume 17 No 2 I March 2021

“We look after each other.” At I-MED Radiology, we have a vision: to be the most respected and trusted medical imaging specialists in the world. And at the heart of that vision is our commitment to treating our patients and work colleagues alike with compassion. If you are interested in working in a welcoming environment, with people who support you in your career, who respect individuality and diversity, then come and talk to us. You’ll be sure of a warm welcome.

Contact our careers team T: +61 2 8274 1080, E: careers@i-med.com.au www.i-med.com.au/careers

Introduction

A Message from the CEO Change in an Uncertain World Mark Nevin, CEO

Our two specialties have been vanguards of changing how modern medicine is investigated, analysed and treated. Looking back over the past twenty years, our members have been among the first specialties to go digital, and they have embedded medical imaging, interventional procedures and radiation therapy into countless patient pathways. The coming decade will no doubt bring further changes resulting from the ingenuity of clinical radiology and radiation oncology. The College’s purpose is to drive best practice in our two specialties through leadership, education and advocacy. The College’s work has a major impact on our members’ medical careers: whether as a trainee, Education Affiliate or Fellow. We have come a long way in terms of member engagement: providing opportunities for you to get involved or input to our work through consultations. The next stage of our evolution as a College should focus on continuous improvement, learning from recent experience and must involve a targeted and more sophisticated approach to managing change. 2020 imposed significant changes upon us: a pandemic, travel restrictions and suspension of once ‘normal’ activities. The College had to respond fast with clinical guidance, reprioritising key projects and undertaking major operational changes to progress work

virtually through our committees. One of the biggest challenges we had was to transform the delivery of our examinations in an uncertain and constantly changing environment. We owe an enormous debt of gratitude for the members who volunteered their time to support our COVID response and particularly the radiation oncology and clinical radiology examinations. I’ve been reflecting on how the College managed change through 2020. Although there were many successes, I am determined to improve how we support members, volunteers and our staff through periods of change, particularly with timely and tailored communications. Looking at the major areas of work for 2021, most if not all involve significant and complex change: • New platforms for exams and managing likely travel restrictions • Implementing the Training and Assessment Reforms • Interventional Radiology • Digital health • Action Plan for Māori, Aboriginal and Torres Strait Islander Health • Rural and regional workforce • Changes to IMG Assessment and Upskilling • Meeting other designated AMC conditions • Theranostics • Lung cancer screening • Revalidation/Recertification and • A virtual option for our ASM.

Doubtless we will have further unexpected work and associated change to manage that come from decisions of governments and regulators. All of these areas will require forward planning, considered messaging, and member and stakeholder engagement to successfully prepare for and embed the change. As CEO, I am focused on upskilling staff working on these critical projects and working with the Board to ensure they are properly resourced. As ever, teamwork will be critical to success. College office bearers also have a key role in oversight and communicating the vision of the future state. Clinical radiology and radiation oncology will continue to evolve and revolutionise medicine. The world will not return to normal in 2021. We need to accept that change is a constant and the College is here to lead and support you through that.

Volume 17 No 2 I March 2021

Features

Te Aho o Te Kahu: The State of Cancer in New Zealand 2020 He Pūrongo Mate Pukupuku o Aotearoa 2020 The State of Cancer in New Zealand 2020

Te Aho o Te Kahu (Te Aho/Cancer Control Agency) has released its first report providing an overall picture of cancer in New Zealand. The State of Cancer in New Zealand 2020 highlights inequities and ways to improve cancer treatment for all New Zealanders affected by cancer. The report also highlights information about the vulnerable state of New Zealand’s cancer workforce. The College has, for several years, advocated for better workforce planning within radiation oncology and clinical radiology (encompassing diagnostic and interventional radiology) in New Zealand. We know that there are doctor shortages across the country and the problem will only worsen with our growing and ageing population. The College’s 2020 Election advocacy (www.ranzcr.com/our-work/advocacy) focused, in part, on workforce issues including training and retention. Addressing these issues will form the foundation of our advocacy efforts in New Zealand in the coming year. The State of Cancer in New Zealand 2020 highlights the significant workforce issues across all professions involved in cancer care. According to the Medical Council of New Zealand (www.mcnz.org.nz), there are currently 69 radiation oncologists with practising certificates and 615 diagnostic and interventional radiologists. The following graph demonstrates the need to increase training numbers due to the ageing of the overall workforce:

Inside News

Figure 3.1: Age breakdown of a range of specialist professions involved providing cancer in Aotearoa, 2019/20 Figure 3.1:in breakdown of a care range State ofAge cancer C.4 Workforce age of specialist professions involved in providing cancer care in Aotearoa, 2019/20 Radiation oncologists Medical oncologists Haematologists Cancer nurses Radiation therapists Diagnostic & interventional radiologists General surgeons General practitioners* 0

20–39 years

40–59 years

50 60 Percent

100

60 years and over

*General practitioners with vocational registration in general practice Source: Health Workforce directorate, Ministry of Health

The changing nature of cancer care also presents challenges to the sustainability of the cancer workforce. People are living longer and have greater expectations around the level of care they should receive, by default the demands on the professionals working in the area are increasing. Incidence ofand Cancer There are substantial in New Zealandtechnological changes, and the complexity of treatment is increasing. Each district health board (DHB) has responded to this increased pressure to different degrees and in Each year 25,000 are different ways, whichKiwis has led to diagnosed different models of care being developed around the country.

with cancer and 9,000 die—Māori Onetwice example sustainability are as of likely to die from cancerPsychosocial support needs to be available to all concerns is in theThe radiation as non-Māori. State of Cancer in people affected by cancer and therapy workforce. The New Zealand 2020 includes a detailedextended beyond treatment – especially for workforce is small, working section on the incidence of cancer in patients. Again and again, I see people across 10 public and private New Zealand. The most commonly returning, looking for some counselling as they cancer centres. There are a diagnosed cancers in New Zealand are experience adjustment difficulties post low number of graduates each treatment. … People tend to struggle with adjusting breast, prostate year andlung, high vacancy andand colorectal:

“

”

to life post treatment and on treatment … The turnover rates, which place current psychosocial funding in DHBs needs to be the workforce in a vulnerable built on … to include the entire pathway, extended position. In a recent study to include people who do not have high and (Taylor and Oetzel 2020), only complex needs but who are struggling to adjust to 20 percent of workforce survey their situation. participants planned to stay Health practitioner in their current career until they retired, with 35 percent expecting to change careers at some stage. The reasons for change included seeking a new challenge, better work conditions, more flexibility and career progression. The remaining 45 percent of survey participants were unsure of their plans for the future. There are multiple initiatives currently underway to address sustainability concerns; one example is the Voluntary Bonding Scheme run by the Ministry of Health. The scheme aims to incentivise newly qualified health professionals to work in eligible specialty areas that are hard to staff and

Features

Figure 1.1: Incidence rates for the 10 most commonly diagnosed cancers 1.1: Incidence rates for the 10 most diagnosed cancers in Aotearoa, in Figure Aotearoa, Māori and non-Māori, age-commonly and sex-standardised, 2008–2017 Māori and non-Māori, age- and sex-standardised, 2008–2017 State of cancer Fig 1.1 Breast Lung Prostate Colorectal Leukaemia Kidney Pancreas Head/Neck Melanoma Non-Hodgkin lymphoma 0

5 10 15 20 25 30 35 40 45 Age- and sex-standardised incidence rate per 100,000 Māori

Non-Māori

Incidence trends over time New Zealand has made gains in survival rates with 66 per cent of cancer patients Cancer incidence in Aotearoa has changed considerably over the past 20 years. surviving at least five years. However, Cancer Bothhigh-income Māori andmortality non-Māori have experienced other countries have madea gradual reduction in the incidence of lung cancer since 1996 (driven largely by reduced to each tobacco), butshown Māoriinrates remain substantially Approximately 9,000 New Zealanders die exposure from cancer year. As figure 1.18, the cancers bigger gains which suggest additional higherthe than non-Māori rates. causing most deaths are lung (around 1,780 deaths/year), colorectal (1,200 deaths/year), breast effort is needed to ensure New (670 deaths/year) and prostate (700 deaths/year) cancers. Zealanders receive the possible Figure 1.2: Lung Fig cancer incidence Aotearoa, 1996–2017 State of cancer 1.2:best Lung cancerinincidence care. The following graph shares thedifferencesMale Figure 1.18 also highlights substantial ethnic in mortality across most cancers, and Female research has shown that Māori are twice likely to die Agefromand cancer as non-Māori (Robsonrate et al Te Aho’s mortality data, including the Age- and sex-standardised incidence rate as (per 100,000) sex-standardised incidence (per 100,000) 60 These inequities in cancer-related mortality have 60 2010). increased over time (Teng et al 2016). For equity gap: more 50 details, see 2: Inequities in cancer.

Prostate

Māori

Non-Māori

2017

2014

2011

2008

2005

1996

2017

1999

1996

Pancreas

2014

2011

Stomach 2008

10 Colorectal 2005

2002

Lung Breast

2002

1999

Figure 1.18: Age- and sex-standardised cancer-related 40 of 40 mortality 2007–2017 State cancer Fig 1.14

“The State of Cancer in New Zealand 2020 highlights inequities and ways to improve cancer treatment for all New Zealanders affected by cancer. The report also highlights information about the vulnerable state of New Zealand’s cancer workforce.”

Trend

Leukaemia Eye/Brain CNS* Non-Hodgkin’s lymphoma Melanoma 0

10 15 20 25 30 Age-standardised mortality rate per 100,000

Māori Non-Māori * CNS = central nervous system

He Pūrongo Mate Pukupuku o Aotearoa 2020 | The State of Cancer in New Zealand 2020

Protect your health, access our wellbeing resources www.ranzcr.com/fellows/general/your-wellbeing

Volume 17 No 2 I March 2021 20

Features

Practising Clinical Medicine Under a Mask and at a Distance Utilising Available Technologies, Developing New Ones The demands of the pandemic have fast-tracked the uptake of digital health and the development of new technologies, or simply new ways of utilising existing technologies. The integration of digital health into our healthcare systems needs to go beyond the ‘emergency fix’ and be set against the long durée of its implementation in a complex system with the accompanying set of puzzles regarding access, security, privacy, workflow integration. It remains to be seen which technological innovations will outlive the pandemic and whether, for instance, populations will still be as willing to relinquish as large a degree of privacy as they have been during the crisis. Whether e-prescriptions are here to stay, whether wearables can continue to be adapted and repurposed for diagnosis as well as tracking. Whether telehealth is reimbursed at parity. What to do about an app that is manufactured for collection of health data by a company that falls outside the regulatory sphere that encompasses healthcare providers themselves.

The pandemic has not miraculously delivered a perfectly formed digital health system, however the exigencies of providing care ‘under a mask and at a distance’ have meant that data have been shared across the globe, as seen in the collaborative work of Dr Yuranga Weerakkody, and carers have come to be involved in consultations despite geographical distance as highlighted by Dr Sid Baxi.

What has been your experience practising your profession during the pandemic?

The necessary social distance of a clinical consultation during COVID-19 has been offset by the time and effort saved for patients in getting to appointments, the reduction in exposure to the risk of COVID-related illness for clinicians and medical staff, greater access to more complete health metrics provided by wearables and apps. There has been increased adoption of lifestyle and wellbeing apps in 2020, perhaps leading to ‘more prevention, less cure’ in a future where their use is commonplace.

We have had patients cancel and delay treatment, trying to balance up the relative seriousness of their tumour versus the risk of COVID-related illness.

We spoke to Dr Sid Baxi, Genesis Cancer Care, about his experience as a radiation oncologist in the past year.

Whether a deep learning based model to detect and classify COVID-19 cases from X-ray images can be used in remote places in countries affected by COVID-19 to overcome a shortage of radiologists.1

Dr Sid Baxi

Inside News

During the pandemic we have had to tackle a number of unique challenges not faced by us in the past. We have had to tackle patient fears of coming for treatment and patient fears of contracting the virus in high-risk hospital environments.

We have had to keep our staff safe and consider their safety with patients coming in and out of hospital from various regions and states. Having been part of a practice on the border, the cross-border issues and the closure and opening of borders ad hoc and quickly has resulted in us needing to be nimble and working out how to get our patients access to care when they lived across the border. Practising clinical medicine under a mask and at a distance has been challenging, practising it over the phone and via video consultations has been challenging.

Reference 1. Ozturk, Tulin et al. “Automated detection of COVID-19 cases using deep neural networks with X-ray images.” Computers in biology and medicine vol. 121 (2020): 103792. doi:10.1016/j. compbiomed.2020.103792

Features

What has been most difficult? Two aspects have been most difficult for me.

Have there been any unexpected upsides?

Number one—trying to get patients across border closures in a timely fashion when medical care was needed and only available across the border has been a great source of stress for the patients and our clinic.

I think there have been a number of upsides including understanding in what aspects of health care we can use telehealth and video consultations so that patients don’t have to drive, park, wait for quick consults that can be done quite safely over the phone.

Trying to practise clinical medicine where you needed the patient in the room but were unable to get that option available at the peak of the pandemic was significantly challenging, when examination holds so much in the clinical assessment of a patient.

It has expedited the government’s roll-out of digital strategies which has been just brilliant. This includes item numbers for video consultations and telephone consultations and the use of e-prescription technologies and e-referral technologies.

“A patient now does not have to take a day off just to visit the doctor and can be called upon during their lunchbreaks and after work to have a consultation by phone. It’s also allowed patients’ carers and families to be more involved in the consultation, if we do a three-way Zoom consultation for example, regardless of their geographical location.”

Volume 17 No 2 I March 2021

Features

What are the specific challenges of practising near a state border? I think the two significant challenges were: the communications piece of aligning the states on either side of the border, their regulations versus the hospital and the clinic’s policies; and messaging that to the patient in a timely and effective fashion when such changes happened, very quickly and often on the weekend.

Is there a particular story/ experience that you encountered during the pandemic that stays with you? I have had an experience, not a pleasant one, that does stay with me. During a sudden lockdown, we had an ambulance vehicle turned away at the border and told to return to its point of origin. At which point it had to be redirected to the nearest health centre that could look after the patient which was much further away and it certainly wasn’t a patientcentred outcome. This was, unfortunately, the didactic application of policy without context and had to be followed in a black and white manner as we were working out how to grapple with the nuances of state border jurisdictions not aligning all the time nor being nimble and contextual in their approaches.

Inside News

What would you do differently in a similar public health crisis in the future? The one thing I would do is make actionable changes in how we operate in a more contextual manner, rather than too rapidly and impulsively, as I think we approached the problem early in the pandemic, March 2020, with an extreme reaction that was not needed nor warranted at that time. Having been through it now, there are grades of responses and we’re better off, we’re better positioned now to respond to any levels of emergency, depending on the crisis level.

What would your message be now—to clinicians, to patients? To clinicians, I would say we have proven that our strategies, everything from social distancing to hygiene, masks and so on, have been very effective at keeping Australians, and Australians in the healthcare setting, safe. And so we need to trust those measures. To patients, it is absolutely key to not delay your care out of fear of a possible COVID-related infection exposure as the problems we face with our patients in the cancer care setting are much more serious than the lower risk of COVIDrelated exposure and infection, as our data over the last twelve months have shown, relative to other countries.

“To patients, it is absolutely key to not delay your care out of fear of a possible COVID-related infection exposure as the problems we face with our patients in the cancer care setting are much more serious than the lower risk of COVID related exposure and infection.”

Features

New Technologies to Distinguish COVID-19 from Other Lung Diseases

Do you have a story to recount where technology has succeeded, or been problematic, in the delivery of care during a public health crisis? We’d love to hear it: editor@ranzcr.edu.au

Our congratulations go to FRANZCR Dr Yuranga Weerakkody for the successful development of a COVID-19 imaging educational app awarded runner up “best new radiology software” for 2020 by Auntminnie.europe. Together with Prof Kay-Geert Hermann, Professor of Radiology, Charité Medical School, Berlin and Dr Fabio Macori MD, Radiologist Ospedale Santo Spirito, Rome, Dr Weerakkody helped design the app as a multicentre collaborative effort between Western Australia, Germany and Italy during the initial COVID-19 outbreak in Europe in early 2020. The app drew on the programming expertise of the noted BerlinCaseViewer team and clinical radiology experience from the three radiologists and some of their clinical and technical support staff. It was designed as a question-andanswer case-based interactive teaching tool with links to important radiology journal publications embedded up to the level initial release (April 2020). These cases are presented as easily scrollable stacks with annotations as the user progresses through a case. Data from a large number of COVID-19 positive cases in Italy, which was an epicentre at the time, were generously made available by lung radiologist Dr Macori. These were then selected and mixed with several mimic cases to help imaging professionals and relevant frontline clinicians realise the differences and similarities with certain overlap of non-COVID-19 conditions on imaging. The app can be accessed from BerlinCaseViewer.de or any app store. *www.berlincaseviewer.de/covid-19-onct-scans/

Dr Yuranga Weerakkody

@BerlinCaseViewr @Dryuranga Dr Yuranga Weerakkody @bonerad

Prof Kay-Geert Hermann

@fabiomacori Dr Fabio Macori

“One of the challenges that the pandemic has posed and still poses is to distinguish the COVID-19 pneumonia from other lung diseases. Besides the PCR test, the Fleischner Society therefore recommends the use of CT imaging, especially if the patient’s condition deteriorates. Certain patterns distinguish COVID-19 from other inflammatory and non-inflammatory lung diseases on CT.* Provided, of course, that one recognizes the specific phenomena.” (BerlinCaseViewer blog)

Volume 17 No 2 I March 2021

Features

College Fellows Honoured 2021 Australia and New Zealand Honours We would like to congratulate the members of the College who have had their work formally recognised in the 2021 Australia Day and New Zealand New Year’s Honours lists.

The New Zealand Order of Merit was instituted in 1996 and is awarded to those “who in any field of endeavour, have rendered meritorious service to the Crown and the nation or who have become distinguished by their eminence, talents, contributions, or other merits.” The New Zealand honours system is a way to say thanks and well done to those who have served and those who have achieved. Such recognition is consistent with the egalitarian character of New Zealand society and enlivens and enriches it.

Inside News

Dr Jann Medlicott Dr Jann Medlicott was appointed as a member of the New Zealand Order of Merit for her services to philanthropy, the arts, and radiology. Dr Medlicott became a Fellow of the College in 1984 and worked as a radiologist until her retirement in 2011. She was Clinical Director of Tauranga Hospital Radiology Department from 1988 to 1995 and co-founded private radiology practices in 1988 and 1998. Dr Medlicott was the Chairperson of the New Zealand branch from 1995 to 1997. During this time, she established a branch office in Wellington, successfully campaigned for the College to change its name to incorporate New Zealand, and introduced procedures to formally assess overseas-trained radiologists for the New Zealand Medical Council. Due to her outstanding contributions to the College as the New Zealand branch Chairperson, as the Secretary between 1997 and 1998, and her multiple roles on other College committees, Dr Medlicott was made a Life Member of the College in 2006. It is an excellent achievement to have this work, alongside her sponsorship of the arts nationally and with the Acorn Foundation, formally recognised in the New Zealand New Year Honours.

Australian Honours and Awards recognise the outstanding service and contributions of Australians. The Honours and Awards system is nominationbased, therefore providing the people of Australia with an opportunity to recognise those whose efforts make our communities and our nation a better place. In announcing the Australia Day Honours list, the Governor-General said “the individuals we celebrate today come from all parts of our great nation and have served the community in almost every way conceivable. They’re diverse and unique but there are some common characteristics, including selflessness, commitment and dedication… The sum of these contributions speaks to our nation’s greatest strength—its people.” Two of the College’s members received awards in the Australia Day 2021 Honours list: Associate Professor Michael Penniment and Dr Ronald Meikle.

Features

Thank you for your exceptional contributions to the professions, making a real difference to the lives of patients.

A/Prof Michael Penniment A/Prof Penniment was recognised for significant service to medicine and radiation oncology. Those who have had the opportunity to work with A/Prof Penniment can attest to his commitment to the field as a clinician, researcher and advocate for radiation oncology in rural areas. A/Prof Penniment is the Director of Radiation Oncology at the Royal Adelaide Hospital (RAH), where alongside his clinical work at metropolitan hospitals in South Australia he is also responsible for radiation oncology treatment in rural South Australia, western New South Wales and the Northern Territory. His experience in rural settings has led to the establishment of the Alan Walker Cancer Centre in Darwin, which has significantly increased the utilisation of radiation oncology treatment in the Northern Territory, including in the Indigenous population. A/Prof Penniment has also conducted multiple research projects with the aim of improving oncology service delivery in rural and Indigenous populations, and has established a team to create culturally specific information packages for Indigenous cancer patients. He is active in advocating for Indigenous patients to have equivalent cancer outcomes to the rest of the population.

Outside of Australia, A/Prof Penniment has been successful in receiving international development funding to provide project planning advice and basic training to assist with the creation of a radiotherapy facility at the Mandara Hospital in Bali.

hospitals to benefit from this technology. Between 1986 and 1990 Dr Meikle developed the Box Hill Radiological Centre, a collaboration between the community and Box Hill Hospital, to provide imaging, pathology and radiotherapy.

A/Prof Penniment has made outstanding contributions to the College through his roles on multiple committees and the Faculty of Radiation Oncology Council, his active involvement in education and training as Branch Education Officer for both Tasmania and South Australia, and as a Training Network Director. As an active member of the Particle Therapy Working Group, he assisted the College with developing a national coordinated strategy plan for particle therapy facilities. He has been a Fellow of the College since 1995.

Dr Meikle has made outstanding contributions to radiology not just as a clinician, but also in his roles at the Australian Diagnostic Imaging Association, which he helped form, and as Co-Chair of the Vascular Clinical Committee of the Medicare Benefits Schedule Review Taskforce. The College awarded Dr Meikle Life Membership in 2014, for his unusually significant contribution to the field of clinical radiology.

Dr Ronald Meikle Dr Meikle was recognised for service to medicine, particularly radiology. Dr Meikle has been a Fellow of the College since 1984. After emigrating to Australia in 1972, Dr Meikle worked at the Royal Melbourne Hospital where he pushed for the installation of CT imaging. Following his time at the Royal Melbourne Hospital Dr Meikle installed the first body scanner in Australia in his practice, and patients would be transported from major teaching

Volume 17 No 2 I March 2021

What’s in Issue 1? Medical Imaging Review Article: Radiology in the era of value-based healthcare: A multi-society expert statement from the ACR, CAR, ESR, IS3R, RANZCR and RSNA Corresponding author: N/A Background: The value-based healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology’s central role; this may have future negative consequences for resource allocation. Methods, findings and interpretation: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia and New Zealand, describes the place of radiology in VBH models and the healthcare value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.

Medical Imaging Pictorial Essay: Imaging of temporomandibular disorder and its mimics Corresponding author: Andy Whyte, 16 Village Close, Mount Martha, Vic. 3934, Australia. Temporomandibular disorders are common, especially in young to middleaged women, and most settle with supportive treatment. MRI is the accepted reference standard for the evaluation of the temporomandibular joint and is indicated when significant internal derangement is suspected, in those who do not respond to conservative management and when the diagnosis is no doubt. Multiple pathological processes involving the temporal bone, upper pharynx and neck can mimic temporomandibular disorder secondary to anatomical proximity and referred pain related to shared sensory innervation.

Radiation Oncology Original Article: Adjuvant radiotherapy for endometrial cancer with cervical stromal involvement: A patterns of practice survey in Australia and New Zealand Corresponding author:Carminia Lapuz, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia. Introduction: The purpose of this study is to describe the patterns of practice in Australia and New Zealand for post-operative radiotherapy in endometrial cancer with cervical stromal involvement. Methods: A ten-item survey including five clinical case scenarios in endometrial cancer with cervical stromal invasion was emailed to Royal Australian and New Zealand College of Radiologists (RANZCR) radiation oncologists in 2018. Responses were analysed to determine relative frequency distributions and preferred adjuvant treatment modalities for the clinical case scenarios. Results: A total of 65 respondents initiated the survey with 27 respondents treating more than 11 endometrial cancer cases annually. Only 31 respondents answered all five clinical case scenarios. Preferred adjuvant radiotherapy modalities varied for the Stage II cases between vault brachytherapy (VB), pelvic external beam radiotherapy (EBRT) or a combination. For the stage IIIA and IIIC1 cases, the majority recommended pelvic EBRT with or without VB boost (79% and 77%), and of these, most combined with chemotherapy (61% and 88%). For 4 of the 5 case scenarios, when pelvic EBRT was offered, most recommended a VB boost. Conclusion: This patterns of practice survey suggests variability in adjuvant radiotherapy recommendations in endometrial cancer with cervical involvement, particularly in cases where there is lack of randomised data and discrepancies in consensus guidelines.

Radiation Oncology Original Article: Pretreatment CT and 18F-FDG PET-based radiomic model predicting pathological complete response and loco-regional control following neoadjuvant chemoradiation in oesophageal cancer Corresponding author: Jessica M Frakes, Department of Radiation Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida 33612, USA. Introduction: To develop a radiomic-based model to predict pathological complete response (pCR) and outcome following neoadjuvant chemoradiotherapy (NACRT) in oesophageal cancer. Methods: We analysed 68 patients with oesophageal cancer treated with NACRT followed by esophagectomy, who had staging 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and computed tomography (CT) scans performed at our institution. An in-house data-characterization algorithm was used to extract 3D-radiomic features from the segmented primary disease. Prediction models were constructed and internally validated. Composite feature, Fc = α * FPET + (1 – α) * FCT, 0 ≤ α ≤ 1, was constructed for each corresponding CT and PET feature. Loco-regional control (LRC), recurrencefree survival (RFS), metastasis-free survival (MFS) and overall survival (OS) were estimated by Kaplan–Meier analysis, and compared using log-rank test. Results: Median follow-up was 59 months. pCR was achieved in 34 (50%) patients. Five-year RFS, LRC, MFS and OS were 67.1%, 88.5%, 75.6% and 57.6%, respectively. Tumour Regression Grade (TRG) 0–1 indicative of complete response or minimal residual disease was significantly associated with improved 5-year LRC [93.7% vs 71.8%; P = 0.020; HR 0.19, 95% CI 0.04–0.85]. Four separate pCR predictive models were built for CT alone, PET alone, CT+PET and composite. CT, PET and CT+PET models had AUC 0.73 ± 0.08, 0.66 ± 0.08 and 0.77 ± 0.07, respectively. The composite model resulted in an improvement of pCR predicting power with AUC 0.87 ± 0.06. Stratifying patients with a low versus high radiomic score showed clinically relevant improvement in 5-year LRC favouring low-score group (91.1% vs. 80%, 95% CI 0.09–1.77, P = 0.2). Conclusion: The composite CT/PET radiomics model was highly predictive of pCR following NACRT. Validation in larger data sets is warranted to determine whether the model can predict clinical outcomes.

Access your College journal online If you are a member of the Royal Australian and New Zealand College of Radiologists, access JMIRO free online. - Go to www.ranzcr.edu.au - Log in using your College username and password = FREE access to all JMIRO current and digitised backfile content from volume 1, 1957!

Features

Life as A Clinical Radiologist in Rural and Regional Settings: What’s the Reality? An Interview with Dr Stephen Currin, I-MED Radiology Network, Coffs Harbour a good relationship with your referrers provides a sense of purpose and job satisfaction. Work/life balance is easy to achieve and especially beneficial to those of us with young families.

What are the limitations? Challenges?

What are the upsides to practising outside of metropolitan centres? I have found that practising radiology in a regional centre has been rewarding and stimulating. The interesting mix of work and pathology allows you to consolidate radiology foundations from registrar training without being pigeonholed into a specific subspecialty too early in your career. It allows you to develop interests in areas you may not have otherwise considered, allowing you to become a well-rounded general radiologist. That being said, there is also sufficient subspecialty work, if your skills are complementary to those of your colleagues, allowing each other to trade more challenging subspecialty cases. Having recently completed two separate North American fellowships in abdominal imaging and MSK, I have found the volume of subspecialty work in these respective areas more than anticipated. There is a strong link between the public and private sectors in our region, allowing a synergistic relationship that is able to provide a comprehensive service to the community. The sense of belonging to the local community and developing

Regional centre radiology can be limited by the resources available and affordability of certain equipment, which may affect patient access to those services. Likewise, the limited resources available to other specialties may naturally influence the way you practise and report. Also, patients often have a more complex journey to diagnosis, given the large catchment area a regional or rural practice may

have. As a radiologist, if you have particular subspecialty interest, there is the potential to deskill, however this can easily be mitigated with proactive planning such as attending conferences, workshops or organising professional sabbaticals/fellowships.

How have either the pros or the cons shifted during the pandemic? Our regional practice was relatively sheltered from the disruptions posed by the pandemic and remained busy. As with the rest of the country we did experience disruptions to supply chains for items such as barium (not that I’m complaining).

What does the future look like for 2021? And beyond?

“The interesting mix of work and pathology allows you to consolidate radiology foundations from registrar training without being pigeonholed into a specific subspecialty too early in your career. It allows you to develop interests in areas you may not have otherwise considered, allowing you to become a well-rounded general radiologist.”

I hope that much like the exodus of many other professionals from metropolitan areas to regional centres, there may be a similar move for many radiologists in search of a lifestyle change. Regional and rural radiology is an excellent option, especially for recent graduates, as our regional centres grow and become more resourced. Until then, teleradiology and virtual radiology will continue to support regional and rural centres.

What needs to change for patients? Keeping up with demand and controlling patient wait lists are a challenge while regional and rural centres continue to grow. Medical imaging is often central to a patient’s medical journey from diagnosis to their management and follow-up and a vital medical service that needs to be prioritised as such in the regional and rural setting. continued over... Volume 17 No 2 I March 2021

NEW ZEALAND ASM AUGUST 6 - 8 2 021

NZ Annual Scientific Meeting Intercontinental Hotel, Wellington 6 - 8 August, 2021

HYBRID MEETING The RANZCR NZ ASM 2021 is a hybrid meeting, with on-site and virtual registration options.

I N T E R N AT I O N A L I N V I T E D S P E A K E R S

Radiology

Radiation Oncology

Professor Laurie A. Loevner

Associate Professor Corinne Doll

Chief, Division of Neuroradiology Professor of Radiology, Neurosurgery, Otorhinolaryngology: Head & Neck Surgery and Ophthalmology University of Pennsylvania Health System Philadelphia, USA

Tom Baker Cancer Center President of Canadian Association of Radiation Oncology Calgary, Canada

Associate Professor Bruno Giuffrè University of Sydney at Northern Clinical School Radiology Department, Royal North Shore Hospital Sydney, Australia

Key Dates: 8 April 2021 - Abstract Submission Opens 27 June 2021 - Abstract Submission Closes 8 April 2021 - Registration Opens 10 July 2021 - Earlybird Registration Closes

www.ranzcr2021.co.nz

Features

“Regional and rural radiology is an excellent option, especially for recent graduates, as our regional centres grow and become more resourced. Until then, teleradiology and virtual radiology will continue to support regional and rural centres.”

What needs to change for clinicians? Similarly, prioritising the aforementioned waitlists would alleviate time to diagnosis for our fellow clinicians. Also, a paucity of locally-based radiologists in the rural setting may pose a challenge for clinicians seeking a radiologist’s expert opinion in a multidisciplinary setting, where patient management is often decided.

What training pathways are available in your region? Our local base hospital is affiliated with a larger tertiary teaching hospital and medical school that allows registrars and medical students to intermittently rotate through the local department and offsite private clinic. As far as I am aware, a more permanent regional or rural radiology training post is not currently available in our region.1. Succession planning in areas of need is vitally important and such a position could improve the current workforce imbalance.

What would you say to someone considering leaving the city behind? Don’t hesitate. You won’t regret it!

Is there a particular story of regional practice that has struck you? There seems to be a new one every day. However, a humbling part of working in a regional practice has been receiving letters of thanks and appreciation from patients and clinicians for what is simply doing my job. Knowing how much time and thoughtfulness goes into something like that makes me feel grateful for the opportunity to contribute to our community. 1. Editor's update: There are currently two training positions at Coffs Harbour Health Campus, one funded under the Australian Government’s Specialist Training Program (STP). The STP funded position can support up to four trainees per year on three-month rotations; a requirement of the Australian Government funding. For more information on current training opportunities in Coffs Harbour, please contact STP@ranzcr.edu.au

“However, a humbling part of working in a regional practice has been receiving letters of thanks and appreciation from patients and clinicians for what is simply doing my job. Knowing how much time and thoughtfulness goes into something like that makes me feel grateful for the opportunity to contribute to our community. ”

Volume 17 No 2 I March 2021

Advocacy

Raising Awareness and Reaffirming Commitments to Patients would add more pressure and stress. It’s amazing that you can get the same kind of care that you get here as you would get in a bigger city.” Radiation oncologist, Dr Madhavi Chilkuri, emphasised the importance of highly skilled and dedicated multidisciplinary teams working together to provide holistic care.

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 marked its 21st anniversary this year, raises worldwide awareness and aims to increase access to life-saving cancer treatment. To mark World Cancer Day, radiation oncologists from across Australia and New Zealand united to stand up, speak out and take action to raise awareness of radiation therapy as a safe and effective cancer treatment. Embracing the theme of ‘I Am and I Will’, members of the Targeting Cancer Management Committee shared their personal commitments to help cancer patients in a series of videos. The videos explain the symptoms and treatment options for a number of cancer types including lung cancer, skin cancer, bowel cancer, head and neck cancer, and prostate cancer. The Targeting Cancer campaign also collaborated with cancer agencies and other stakeholders including the Australian Society for Medical Imaging and Radiation Therapy (ASMIRT), the Clinical Oncology Society of Australia

Inside News

(COSA), Lung Foundation New Zealand and the Melanoma and Skin Cancer Advocacy Network (MSCAN) 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. You can watch and share the video series on the Targeting Cancer website, www.targeting.cancer.com

Watch the beginning of cancer patient Lex’s treatment journey Targeting Cancer recently produced a video to share the inspiring story of Queenslander, Lex, who has begun his radiation therapy treatment journey after Lex was diagnosed with a 4cm cancerous tumour at the back of his tongue. Lex and his wife Tricia live in Mackay but stayed in Townsville—a four-hour drive away from their home—for seven weeks while Lex underwent radiation therapy. The couple were relieved that they didn’t have to travel to a bigger city to access treatment. Tricia said, “I’m actually glad that we’re not in a major city because I think that

Dr Chilkuri said, “These patients require a very coordinated, multidisciplinary approach to their treatment and to have timely access to all the specialists and all the health workers that might make a difference in their outcomes, not only for cure but also for function.”

“I’m actually glad that we’re not in a major city because I think that would add more pressure and stress. It’s amazing that you can get the same kind of care that you get here as you would get in a bigger city.” Lex and Tricia expressed their heartfelt thanks to all involved in their care and felt fully supported by their treatment team. Tricia said, “The wonderful thing along the way is the people that have come into our path—the people that have supported us every step of the way and guided us. I think that’s what is getting us through.

Advocacy

“These patients require a very coordinated, multidisciplinary approach to their treatment and to have timely access to all the specialists and all the health workers that might make a difference in their outcomes, not only for cure but also for function.”

“We’ve seen a lot of people but…we can see that they’re all part of the big picture and together they’re helping us. It’s like one. That’s been amazing.” You can watch Lex and Tricia’s story on the Targeting Cancer website and Twitter and Facebook profiles.

Help us share your patients’ stories 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 to 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 emailing faculty@ranzcr.edu.au

Advances in Treatment for New Zealand Breast Cancer Patients The COVID-19 experience has provided significant challenges for cancer patients and the oncology staff offering care and treatment. Radiation oncology teams have made special provisions for patients during the pandemic so that they can continue to receive essential radiation therapy services. The circumstances have also provided an environment to consider new approaches to providing high-quality radiation therapy in an evidence-based setting. It was timely then that new research from the UK found that breast cancer patients can achieve the same results from fewer radiation therapy treatments. Women

in New Zealand with breast cancer are frequently treated with 15 radiation therapy treatments over a three week period after breast-conserving surgery. Research from the FAST-Forward trial published in The Lancet in April 2020 showed that at five years post treatment, five treatments over one week provides the same outcomes for patients as 15 treatments over three weeks. Fewer treatments are less time-consuming for patients and sometimes there is a lower chance of adverse side effects. Radiation oncologists in New Zealand with a special interest in breast cancer treatment have agreed that this

data provides evidence to support offering the one week schedule to early breast cancer patients who fit the trial’s eligibility criteria and where their radiation therapy plan adheres to the planning constraints dictated in the trial. The New Zealand Ministry of Health’s Radiation Oncology Working Group (ROWG) has also supported the implementation of this treatment schedule in New Zealand and recommends that this shorter treatment be offered to suitable women provided they are fully informed that longer term follow up data is still awaited.

Volume 17 No 2 I March 2021

LIVE

VIRTUAL

ON-DEMAND

71st Hybrid Annual Scientific Meeting • 16 - 19 Sept 2021

REGISTRATION NOW OPEN ELYSIUM: DIAGNOSTICS AND THERAPEUTICS (NOW AND THE FUTURE) WITH AI

Official Presenting Partner of RANZCR2021

ranzcr2021.com

Education

InsideRadiology is an Australasian resource on clinical radiology tests, procedures, and interventions, providing up-to-date information to health consumers and health professionals and improving doctor-patient communication. www.insideradiology.com.au InsideRadiology is a conduit of communication between the College, health consumers, and health professionals; further promoting the role and value of clinical radiology and clinical radiologists in patient care.

Web activities Since the New Year we have had an increased number of visits to the site resulting in the highest volume of traffic in the last seven months. The Computed Tomography page attracted the largest number of visits so far this year with 558 followed by Gadolinium Contrast Medium and the MIBG Scan pages.

Computed Tomography

X-ray tubes rotate around the patient at high speed and up to 320 axial slices of the body can be obtained per rotation. This produces a large amount of data which is analysed using powerful computer algorithms to produce images which can be viewed in any anatomical plain or reconstructed into three dimensional rotating images. All body structures can be visualised and this can be enhanced with the use of intravenous iodinated contrast medium. The rapid acquisition of data from CT means that accurate images and information can be obtained without being degraded by patient movement, be it physiological (such as cardiac or respiratory) or unexpected (such as an uncooperative patient).

In honour of our most popular page for 2021 so far:

Visitor locations

Computed Tomography (CT) is a high-resolution technique using X-ray technology to generate images of any area of the body. Patients are placed on a moveable X-ray table which then enters the CT gantry. Depending on the equipment used, one or sometimes two

Trans-Tasman visitors account for 21 per cent of the total activity on the site, while 40 per cent of visitors are accessing the website from the US and ten per cent from the UK. The majority of our Trans-Tasman audience are accessing the site from large cities,

with eastern Australian capital cities responsible for more than 65 per cent of Australian and New Zealand visitors, however there is still a steady stream of visitors from regional and remote locations.

Supplementing your online resources InsideRadiology encourages its information partners, hospitals, and radiology practices to link directly to the InsideRadiology website so that staff, patients and referrers can access trusted information straight from their own website that can easily be printed into a fact sheet. InsideRadiology will continuously update the items as part of an ongoing review strategy so that radiology sites have up-to-date information for their patients without the extra administration. Please help us promote InsideRadiology by following us on Twitter and Facebook (@InsideRadiology) If you need further information please contact insideradiology@ranzcr.edu.au

InsideRadiology currently covers the following interventional procedures: o Angioplasty and Stent Insertion

o Pleural Aspiration

o Ascitic Tap

o Radiofrequency Ablation

o Biliary Drainage

o SAH Vasospasm Endovascular Treatment

o Bursal Injection

o Selective Internal Radiation Therapy [SIRT]: SIR-Spheres®

o Carotid Stenting

o Spinal Cord Embolisation (AVM/ DAVF)

o Carpal Tunnel Ultrasound and Injection

o Thyroid fine needle aspiration (FNA)

o Image Guided Cervical Nerve Root Sleeve Corticosteroid Injection

o Transarterial Chemoembolisation (TACE)

o Image Guided Liver Biopsy

o Uterine Fibroid Embolisation

o Image Guided Lumbar Epidural Corticosteroid Injection

o Varicose Vein Ablation

o Image guided lumbar nerve root sleeve injection

o Vascular Closure Devices

o Inferior Vena Cava Filters

o Venous Access

o Joint Injection

o Vertebroplasty

o Nephrostomy

Volume 17 No 2 I March 2021

Advocacy

Cancer Australia Advises the Formation of a National Lung Cancer Screening Program In August 2019, the Australian Minister for Health, The Hon. Greg Hunt MP, requested that Cancer Australia conduct an enquiry into the prospects, process and delivery of a national lung cancer screening program in Australia. Following from this work, Cancer Australia is formally advising the Australian Federal Government to create a national lung cancer screening program, saying it would save 12,000 lives over the next decade. In its Report on the Lung Cancer Screening Enquiry, Cancer Australia said based on the national and international evidence, a screening program using biennial low dose computed tomography (LDCT) in asymptomatic high-risk Australians could detect cancers in their early stages when treatment is most likely to be successful. Such a screening program would save lives, reduce lung cancer mortality in Australia by 20 per cent in the screened population, and improve the survival and quality of life of Australians affected by lung cancer1. The College is in the final stages of developing a position statement to assist with advocacy to governments to address key issues that may affect the successful design and implementation of a lung cancer screening program. The College is recommending governments in Australia and New Zealand: 1. Develop a national strategy for lung cancer screening to prioritise low-dose computed tomographic (LDCT) screening for specific atrisk populations. The College was pleased to see LDCT detailed as the recommended screening tool in Cancer Australia’s report. 2. Use a targeted risk screening approach by containing the patient population eligible for the screening program to individuals at high risk.

Inside News

3. Establish a national funding model to ensure equitable access to the lung cancer screening program. 4. Focus on national campaigns to prevent young people smoking and broader public health campaigns around smoking cessation among dependent smokers. 5. Ensure a strong national policy commitment to address the burden of lung diseases with focus on reducing occupational risk, ensuring equitable access to treatment and services, investing in research and tackling stigma. The College believes that the criteria underlying a national lung cancer screening program should: 1. Ensure there is evidence of improved mortality, morbidity or quality of life as a result of screening and that the benefits of screening outweigh any harm. 2. Facilitate the provision of timely, appropriate, high-quality and safe diagnostic assessment. 3. Ensure screening is targeted at individuals without overt signs and symptoms of the disease and as such can detect disease at an early stage.

4. Ensure equitable access for all in the target population in order to limit the loss of opportunity focusing on lifting barriers to vulnerable populations. 5. Encompass review as part of the Population Based Screening Framework requirements to ensure an evidence-based approach to screening and the continued inclusion of new evidence from emerging population studies. 6. Address the risk of stigmatisation to ensure full participation so that priority cohorts can realise the benefits offered by lung cancer prevention, control, and treatment. The College will continue to keep members updated as this important advocacy work continues. If you have any questions or comments, please direct them to professionalpractice@ranzcr.edu.au

References 1. Report on the Lung Cancer Screening Enquiry, www.ranzcr.com/documents/5265-report-on-the-lungcancer-screening-enquiry-by-cancer-australia/file

Features

College Actions on the Australian Medical Council’s Accreditation Report In September 2019, the Australian Medical Council (AMC) completed a reaccreditation assessment of the specialist medical program to the award of fellowship to RANZCR and the College’s continuing professional development programs. The final report can be accessed on the College website1. Although the College was found to have substantially met the accreditation standards there were a number of conditions and recommendations that still needed to be addressed. The College is required to resolve these during 2021 and 2022 and put in place the necessary actions. The AMC require progress reports at agreed intervals to demonstrate that the appropriate measures have been adopted.

Training and assessment at trainee and post Fellowship level is core College business, so the Board and Faculty Councils have tasked all committees concerned to address and resolve these issues where appropriate. Going forward, College committees will need to keep the conditions and recommendations of the AMC report at the forefront of their work and thinking. Working through the Standards, specific concerns that need to be addressed in summary are set out below. One of the major actions that has already been implemented from Standard 2 and parts of Standards 1 and 7, which addresses Aboriginal and Torres Strait and Māori engagement, is the formation of the Maori, Aboriginal and Torres Strait Executive Committee (MATEC), a high-level bi-national committee reporting directly to the

Board. The goal of MATEC is to support both clinical radiology and radiation oncology to deliver more equitable health outcomes for Aboriginal and Torres Strait Islanders and Māori people. MATEC has already convened and is working on strategies for the College to consider. The required policies are being reviewed with the first one—the Reconsideration, Review and Appeal of Decisions Policy (RRADP)—now implemented. It is important to note that the AMC has considered changes to College education and training programs as a result of the COVID-19 pandemic through a separate process for monitoring those changes. In the coming months members will receive updated information as the new initiatives and changes are rolled out.

Standard 1

relates to the conflict of interest policies and processes and engaging with jurisdictions and employers for consistent delivery of training programs as well as collaborating with the Aboriginal, Torres Strait Islander and Māori health sectors

Standard 2

is about developing and implementing programs aligning outcomes with the health needs of Aboriginal, Torres Strait and Māori peoples

Standard 3

needs to address the curriculum content, teaching, monitoring and evaluation of both training programs

Standard 4

relates to the access and delivery of training and teaching resources

Standard 5

needs to address assessments and examinations

Standard 6

is concerned with the College’s overarching framework and responsibilities for monitoring, evaluation and feedback across both training programs

Standard 7

needs to address selection guidelines, support Aboriginal, Torres Strait Islander and Maori trainees and develop clear pathways to address trainee concerns

Standard 8

is related to the support, training and professional development of supervisors along with reviewing accreditation training sites and rotational requirements

Standard 9

is met

Standard 10

relates to IMG processes and greater support for IMGs

References 1. RANZCR Accreditation Australian Medical Council Report, www.ranzcr.com/documents/5264ranzcr-accreditation-australianmedical-council-report-2020/file

Volume 17 No 2 I March 2021

Advertorial

The Human Drive: Using Technology to Support Cancer Care The ongoing COVID-19 pandemic is severely impacting the way clinical teams work around the world. Before actually “starting” my blog post, I want to use the space provided to me to underline that healthcare professionals are among the greatest heroes of our time. Being part of an organization that is working towards a world without fear of cancer, I have been truly inspired by the many creative adaptations that treatment centers have immediately put in place to make sure that the most vulnerable cancer patients can still receive treatment.

as a response, radiation oncologists and surgical oncologists in treatment centers across the globe took a close look at their patients and assessed— together—what the best individual solution for a non-surgical alternative could be. Frequently, radiotherapy and radiosurgery were these preferred alternatives.

2. Adopting telemedicine to reduce personal contact

In the middle of 2020, Varian had the opportunity to sponsor a series of online webinars that explicitly dealt with ensuring cancer care during these challenging times. In these webinars, some very insightful, creative, and wonderful examples were discussed. Based on these examples, I would like to highlight three core themes that have greatly contributed to overcoming some of the challenges brought along by this pandemic. First, and where appropriate, it was key to find alternative solutions to surgeries. Second, many healthcare facilities switched to remote solutions to limit potential patient exposure. Third, clinical teams from across specialties set up great methods to connect with each other and to share knowledge and best practices. I would like to briefly describe what this means in practice.

Another trend that caught on fast was the widespread adoption of telemedicine. This helps minimize patient travel to the cancer center without interrupting the treatment. This trend is extremely important, now and in the future, because it reduces the exposure of—often immunosuppressed—cancer patients to viruses. Throughout the pandemic, we have seen more and more hospitals and treatment centers switching to telephone and/or video consultations. What was a surprise to many is the fact that also the elderly patients are showing to be very open towards using mobile phone applications when it comes to managing their treatment schedule or their symptoms. This reduces the time spent in the healthcare facility to the actual treatment time, while patients are able to have conversations with their treating physicians remotely.

1. Providing alternatives to surgeries

3. Sharing knowledge and best practices

Surgical teams around the world have been faced with limited access to operating rooms and personal protective equipment. This means that all of a sudden, providing the conventional standard of care was not possible anymore. The risk of exposing patients to COVID-19 during surgery was just too high. We have learned that,

We have seen local, regional, national, and international networks emerge that aim to foster knowledge exchange. I had the chance to listen into a couple of network discussions, and it is just so motivating and inspiring to hear how healthcare professionals are openly sharing their challenges and successes when it comes to ensuring that cancer

patients are receiving their treatment. Some treatment centers even shared their schedules or organized safe transport options for their patients. What all three themes have in common is the fact that they would not be implemented if it were not for the dedicated people that drive them. This includes the healthcare providers just as it includes the patients. I am writing this blog post on behalf of Varian, a proud industry partner to many international non-profit initiatives that foster cooperation, collaboration, and innovation. We are committed to the supporting cities and regional centres around the world as they work to improve access to equitable, quality cancer care and help them to thrive in a world without the fear of cancer. Christopher A. Toth President, Oncology Systems Varian Medical Systems

Education

It’s Time to Reconnect

College ASM takes on a new look to keep delegates safe Following last year’s postponement of the College’s Annual Scientific Meeting, planning for the 2021 ASM to be held 16–19 September in Melbourne is well underway. The ASM is the College’s flagship event and with international borders unlikely to open until the end of the year, there is now no better time for members in clinical radiology and radiation oncology to reconnect at their own College event. It will be a new way forward in 2021, with a number of initiatives and program variations planned. These will be complemented by the core program and social elements that have seen the continued success of the ASM over the years. New features include the introduction of a creche facility to support working parents; a revision to a three-day program (Thursday to Saturday) followed by hands on workshops on the Sunday including exam preparations, FALCON workshops and equipment-based training, thanks to the support of our sponsors. While our goal is for the largest number of attendees at an ASM in recent years, we recognise that we are living in uncertain times and it would be remiss if we did not carefully consider the options available to ensure a safe, successful meeting for all participants. Our plan includes offering the ASM as a hybrid event, to provide delegates the opportunity to join in person at the Melbourne Convention Exhibition Centre or alternatively via the online virtual platform. This option is particularly of benefit for our rural and regional members who may not have the time to travel to Melbourne but more importantly combats the possibility of area lockdowns and the inability to participate in the ASM at the last minute.

“The ASM will be an event produced locally by representatives from clinical radiology and radiation oncology and will showcase the brightest minds with presentations from across the globe. It is our hope that you will join us in Melbourne and support the return of important events to the city, a return celebrated by a distinctive ‘buy local’ philosophy to make sure Melbourne’s businesses benefit thanks to RANZCR2021.”

Volume 17 No 2 I March 2021

Education

For those of you attending in person, on arriving at the Melbourne Convention Exhibition Centre, you can feel comfortable that the venue and organisers are ensuring a safe environment for all participants. This includes entry into the venue for ticket holders only with no public admission; a low touch registration process including self-printing name badge terminals; room capacity control measures to ensure no overcrowding; and individually packaged meals for tea breaks and lunches.

Delegate Check in Low Touch

Inside News

The ASM will be an event produced locally by representatives from clinical radiology and radiation oncology and will showcase the brightest minds with presentations from across the globe. It is our hope that you will join us in Melbourne and support the return of important events to the city, a return celebrated by a distinctive ‘buy local’ philosophy to make sure Melbourne’s businesses benefit thanks to RANZCR2021.

Registration is now open at www.ranzcr2021.com so now is your chance to support Victoria and reconnect with colleagues at your College ASM. We look forward to welcoming you to Melbourne.

Temperature Check

Education

RANZCR Workshops, Courses and Events 2021 RANZCR Webinar Series The Conferences and Events team ran a series of successful educational webinars in 2020 and we are excited to say they are here to stay for 2021. Further dates and topics will be released shortly.

2021 Series Tuesday 9 March

Artificial Intelligence: A Clinical Perspective

Monday 15 March FROGG Genitourinary Sessions for Radiation Oncology Trainees Dr Alison Tree Tuesday 16 March JMIRO: How to Be a Good Reviewer Wednesday 14 April MR Imaging in Sports Medicine Webinar On Demand If you miss any of the live sessions, you can watch them on demand via the College’s webcast library: webcast.ranzcr.com/Mediasite/Showcase/ If you would like to suggest a webinar topic, email us at events@ranzcr.edu.au

RANZCR/ACR Education Center Courses To be confirmed Due to current border closures we are unable to fly in our expert faculty from the US. We are working with ACR on alternative methods for 2021. We will communicate any updates as soon as we have them.

Radiation Oncology Trainee Phase 1 Course Online for 2021 The Phase 1 Course is designed for trainees within their first six months of training and to assist trainees as they approach their Phase 1 exams. This course will be run in an online format for 2021. Further information on how to register will be available shortly.

NZ Branch Annual Scientific Meeting 6–8 August 2021 InterContinental Hotel, Wellington For more information please visit our website: www.ranzcr2021.co.nz

RANZCR Annual Scientific Meeting 16-19 September 2021 Melbourne Convention and Exhibition Centre For more information please visit our website www.ranzcr2021.com If you have any questions relating to any College events, contact the Conferences and Events team at events@ranzcr.edu.au

Volume 17 No 2 I March 2021

Education

Congratulations to Dr Scott Carruthers Inaugural Recipient of the FRO Indigenous Health Prize Through a directorship with Northern Territory Radiation Oncology, Dr Carruthers has had an ongoing support role with cancer care in the Northern Territory since 2010. Below he writes about his experience of Indigenous Health in cancer care, and the publication that received the 2020 FRO Indigenous Health Prize. "Thank you to the College for encouraging research with this annual prize.

In 2020, the College launched the Faculty of Radiation Oncology (FRO) Indigenous Health Prize to promote research that increases awareness and understanding of Indigenous Health issues in cancer care. The prize is awarded in the event of high-quality research in Indigenous Health being published in a peer-reviewed journal. The inaugural recipient of the prize was Dr Scott Carruthers, for his research that was published in the Journal of Medical Imaging and Radiation Oncology (JMIRO) “Measuring (and narrowing) the gap: the experience with attendance of Indigenous cancer patients for Radiation Therapy in the Northern Territory.” Dr Carruthers is a radiation oncologist at the Royal Adelaide Hospital and Icon Cancer Centre. He completed his MBBS at the University of Adelaide and completed specialist oncology training in Adelaide, with postgraduate training in Melbourne and Edinburgh, United Kingdom. Dr Carruthers became a Fellow of the College in 1996.

Inside News

“The establishment of the centre was a joint effort with the Northern Territory and Commonwealth Governments, supported by the College, and has allowed local delivery of radiation therapy, thus avoiding interstate travel for many patients.” Since 2010, Northern Territory Radiation Oncology (NTRO), based in Darwin, has provided radiation oncology services for Northern Territory patients at Alan Walker Cancer Care Centre (AWCCC), Royal Darwin Hospital. The establishment of the centre was a joint effort with the Northern Territory and Commonwealth Governments, supported by the College, and has allowed local delivery of radiation therapy, thus avoiding interstate travel for many patients.

Within the Northern Territory demographics, a sizeable proportion of patients are classed as Indigenous, either from urban or regional/remote locations. When the clinical service commenced in 2010, it was clear that Indigenous patients were often at a disadvantage for cultural reasons, in addition to distance from home, in terms of receiving treatment. In 2011, the NTRO clinical team conducted a small initial analysis of attendance of Indigenous patients, and was published with Dr Hien Le, senior registrar as lead author. This analysis found no difference between Indigenous and non-Indigenous patients in their levels of engagement, but its more limited scope didn’t analyse for treatment interruptions or breaks. Despite finding no apparent difference, NTRO undertook measures to improve the support for Indigenous patients, such as Indigenous liaison officers, and education programs such as CEPO (Clinical Experience Program in Oncology) in 2012, providing teaching for rural and remote Aboriginal health practitioners (AHP) to enable them to deliver improved support for their cancer patients. The research published in JMIRO in 2019, “Measuring (and narrowing) the gap: the experience with attendance of Indigenous cancer patients for Radiation Therapy in the Northern Territory”, was largely due to the tireless effort of senior radiation therapist, Mary Pennefather, who prospectively collected the data. It is an analysis of five years of attendance, both pre-radiation therapy and during radiation therapy (RT), from the commencement of the service, including all referred Indigenous patients, numbering in excess of 400.

Education

“When the clinical service commenced in 2010, it was clear that Indigenous patients were often at a disadvantage for cultural reasons, in addition to distance from home, in terms of receiving treatment.”

This was compared to just over 400 nonIndigenous patients over the same fiveyear period, matched by including one in every four patients chronologically as their referral was received, with the finding of a significant difference in attendance for Indigenous patients, both prior to and during their radiation therapy course. Attendance during radiation therapy over the five years showed significant improvement over time for Indigenous patients from 70 per cent to 81 per cent, although pre-RT attendance did not improve over time. We found no significant difference in RT attendance between urban and regional/remote patients, although favouring slightly better attendance for urban Indigenous patients. The research has been an important step to understand the level of differences across the Northern Territory patient population, and to then allow strategies to improve further on inequities, including lobbying for new support initiatives. Mr Kar Giam, Executive Director of NTRO, has played the leading role in developing these programs.

Cancer Education at Batchelor Institute: Aboriginal Health Practitioners with Peter Nguyen, Radiation Oncology Registrar, and Giam Kar, NTRO director.

Examples of recent and ongoing programs include: 1. AHP Cancer Care Workshops, which are accredited as a Certificate IV program, with participants involved in a week of theory, including three days of clinical experience. Key stakeholders from the NT Cancer Care Network, Primary Care, NGOs and Aboriginal Health Organisations have been involved in the development of the program. This is supported by funding from the Northern Territory Public Health Network. 2. Cancer care education to final year AHPs at the Batchelor Institute, including clinical experience provided by NTRO at AWCCC. 3. Borroloola Aboriginal Cancer Navigation Project (2020 to 2022), funded by MacArthur River Mines Benefit Trust, which is a follow-up initiative from the AHP training program conducted by NTRO at AWCCC. Future research will aim to look at further trends over time and assess these hopefully successful interventions. The FRO Indigenous Health Prize money will certainly help to meet the costs of future statistical analysis." Dr Scott Carruther’s ResearchGate profile: www.researchgate.net/profile/ Scott_Carruthers

Are you involved in Indigenous Health research in cancer care? The FRO Indigenous Health Prize offers AU$2,000 for Indigenous Health research that has been published in a peer-reviewed journal. Applications for the 2021 prize are open until 12 April 2021.

For more information on this prize, as well as other research prizes and grants the College offers, visit the website: www.ranzcr.com/ college/grants-and-awards

“The research has been an important step to understand the level of differences across the Northern Territory patient population, and to then allow strategies to improve further on inequities, including lobbying for new support initiatives.”

Volume 17 No 2 I March 2021

Education

Advancing Knowledge: A New $20,000 Research Grant Opportunity for Radiation Oncologists The College and TROG Cancer Research regularly collaborate to promote world-class research involving radiation therapy to improve the quality of life of people affected by cancer. Together, they are pleased to announce the inaugural RANZCR-TROG Research Grant. This AU$20,000 grant will support a trainee or Fellow to undertake a TROG Category D project and can be used to supplement an existing salary from

an institution or for additional research project support such as research assistants and statistical support.

plays a significant role to the benefit of patients, the recipients themselves, and the wider oncology community.

A TROG Category D project is defined as “An investigator-initiated project or registry that involves data capture, data mining or secondary analysis”, and more information about this type of project can be found on the TROG website: www.trog.com.au

Applications close on Monday 30 August 2021. This opportunity has been made possible by the grant sponsor, AstraZeneca.

This grant is among a range that the College offers to promote the culture of radiation oncology research and to support our most able and committed early career researchers to carry out significant research projects. It is hoped that the recipients of this grant will go on to have careers in which research

To find out more and apply, email gaps@ranzcr.edu.au or visit the College website: www.ranzcr.com/college/grantsand-awards/research-awards-andgrants

2020 RANZCR Research Grant Recipients RANZCR Research Grants provide financial support for our members to conduct research. Grants are awarded for sums between AU$5,000 and AU$30,000. Congratulations to the recipients of the 2020 RANZCR Research Grants:

Clinical Radiology Dr Arian Lasocki (VIC), “MRI features correlating with IDH mutation status in young glioblastoma patients.” Prof Stacy Goergen (VIC), “Phenotyping the fetus with abnormal cavitation, enlargement or persistence of the ganglionic eminence: the importance of biometry, additional intracranial and extracranial findings in diagnostic specificity” Dr Helen Frazer (VIC), “Transforming Breast Cancer Screening with Artificial Intelligence (AI)” Prof Alan Coulthard (QLD), “Efficacy of single dose enoxaparin post elective neurointervention in prevention of thromboembolic events (EPPICS II)” Dr Sijing Feng (NZ), “Automated Pneumothorax Detection on Adult Erect Chest X Rays (CXR) with Convolutional Neural Network (CNN) Algorithms”

Radiation Oncology Dr Yu Yang Soon (Singapore), “A randomized Phase II trial of Osimertinib with or without stereotactic radiosurgery for EGFR mutated non-small cell lung cancer (NSCLC) with brain metastases (OUTRUN)”

2019 Exam Prize Recipients

Dr Michelle Or (NSW), “Chemoradiation resistance evolution in locally advanced rectal adenocarcinoma (LARC) delineated by single cell RNA sequencing”

The CE Eddy Prizes are awarded to the most successful candidates in the Part 1 Clinical Radiology and Phase 1 Radiation Oncology examinations:

Congratulations to the recipients of the 2019 exam prizes.

Dr Tracy Liu (Clinical Radiology) If you would like to apply for any of our research grants or awards, the College is now inviting applications for 2021. A variety of opportunities are available to support research projects and foster a culture of research at the College. Visit www.ranzcr. com/college/grants-and-awards/ research-awards-and-grants

Dr Matthew Knox (Radiation Oncology) The HR Sear Prize is for the most successful candidate in the Part 2 Clinical Radiology examinations: Dr Evyn Arnfield The MGF Donnan Prize is for the best candidate in Pathology at the Part 2 examinations in Clinical Radiology: Dr Grace Hennessy The Kaye Scott Prize is for the most outstanding performance in the Radiation Oncology examinations. This is only awarded in the case of exceptional trainee performance: Dr Sarah Bergamin

Inside News

Education

Training and Assessment Reform: Hard Work Continues ‘Behind the Scenes’ While we had hoped that 2021 would return some semblance of normal, we are still navigating through the challenges of COVID-19. Despite this, both Faculty Implementation Working Groups (IWGs) have continued their work with preparations toward implementation of the enhanced training program.

Stakeholder consultation We value the feedback received from members and external stakeholders on the enhanced training program. Over the past few months our IWGs have considered the concerns raised and, where possible, have recommended changes to address them. For example, in radiation oncology some members noted that it may be difficult to repeatedly assess all trainees on recruiting a patient to a clinical trial using the Communication Skills Assessment (CSA) tool. The Radiation Oncology IWG have proposed this become a learning activity. Improvements to the enhanced training programs of both specialties will be discussed by the necessary committees in the coming months and resulting outcomes will be communicated to the membership.

Training Program Handbooks There is a vast amount of information and a number of documents and policies pertaining to the program, some of which is found on different parts of the College website. One resource has now been created for each Faculty, a Training Program Handbook, to collate all key content. For each specialty, the primary purpose of the Handbook is to provide information and guidance for Fellows, trainees and staff in relation to completion of the Radiation Oncology

or Clinical Radiology Training Program. Guidance and instructions within the handbook will be consistent with associated College and Faculty policies. Some content must be retained in separate documents. Examples include policies, terms of reference of training-related committees and more specific information about how College representatives fulfil their roles as Directors of Training (DoTs), Clinical Supervisors (CSs), Examiners, Accreditors and so on. Short explanations will be featured in the Handbook, together with hyperlinks to the individual files. Training program details that are subject to regular change, such as the dates of upcoming examinations or courses, will be accessible on the website rather than included in the Handbook. A hyperlink to the webpage will be included in the relevant sections. We thank the Fellows involved in the Handbook review process for their tireless work.

Policy review Competency-based training has less emphasis on the time trainees are in accredited training positions and more focus of completion of learning and assessment to demonstrate competence. Therefore, many policies of the current training program need to be amended for the enhanced program. In some instances, policies need to be retired. Working through the Training Program Handbooks has also highlighted similarities of the two programs and the potential for crossFaculty policies. The Specialty Training Unit is currently undertaking this review while the Education and Training Committees are considering revised drafts as meetings occur in 2021.

Training e-Portfolio System The foundation of the training programs for monitoring trainee performance and progression will be the Training e-Portfolio System which will replace TIMs in 2022. The College's IT team has been building the system for the requirements of each program and continues to update elements as program elements of the program are refined and approved. Testing will commence shortly.

Workshops and webinars: Training and Assessment Reform The College holds several workshops each year for DoTs. In 2020, due to the COVID-19 pandemic, the College was unable to hold face-to-face DoT workshops. Instead, webinars were held to provide DoTs with training. The face-to-face workshops would have predominantly focused on the new training programs, providing necessary information on the training program, learning outcomes, work-based assessments, transition arrangements, ePortfolio system at the one full day event. Social distancing restrictions permitting, the College plans to resume some face-to-face DoT workshops in 2021 when permissible. Given the restrictions, the College is planning a range of face-to-face and online workshops and webinars that focus on the delivery of the Enhanced Training Program. We will send out information shortly on the schedule of workshops and webinars. Regular monthly resources, to be included in the DoT enews, are also being developed to further upskill DoTs for the Enhanced Training Program.

Volume 17 No 2 I March 2021

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Clinical Radiology

Our Focus in 2021 A Message from the Dean

Clin A/Prof Sanjay Jeganathan The past 12 months have presented many challenges for us all both personally and professionally, but as we are now settling into what could be described as a ‘COVID normal’ state, FCR Council is looking forward to progressing some important issues this year. At the beginning of each year FCR Council attends a planning day as an opportunity to review the breadth of work being undertaken across the Faculty. I am always amazed by the volume of work our member volunteers are engaged in and the consistently excellent quality outputs we achieve as a result of this work. It is a testament to the dedication and commitment of our member volunteers and I would like to take this opportunity to once again share my heartfelt thanks for your time and efforts. A foremost priority for the College in 2021 is the implementation of the Australian Medical Council accreditation requirements and the rollout of the training and assessment reforms. The College’s ongoing accreditation is reliant on meeting all the conditions and recommendations set out in the AMC report. The training and assessment reforms are the result of feedback from trainees and supervisors as well as the College’s desire to provide contemporary and relevant specialist training programs. This change is, in large part, a quality improvement initiative to ensure that our training program is an exemplar of current best practice in medical education.

There are also several important and emerging issues that Council has identified as strategic priorities for this year. As with much of clinical radiology these issues are multi-faceted and will require carefully considered solutions.

Wellbeing of members, trainees and IMGs As specialist doctors we understand the importance of providing high-quality care to our patients. In order to provide this standard of care, it is critical that we also prioritise caring for the health and wellbeing of ourselves and our colleagues. The College knows that issues relating to wellbeing, work-life balance and burnout are a real concern for our members—as they are for the medical profession in general—particularly considering the additional stresses that COVID-19 has placed on us all. The College has developed a suite of practical information and useful resources to support your health and wellbeing as well as signposts to where you can seek help, and how you can help a colleague. I encourage you all to look at the resources available on the College website and share these across your networks. The College takes the wellbeing of our members seriously and Council continues to discuss ways that we can support our members further in this space.

Ensuring rural and remote patients have access to high-quality radiology services There is currently an uneven distribution of clinical radiologists, with more needed in regional and rural areas of Australia. Access to high-quality medical imaging services is crucial to the delivery of effective health care in regional and rural communities. Uneven workforce distribution is not a problem unique to clinical radiology nor to Australia and New Zealand, but we need to do more to attract and retain doctors working in rural locations. Technological advances and the increased value that interventional radiology is bringing to patient care will mean that radiologists being present on site will only become more critical in future. The College is working on a range of measures to address workforce shortages in regional areas including growing training positions and opportunities for network rotations, akin to regional placements. We are also gaining insights from our workforce census to inform this work. There are no simple solutions, and this will continue to be a challenge that we need to work hard to address.

continued over...

Volume 17 No 2 I March 2021

Clinical Radiology

Upcoming Australian Federal election An Australian Federal election is imminent—the earliest time it can be called is August 2021 and the latest in May 2022. The College needs to be ready to advocate to government on behalf of our patients and members for improved access to clinical radiology services. To that end, Council has started working on election asks that we would like each political party to agree to during the election campaign and commit to actioning if elected. We are considering priority issues which are high level but achievable for the next government. We will share these priority asks with members once they are finalised in the coming months.

Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC) The College has formed a Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC). This committee reports directly to the Board and has the key goal of supporting clinical radiology and radiation oncology to deliver more equitable health outcomes for Aboriginal, Torres Strait Islander and Māori people. Council has received an update on the preliminary work of MATEC which has been focused on the development of an Indigenous Action Plan. It will be Council’s responsibility to embed cultural competency across the faculty and we are currently considering how these goals can be achieved. This is also mandated by the AMC.

Digital health Digital health was identified as a priority for FCR Council in 2020. Last year we published a white paper which articulates our priorities for digital health which are: standardised terminology; the establishment of an eReferral system; access to historic images; development of imaging guidelines; and the managed rollout of artificial intelligence (AI). We are very pleased with the progress of the first priority, standardised terminology, via our Radiology Referral Set proposal and the Digital Health Agency’s enthusiasm to work with us on this important project. That is just a snapshot of some of the major projects which will keep us busy again this year. I look forward to working with Council and the broader membership on these important issues. As always, you can keep up to date with the Faculty’s progress in our monthly eNews, on the College social media accounts and website.

lnsid1 eR01diology

Clinical Radiology Information for

HEALTH CONSUMERS & HEALTH PROFESSIONALS Raises awareness of medical imaging and the role of the clinical radiologist. Written by RANZCR Fellows and other Australian and New Zealand health professionals, edited by consumer and GP contributors. ✓ Information about clinical radiology tests and procedures in plain English ✓ Additional technical information for health professionals ✓ Approximately 100 information items with new items added regularly

Inside News

Clinical Radiology

Examinations in 2021 Chief Censor In Clinical Radiology

Dr Meredith Thomas

Many of you would be aware of the challenges the Specialty Training Unit (STU) encountered during 2020 due to COVID-19 related disruptions, indeed many of you volunteered your time and resources to develop and facilitate adapted training activities and enable training to continue and trainees to progress. Heartfelt thanks to all involved. Nowhere were these challenges more keenly felt than in the running of our examinations, and I would like to wholeheartedly thank our Chief of Examinations Dr Barry Soans for his commitment to ensuring that examinations proceeded. Additionally, I would thank the key Secretariat staff involved in the running of the examinations, particularly Shane Bryan, Manager of Examinations, Ben Mason, Project Officer, and Pamela Spoors, Head of Specialty Training, as well as the other members of the examination team. We had an unprecedented number of examination candidates in 2020 Series 2: 166 for Part 1 examinations; and 228 for Part 2 examinations. Thanks also go to the exam-sitting trainees and International Medical Graduates (IMGs), who managed to maintain an “exam-readiness” state for much of 2020, after Series 1 examinations were cancelled and Series 2 delayed. Thank you all for your patience and fortitude! Special mention to the SA trainees who additionally had to deal with last minute viva delays due to an unanticipated lockdown, eventually flying to Sydney en masse

several weeks later than anticipated to undertake their vivas at the Sydney Cliftons Centre. COVID-19 related travel restrictions required us to move both written and oral exams to local jurisdictions, and this brought with it significant challenges: sourcing adequate facilities; addressing IT challenges; and seeking the assistance of local Fellows and examiners. Particular thanks to the Lead Examiners and local Exam Champions who played a vital role in ensuring the exams ran smoothly. We recognise the IT challenges encountered at some of the examination sites and again apologise to the trainees and trainers who were adversely impacted. With the assistance of the Australian Council for Educational Research (ACER) we were able to take this into consideration when determining whether we had adequate information to assess trainee competence. Also, with the assistance of ACER, we have recently released the 2020 Series 2 Examination Report and will shortly be releasing comparative historical data. We hope that this provides useful and meaningful information on areas of strength and weakness that can inform trainee and IMG learning. Overall examinations results were better than in the past, for both written and oral examinations, and it is interesting to consider the reasons for this—despite the stresses of 2020 the additional six months of study likely benefitted the sitting cohort.

Overall pass rates were as follows: Part 1: AIT Paper 1 (essay format) 86% AIT Paper 2 (MCQ) 92% Anatomy Paper 1 (write short notes) 74% Anatomy Paper 2 (radiographic anatomy) 92% Part 2: e-Film Reading 68% Radiology MCQ 84% Pathology MCQ 91% Viva Neuro, Head and Neck 84% Viva Thoracic and Cardiovascular 85% Viva Abdomen 85% Viva Musculoskeletal 80% Viva Paediatrics 80% Viva Breast 80% Viva Obstetric and Gynaecology 70% Viva Pathology 79% The report provides additional information regarding systems results in the Radiology MCQ and the eFR, as well as jurisdictional results for the various components and IMG/trainee breakdown. While numbers in many jurisdictions are too small to draw conclusions from a single analysis, we hope that a longitudinal observation of results over time will provide valuable information to the various training sites and networks going forward. The 2021 examinations will likely be equally as challenging, given the ongoing and unpredictable travel and border restrictions in the various jurisdictions. continued over... Volume 17 No 2 I March 2021

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Clinical Radiology

We will continue to run the examinations as closely aligned to normal practice as possible, while complying with public safety requirements stipulated by government health authorities, as agreed by the College Board of Directors in 2020. A comprehensive examination plan is being developed based of the following objectives: • Providing two examination series, aligned to the usual timeframe (where possible) • Utilising the new examination platform Practique for all written examinations, with the capacity for proctoring, where appropriate • Developing alternative methods of delivery for the viva examinations, moving to digital cases in 2021 Series 2 as recommended at the recent AMC accreditation • Returning to the usual practice of two examiners for vivas

• Retaining the “OSCER” style timetabling of viva examinations • Returning to usual policy requirements around examinations sittings, for example the requirement to sit consecutive examinations and number of examination attempts • Delivering examinations in a cost and resource efficient manner. For Series 1, examinations will again be run in local jurisdictions, within their capabilities, with both local and central College support. It is anticipated that trainees will sit in their local jurisdictions, recognising that there may need to be movement of examiners to facilitate viva examinations, and that extraordinary circumstances may arise.

robust examination governance system as we transition to the new examination formats (Phase 1 in 2022, Phase 2 in 2023) as part of the Training and Assessment Reforms. I acknowledge the tremendous work done by the current members of the Clinical Radiology Examinations Review Panel, particularly those who are stepping down, and look forward to working with those of you who have volunteered to be on the new panels to negotiate the COVID-19 disruptions of 2021, and transition to the new examination format from 2022.

From 2021, the examinations will be supported by new examination panels, overseen by a committee of the Chairs of the various panels and the Chief Censor and Deputy Chief Censors. This is will provide a more

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Volume 17 No 2 I March 2021

Clinical Radiology

Clinical Radiology Trainee Matters first class healthcare during incredibly demanding conditions. A particular mention goes out to those of you who sat exams with all the delays and additional stresses involved.

Dr Sarah Robertson In a surprising turn of events, 2021 started just how 2020 left off. The recent Queensland and Western Australia lockdowns have reiterated just how unpredictable the COVID-19 situation remains and that we will feel the effects of the pandemic and its response for quite some time to come. I think we can all agree that last year was a difficult one. If nothing else, 2020 has shown us what we, as trainees, and more widely, what we, as a profession, can achieve. I would like to congratulate all trainees for continuing to provide

Inside News

This year I am immensely privileged to be part of a motivated and talented Clinical Radiology Trainee Committee (CRTC) with representatives from QLD (Tom Pearson and Daniel MacManus), NSW (Allister Howie and Amer Mitchelle), SA (Danielle Coupland), and NZ (Laura Hill). In true COVID fashion we were unable to have our usual face-toface handover and instead had to settle for video conference. The CRTC’s role is to advocate for trainees at the various College committees and working groups. Our purpose is to ensure trainees’ experiences and interests are incorporated in the College decision making process. Some of the key areas we will be focusing on in 2021 include: • Trainee advocacy and input regarding the delivery of Part 1 and Part 2 examinations • Continued feedback regarding the new curriculum and assessment format

• Integrated subspecialty training (e.g. nuclear medicine and interventional radiology) • Trainee after hours workload • Trainee engagement and communication on both College and CRTC level • Delivery of the trainee day program at the Melbourne 2021 ASM (hopefully). Dr Sarah Robertson Chair, Clinical Radiology Trainee Committee (CRTC) 2021

If you have any comments, questions, or feedback on any trainee-related issues or want any information on the CRTC please don’t hesitate to email us at clinicalradtc@gmail.com

Clinical Radiology

A Word from the Chief of Professional Practice

A/Prof Dinesh Varma

The Professional Practice Committee completed its second year in 2020, quite an unsettling year for all across the globe and especially those in the field of medicine. Despite the challenges posed by the COVID-19 pandemic, the Committee was able to meet frequently, embracing online meetings to ensure we continued with the work in front of us. The Committee met a total of five times last year and covered topics from the soon-to-be-released Range of Practice, to meeting with other parent bodies involved with the College’s various conjoint committees. One of the Committees key priorities for 2020 and indeed 2021, is ensuring the smooth transfer to the new Continuing Professional Development (CPD) program guided by the Medical Board of Australia (MBA) and the Medical Council of New Zealand (MCNZ). The program is due to commence in January of 2022 and the College is on track to have the program finalised and available for circulation well in advance of this date. Moving into the work of 2021, the Committee will first meet at the end of March to begin work on the key priorities of the year, underpinned by the College’s strategic commitment to clinical excellence.

CPD program The MBA and MCNZ have notified medical Colleges of the proposal to update the registration requirements for medical practitioners across Australia

and New Zealand. The College is working toward updating the current CPD program to align with the changes set forth by the governing bodies. These changes include a move from points to hours and from a triennium cycle to a yearly cycle. The College is well-placed to implement these changes in early 2022. The PPC continues to guide the choices that will affect members when completing their CPD, with the goal to make the program user friendly and valuable to your continued learning. If you have any questions regarding the changes, please email cpd@ranzcr.edu.au

Certification framework The Committee has recently started work on developing a certification framework which will guide the decisions around how new technologies or radiology procedures will be recognised both internally and externally. This framework will, along with the Range of Practice developed by the Committee last year, be a central document in recognising the basic through to advanced skills of radiologists and determining where further training is required.

which will provide a clear direction for members wishing to develop their skills in a specialty area. Working also with the Specialty Training Unit committees, such as the Clinical Radiology Education and Training Committee, the advanced training pathway will be developed to align with the enhanced curriculum to have cohesion across the College’s pre and post Fellowship training pathways. I would like to remind members that the 2019–2021 CPD triennium finishes this year. Due to COVID-19 exemptions provided by the MBA and MCNZ, there is no minimum requirement for 2020 or 2021, and a reduction in the minimum triennium points from 180 to 125. If you have not already done so, please enter the minimum 125 points online. Clinical radiology members must enter CPD points across three categories to be compliant. Any CPD questions can be sent through to cpd@ranzcr.edu.au In closing, I would like to wish all members a wonderful 2021 and I am hopeful this year will allow us greater normalcy than last year. Yours sincerely, A/Prof Dinesh Varma

Advanced training pathway

Chief of Professional Practice

Following on from the certification framework development, the PPC will work with the Interventional Radiology Committee (IRC) to develop an advanced training pathway for specialist interventional practice within radiology. This is an exciting piece of work,

Faculty of Clinical Radiology

Volume 17 No 2 I March 2021

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Radiation Oncology

A New Year in the Faculty of Radiation Oncology A Message from the Dean

Dr Keen Hun Tai

The 2020 radiation oncology examinations have been successfully delivered under difficult circumstances allowing many trainees to progress in the program and many others will be eligible to apply for Fellowship. In the period of the pandemic with much disruption to the norms, this is something that not all colleges have been able to achieve. Congratulations to all.

Faculty of Radiation Oncology Professional Practice This past year has certainly focused much attention on the Education and Training program. Similarly, there have been disruptions to and suspension of the Continuing Professional Development program during 2020. For the trainees who have been successful in the Phase 2 examinations and progressed to Fellowship, it is only the beginning of another part of the journey of life-long professional learning and development. The CanMEDS Framework forms the basis of the College’s Education and Training and Continuing Professional Development (CPD) program, to provide continuity of professional development from training to Fellowship. All Fellows are required to participate in CPD and the College CPD program has served us well. In the quest for continual improvement and in line with the regulatory changes imposed by the Medical Council of New Zealand (MCNZ) and Medical Board of Australia (MBA), the CPD program must evolve.

So too must the organisational structure that supports CPD, to ensure that the Post-Fellowship Practice Standards are contemporary and fit-for-purpose. CPD must ensure that as practising radiation oncologists we maintain our clinical skills and knowledge and at the same time continue to develop them to meet

changes for re-certification of medical practitioners. In Australia, we are currently awaiting final release of the CPD registration standard from the MBA, which we anticipate will be very soon. The College has been working hard to make the necessary changes to the CPD program and are working toward these changes commencing in 2022 for members.

“CPD must ensure that as practising radiation oncologists we maintain our clinical skills and knowledge and at the same time continue to develop them to meet the challenges of improving practice changes as expected by patients and the community.”

The Faculty of Radiation Oncology (FRO) has a number of standing committees with the Post-Fellowship Education Committee (PFEC) working with the College secretariat, currently well led by Dr Ziad Thotathil, charged with maintaining the CPD program. Past and present members of PFEC have worked hard to maintain the program to ensure it satisfies regulatory requirements. I would like to thank you on behalf of the Faculty. In 2017, FRO Council started discussions on the evolution of PFEC to the Professional Practice Committee (PPC) in response to increasing complexities and the vital importance of maintaining professional standards as well as continuing professional development. The chair of this committee was determined to be known as the Chief of Professional Practice. The committee is to be in place in 2022 in time to also ensure that the regulatory changes required by MCNZ and MBA are integrated into the CPD program.

the challenges of improving practice changes as expected by patients and the community. CPD must also use evidence-based guidelines informed by research and be delivered within the boundaries of our regulatory bodies. Indeed, MCNZ has already mandated

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Volume 17 No 2 I March 2021

Radiation Oncology

It is envisaged that the Chief of Professional Practice and the PPC will liaise and work with all the other FRO standing committees to ensure that together with our College staff, there is a continuum of training, education and professional development. This journey starts from being in the initial training program to becoming a radiation oncologist who has the right tools and opportunities to practise contemporary radiation therapy in a safe, evidencebased manner for the best interests of our patients. An expression of interest for the new office bearer position of Chief of Professional Practice will be sought in April 2021; and PPC member expressions of interest will be circulated following that. The Faculty of Radiation Oncology will appoint this new office bearer position. With the Chief of Professional Practice and the PPC becoming active in January 2022, PFEC will be dissolved in December 2021. Please keep an eye on the Faculty eNews and College website for further information.

Faculty of Radiation Oncology Mentoring Program Pilot Launch Mentoring has always been considered an important part of professional development. Trainees often have mentorship via their Directors of Training and Clinical Supervisors and indeed their peers in the training program. For their research requirements, trainees have access to research mentors within their networks.

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Fellows, particularly those who have recently become so, can also benefit from mentorship. In 2016, there was increasing recognition that there should be a formal program for this. PFEC developed a work plan on this in that year in parallel with the development of

“With the generous, tireless and dedicated effort by many Fellows in this Working Group, the first RANZCR Mentoring Program Pilot has come to fruition in January of this year. On behalf of the membership, I would like to thank you all for this much needed and anticipated program.” a program for trainees by the Education and Training Committee. Collaborating with PFEC, the FRO Mentorship Working Group was formed in February 2018. With the generous, tireless and dedicated effort by many Fellows in this working group, the first RANZCR Mentoring Program Pilot has come to fruition in January of this year. On behalf

of the membership, I would like to thank you all for this much needed and anticipated program. There is a total of 10 pairs participating in the pilot program. They first met online on 22 January 2021 for the launch, both Dr Lance Lawler, College President, and I attended. The 10-pair group met again in mid-February 2021. The program pilot will run for 12 months and feedback provided throughout the year will shape what I hope will be an ongoing program provided to our members. The College has engaged Shape Consulting to assist with hosting the webinars. They bring many years of experience in facilitating mentoring relationships with an acute awareness of the psychology behind a mentoring relationship as well as an ability to bring out the most from both mentors and mentees. It is envisaged that this program will carry on in 2022 and beyond; with expressions of interest to be listed on the College ‘Current Opportunities’ page. Further communication will be sent to members via the Faculty eNews and Trainee eNews relating to the program, keep an eye on your inbox.

If you have any questions and suggestions related to the Mentoring Program, please email mentoring@ranzcr.edu.au

Radiation Oncology

Impressive Results in a Difficult Year Chief Censor in Radiation Oncology

Dr Yaw Chin

The 2021 New Year has kicked off with hope and optimism; the hope that the COVID-19 vaccines developed will reduce the number of infections and ease the social restrictions that have impacted every facet of our lives. However, it is unclear when the timelines for this to occur will actually come to fruition this year. With this uncertainty in mind, we cautiously plan and organise for this year’s activities, recognising that there are still many potential roadblocks ahead as demonstrated by the recent snap lockdowns. As previously communicated, the results of the 2020 Phase 1 examinations were released on 15 December 2020. At the Board of Examiners meeting, 28 out of 35 candidates who presented satisfied all requirements and passed the Phase 1 examinations. Three further candidates were offered supplementary viva examinations in Anatomy. These were conducted virtually on 27 January 2021 and all three candidates were successful in that sitting. This gave the final overall pass rate of 89 per cent. The results of the 2020 Phase 2 examinations were released one month later, on 15 January 2021. The breakdown of pass rates according to the individual papers are as follows: Writtens Radiation Therapy Clinical Oncology Pathology

85.7 per cent 92.9 per cent 82.3 per cent

Vivas Planning Patients and Prompts Pathology

95.8 per cent 100 per cent 92.3 per cent

This gives an overall pass rate for Radiation Therapy, Clinical Oncology and Pathology of 81 per cent. The passing rates for both phases are among the highest rates in recent years and is a testament to our trainees’ strength and resilience in navigating through what has been a most arduous and stressful year. Correspondingly, immense gratitude and congratulations

“The passing rates for both phases are among the highest rates in recent years and is a testament to our trainees’ strength and resilience in navigating through what has been a most arduous and stressful year. ” go out to both Phase 1 and Phase 2 examination teams, who have demonstrated an incredible amount of patience, flexibility and fortitude as they contend with a multitude of changes, often with very little notice provided. The achievement of delivering these examinations under extremely difficult and trying circumstances is applaudable and specific acknowledgment goes out to Dr Sean Brennan as Chief of Examinations and Drs Claire Hardie and Carminia Lapuz as Phase 1

examination leads. My heartfelt thanks and appreciation to all three individuals as they step down from their respective roles and move on to bigger and better endeavours. The Phase 1 examination date for 2021 has now been set for Friday 10 September 2021 and will be aligned with the current paper-based examination format. All going well, the examinations will continue to take place at one central training site/location per training network, with contingency plans in place, taking into account potential lockdowns. Following the recent Board of Examiners meeting, the Phase 2 examination timelines have also been confirmed to occur in line with previous years’ Series 2 examinations with the written component to be delivered in July and the viva voce component in August. This allows maximum time to plan for the 2021 examination series and minimum disruption to the 2022 examinations, which will revert to being delivered twice per annum. In order to mitigate the risks caused by potential border and travel restrictions, the Education and Training Committee (ETC) has decided that the viva voce component of the 2021 Phase 2 examinations will continue to be delivered in a virtual format, with no live patients required for the patient/prompt-based questions. Again, the plan is for these to occur at one central training site/ location per training network, with contingency plans in place, taking into account potential lockdowns. continued over... Volume 17 No 2 I March 2021

Radiation Oncology

As you are all aware, accreditation site visits have been postponed for most training sites in 2020. Extensions have been granted to sites whose accreditation were due to expire in 2020 by an additional 12 months. A schedule for 2021 has now been drafted for potential face-to-face visits and virtual visits depending on the priority to meet accreditation standards. With the backlog of visits from last year, the accreditation team will require substantial bolstering, and I am hopeful that Fellows will engage with the accreditation team as the need arises. Dr Lisa Sullivan continues to spearhead work in the Training and Assessment Reform (TAR) sphere and major progress has been achieved with the near completion of the Radiation Oncology Training Handbook. Concrete plans

for implementing the new training program will subsequently occur after the upcoming Implementation Working Group (IWG) meeting. This will require close collaboration with the training networks and the scheduled Directors of Training (DoT) webinars this year will be focusing on some of the most significant changes that are going to occur when the new training program comes into force in 2022. I would like to highlight one particular change in the new training program which involves the formation of the Network Portfolio Review Committee (NPRC) within each training network. These committees are tasked with reviewing trainees’ portfolios and are responsible for approving their progression into Phase 2 of the training program, as well as eligibility

for admission into Fellowship. This is in keeping with the philosophy of programmatic assessment, where the entire assemblage of prospectively gathered information of a trainee’s learning journey is reviewed and analysed, in order to make high-stakes decisions for trainee progression. The NPRC also allows these high-stakes decisions to occur at an arm’s length principle, removing the onus of having these determinations singly shouldered by the DoTs.

If you have any questions or comments about this article please contact Brendan Grabau | Senior Training Advisor | Training Programs on ronctaa@ranzcr.edu.au

Quality Corner

Radiation Oncology Telehealth Principles The Faculty will imminently release “Radiation Oncology Telehealth Principles” to assist radiation oncologists and their departments to achieve best standard of practice in this decade of the 2020s. The document recognises the acceleration into telehealth medicine, and the rapid expansion of the infrastructure, expertise, experience and expectations required for remote medical advice and care. With the potential benefits to all stakeholders of this increasing power comes a responsibility to ensure safety and quality standards; compliance with relevant legal, regulatory and ethical

Inside News

standards; and protection of clinicians and patients from potential pitfalls of new technology. The “Radiation Oncology Telehealth Principles” aims to provide the highlevel framework to enable and guide these evolving practices. The work was led by the FRO Quality Improvement Committee and the able supporting team in the College, with wide consultation regarding the legal, ethical and regulatory environment from external agencies and peak professional groups. The draft document was also circulated widely within the Faculty and members for comment, advice and suggestions and these were incorporated into the final document.

The Faculty document first enumerates the overarching principles with which telehealth must align, and then goes on to list standards for various aspects of telehealth. Radiation oncology services that systematically establish and run telehealth for patients are expected to understand and comply with these standards. The Faculty commends these Principles to radiation oncologists and radiation oncology services or organisations and hopes that the clear articulation of what should be expected will assist in the safe and high-quality performance of these services and thus allow radiation oncologists to provide the best service possible for their patients.

Radiation Oncology

Radiation Oncology Trainee Matters

Dr Chamitha Weerasinghe As I write this article, the COVID-19 vaccination program is being rolled out and our most vulnerable members of the community are being protected by the best means available to us. It is remarkable, almost surreal, to see this next step being taken after the events of the past 12 months. With a whole lot of hope in my heart, I wish you all a Happy New Year. Firstly, I would like to congratulate Dr Wee Ong and the outgoing 2020 Radiation Oncology Trainee Committee (ROTC) on their excellent work representing us. I am very proud to introduce a group of caring and immensely talented trainees who make up the ROTC for 2021.

Chamitha Weerasinghe

NSW – Northern

Chair

Ta-Chi Zhong

NSW – Southern

Secretary and Radiation Oncology Research Committee

Katherine Tse

Radiation Oncology New Zealand Executive Committee

Kim Budgen

QLD

Economic and Workforce Committee

James Gallo

QLD

Radiation Oncology Education and Training Committee

Adam Byrne

SA/NT

Quality Improvement Committee

Cristian Udovicich

VIC/TAS

ASM Organising Committee

Caris Chong

Targeting Cancer Committee

Our priority remains advocacy for radiation oncology trainees and our key priorities for 2021 reflect this. The issues we will be focusing on in 2021 include; • feedback regarding the Radiation Oncology examinations • improved communication and relationships between trainees, local representatives and the College • delivery of the trainee day program at the 2021 ASM.

Remember, we can only advocate for you about the issues we hear about from you. Please talk to your local and state representatives if you have any ideas for improvement or any training-related issues. As always, no issue is too big or too small. Best wishes, Dr Chamitha Weerasinghe Radiation Oncology Trainee Committee Chair 2021

Our committee includes representatives from VIC/TAS (Cristian Udovicich), SA/ NT (Adam Byrne), QLD (Kim Budgen and James Gallo), WA (Caris Chong), NSW (Ta-Chi Zhong) and NZ (Katherine Tse). In true pandemic style, you can see our incoming and outgoing ROTC with our Educational Support Officer (ESO) Senice So at our virtual handover.

Volume 17 No 2 I March 2021

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Interventional Radiology

Scoping Out the Future for Interventional Radiology and Neuroradiology Interventional Radiology (IR) and Interventional Neuroradiology (INR) Training Pathway Working Group Since the publication of the RANZCR Road Map for Advancing Interventional Radiology and Interventional Neuroradiology in Australia and New Zealand in February 2020, the Interventional Radiology Committee (IRC) has made significant progress towards achieving specialty recognition. A key piece of work is the development of the College’s IR and INR training pathway, which builds upon the existing structures of the locally offered European Board of Interventional Radiology (EBIR) and Conjoint Committee for Recognition of Training in Interventional Radiology (CCINR). In this article, we share the progress made with this considerable project. Currently, all College trainees develop a range of clinical competencies required for basic procedural practice (formerly Tier A procedures). These skills also lay the foundation for advanced interventional practice for those radiologists who undertake further training through fellowships in IR or INR, procedural experience or through continuing professional development (CPD) activities after attaining Fellowship of The Royal Australian and New Zealand College of Radiologists (FRANZCR). The IR and INR Training Pathway Working Group was established by the IRC in August 2020 and tasked with developing an advanced training program for radiologists to pursue specialist IR and INR skills within a structured program beyond the scope of the College’s Clinical Radiology Training Program. The membership of this working group comprises:

• College members who practise IR and INR across Australia and New Zealand • Formal representation from the: o The College Interventional Radiology Committee (IRC) o Interventional Radiology Society of Australasia (IRSA) o Australian and New Zealand Society of Neuroradiology (ANZSNR) • Independent Medical Education expert. The working group reports to the IRC with oversight provided by the Professional Practice Committee (PPC) under the leadership of the Faculty of Clinical Radiology (FCR) Council. Once completed, the program will achieve many important objectives: • Clearly define the specialty training curriculum and pathway to achieve specialist IR and INR qualifications in Australia and New Zealand • Set the minimum requirements and quality standards for IR and INR fellows • Ensure patients have access to safe, best-practice and high-quality IR and INR care • Provide a qualified workforce with clinical and technical skills who are clinical leaders to meet current and future needs • Complete an essential requirement for IR and INR to be registered and protected as distinct medical specialties recognised by the College and the respective regulatory bodies in Australia and New Zealand.

Projects in train

College’s pathway • defining an Advanced Range of Practice (ARoP) which will clearly define the scope of practice for IR and INR, delineating it from other areas of medical specialisation. The takeaways from these projects will guide the development of a training program, including learning outcomes, curriculum, assessment, an accreditation program and an evaluation framework.

When do College members have a say? With the scale and complexity of developing this IR and INR training program, stakeholder engagement will be key to the success of this project. Important stakeholder consultations will be undertaken at key milestones along the project, the next consultation will be for seeking feedback on the Advanced Range of Practice for IR and INR. What’s happening next: the working group will keep members informed of progress through College newsletters, eNews and the College website. Your say: we welcome all feedback from the College membership on this exciting project, contact us at interventional@ranzcr.edu.au Access the road map here: www.ranzcr.com/college/ document-library/a-road-map-foradvancing-ir-and-inr-in-australiaand-new-zealand-position-paper

The working group has made some critical project developments to date including: • an audit of audit of local (EBIR and CCINR) and international IR and INR training programs, allowing the working group to translate key learnings from these programs to the Volume 17 No 2 I March 2021

General Interest

Medical Board of Australia and Medical Council of New Zealand Changes to CPD The introduction of the Professional Performance Framework in Australia and Strengthened Recertification in New Zealand will reform the way medical practitioners obtain and preserve your knowledge and skills for ongoing professional practice. The changes to CPD aim to raise its quality and effectiveness through enabling optimal CPD by maintaining and enhancing the performance of doctors. This can be achieved through efficient, effective, contemporary, evidence-based CPD relevant to your scope of practice. The key changes are designed to increase quality, effectiveness and choice. The College has continued to remain abreast of developments from both the Medical Board of Australia (MBA) and Medical Council of New Zealand (MCNZ). The MCNZ released their model for recertification requirements for vocationally registered doctors practising in New Zealand in November 2019 and the MBA released their draft CPD registration standard in July 2019, consultation periods have followed this. As a part of the CPD reforms, the College is implementing a new CPD portal. This platform was chosen in mid2019 after testing a number of options. Guidance from our Professional Practice Committee (FCR) and Post Fellowship Education Committee (FRO) has

Inside News

ensured that the new platform will have enhanced usability, a fresh new look and be fit-for-purpose for the changes to the College’s CPD program. Some of the notable changes to the CPD program as per the MBA and MCNZ reforms are: • CPD will now be completed on an annual cycle (previously trienniums). The College is working towards the first annual cycle commencing in 2022. • CPD will be measured in hours (previously points). 50 hours of CPD will need to be logged for every annual cycle. Note pro rata arrangements will still be available for those members on parental leave, extended sick leave and other extenuating circumstances. • The MBA and MCNZ have stated that CPD activities will need to be undertaken across the following categories—measuring outcomes, reviewing performance and educational activities. It is anticipated that members will need to log a minimum of 12.5 hours per category, with the remaining 12.5 hours to be logged in any category of choice—to make the 50 hours in total.

A reminder: end of CPD triennium The 2021 calendar year marks the end of the 2019–2021 CPD triennium for members. By the end of 2021 all clinical radiology members are required to have logged 125 CPD points and radiation oncology members are required to have logged 130 CPD points. This is a revised amount due to the CPD exemptions set by the MBA and MCNZ due to the COVID-19 pandemic. Please note there will be no further exemptions to CPD in 2021. In addition to this, there will be no annual compliance audit for the 2020 and 2021 CPD calendar years, however an overall triennium audit will still take place. A reminder that failure to meet the revised CPD requirements by the end of 2021 may put your medical registration and Fellowship at risk.

If you have any questions about the revised CPD requirements for 2019–2021 triennium, please contact the team at cpd@ranzcr.edu.au

News

GET INVOLVED: SPECIAL INTEREST GROUPS The College’s Board establishes Special Interest Groups in areas of specific interest to the membership within clinical radiology and radiation oncology Contact us to find out more and join a Special Interest Group

www.ranzcr.com/contact

Clinical Radiology Special Interest Groups

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

Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC)

Australian and New Zealand Society of Thoracic Radiology (ANZSTR)

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

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

Obstetrics and Gynaecology Special Interest Group

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

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

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

Australian and New Zealand Emergency Radiology Group (ANZERG) ANZERG is a network of members interested in emergency and trauma radiology.

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

Radiation Oncology Special Interest Groups Breast Interest Group Faculty of Radiation Oncology (BIG-FRO) The aims of the BIG-FRO are to promote best clinical practice for the management of breast cancer, and to enhance the profile of radiation oncology in the setting of breast cancer.

Faculty of Radiation Oncology Genito-Urinary Group (FROGG) FROGG aims to promote good radiotherapeutic and oncological practice as part of multidisciplinary patient management.

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

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

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

Faculty of Radiation Oncology Particle Therapy Special Interest Group (PTSIG) PTSIG aims to bring together radiation oncologists to investigate and promote the role of particle therapy in the treatment of cancer, to ensure particle therapy is introduced in a coordinated way through a collaborative approach – to ultimately benefit patients.

Australian and New Zealand Palliative Radiation Oncology Group ANZPROG is a group of radiation oncologists who advocate and promote the role of radiation therapy in palliative care. It allows members to share the clinical experience of radiation therapy provision in the palliative oncology setting. Volume 17 No 2 I March 2021

News

Australian Rural Radiologist Shortage: We Can Do a Lot More

Dear reader You might be expecting to read about the good things the Rural Radiology SIG has achieved, but I may disappoint you. We have not been able to reverse the rural radiologist shortage. Worse, it will continue to get worse, because only eight per cent of the total Australian radiology training positions are outside ASGS-RA1, that is, outside the major capital cities, Newcastle, Wollongong and Geelong. Thirty per cent of the population live outside RA1. There is consistent observational evidence from around the world, including Australia, that doctors choose to live and work where they have trained. Recent peer-reviewed articles have proven that the longer a doctor spends in a rural medical or clinical school and subsequently in a rural environment post-graduation, the more likely that doctor will choose to live and work rurally. The College has documented the shortage of rural radiologists, just as others have documented the shortages of all health practitioners endured by rural Australians. The shortages are the major factor in the documented poorer health outcomes rural Australians suffer. Rural Australians rightly expect the profession and College to ensure there is equitable access to high quality radiologists. By 'workforce', I mean the locally resident workforce: available 24/7; invested in upskilling their peers and fellow practitioners; team member with other local practitioners; invested generally in the community.

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It is about time the highest priority is afforded all non-metropolitan communities in Australia and New Zealand. Improving the educational and training opportunities of all rural Australians and improving the rural radiology workforce will help Close the Gap. Improving the human capital of rural Australia will have benefits for the whole nation. The Commonwealth understands the problem. Its Rural Health Multidisciplinary Training (RHMT) Program is evidence in action. We should applaud the Commonwealth and work with them. However, there is a problem with the Commonwealth’s STP and IRTP positions, especially in radiology: the cost of training is prohibitive in private practice, because there is no Medicare rebate for radiology trainee service or teaching, whereas in the public hospitals, trainees can work without the constant direct supervision necessary in private.

The College would not be alone if it did more rural training. Other colleges have been expanding their rural training programs for decades. Interestingly, the RACS's recently released Rural Health Equity Strategic Action Plan is an example of a College adequately prioritising its social responsibility. Among other things, it champions rurality as a diversity element, recognises the conflict of interest of metrocentric RACS committees (etc), will foster a pro-rural culture and will Select, Train, Retain and Collaborate for Rural. Dr Nick Stephenson Chair Australian and New Zealand Rural Radiology Special Interest Group (ANZRRSIG)

There are other barriers to increased rural training, which the RRSIG has brought to the College’s attention. The states and territories are responsible for their respective jurisdiction’s workforces (2005 Review of Australian specialist medical colleges, ACCC & AHWOC). The trouble is the funding and infrastructure for specialist training is metropolitan-based. Creation of new rurally-based training jobs and infrastructure needs to occur. The College, in collaboration with other colleges, should lobby the jurisdictional governments and their bureaucracies to get more rurally-based training, e.g. in NSW, funding of Directors of Clinical Training, Offices of Medical Education and specialist teaching time (including by VMOs) in all Base hospitals and many rural hospitals.

Editor-In-Chief: this is an edited version of the article submitted to Inside News.

News

New Zealand Branch News

Dr Gabes Lau

Kia Ora. As 2021 has gotten underway, so have the on-again/off-again lockdowns. It is likely COVID will be with us for the duration of 2021 but there are encouraging signs regarding NZ’s vaccination programme and a transTasman bubble.

New Zealand ASM Planning for the 2021 NZ ASM is proceeding with lots of exciting speakers. It is being planned as a hybrid event (face-to-face and virtual) so it will take place regardless of NZ’s COVID situation. Our fingers are crossed—it would be nice to see NZ’s membership in Wellington, August 6–8. Registration opens on 8 April.

He Pūrongo Mate Pukupuku o Aotearoa 2020 The State of Cancer in New Zealand 2020

Te Aho O Te Kahu Te Aho (Cancer Control Agency) released their first report on the state of cancer in New Zealand. I understand there is an article dedicated to the report in this edition of Inside News. It is helpful to have a single document providing so much information about cancer in New Zealand. Of note, there is a $6.2 million research fund that has been announced by the Health Research Council, Te Aho and the Ministry of Health.

The purpose of the RFP is to fund high-quality cancer research linked to equity. This is a wonderful opportunity for the College’s members to undertake research.

NZ Branch Committee Meeting The NZ Branch Committee held its first meeting for 2021 in February. The Branch discussed a range of pertinent issues including: • The Training and Assessment Reform which is scheduled for a February 2022 start. The College is working on documentation and educational sessions to make sure members involved in training understand what will be required. • The College has been working on a paper in support of appropriate and arm’s-length referrals. A draft should be posted on the College’s website sometime in March for consultation— we look forward to member and stakeholder feedback. • International Accreditation New Zealand (IANZ) may be interpreting the College’s standards on secondary monitors in a way that poses a challenge for accreditation. We will be working to resolve this issue.

We’d be grateful if members that have been having IANZ accreditation issues related to their secondary monitors could email nzbranch@ranzcr.org.nz

The Radiology Collaborative Aotearoa This time last year, I shared details about the creation of the National Radiology Collaborative Action Group (NRCAG). This group (which did not meet in 2020) has now evolved into the Radiology Collaborative Aotearoa (RCA). The RCA met in February to discuss the Ministry of Health’s (MoH) current work regarding radiology in New Zealand. Items of particular interest to members include: • Spending on the COVID waitlist catchup—the MoH funded 70 projects in 2020. Additional funds will be allocated in 2021 and 2022. Meeting attendees were pleased about the positive impact that funding made in reducing waiting lists. However, there were many questions about how some of the funding could be used for longterm improvements. • Te Aho shared an update regarding work they have started on surveillance. Protocols for post-treatment cancer surveillance are variable around NZ. Te Aho hopes to provide guidance to standardise appropriate levels of surveillance. More information will be made available as this work progresses. Again, meeting attendees were largely supportive of this work and envisioned a process where most surveillance would be able to take place in the community.

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News

• The Medical Radiation Technologists Board (MRTB) undertook consultation in 2020 to amend registration requirements for overseas-trained practitioners. In December 2020, they announced the outcome which will see a more streamlined pathway for registration of MRITs, NMTs and sonographers. It is hoped that this will help alleviate some workforce shortages. • New Zealand desperately needs to train more radiologists in New Zealand. Health Workforce will not be increasing funding for training for the 2022 registrar intake—they are waiting on upcoming announcements related to the Health and Disability Review before making any changes to the funding of training.

The College’s Wellington office is still working primarily from home. Members are encouraged to make contact with the office if you have any concerns or questions. Please email nzbranch@ranzcr.org.nz You are welcome to provide a number if you want someone to give you a ring. Kia kaha. Stay safe, vigilant and strong. @GabesLau cancer_agency Te Aho o Te Kahu, @ Cancer Control Agency NZ

Australasian International Breast Congress (AIBC) 6th World Congress on Controversies in Breast Cancer (CoBrCa)

Australasian Society for Breast Disease (ASBD)

Breast Surgeons of Australia & New Zealand (BreastSurgANZ)

Brisbane, Australia October 14-16, 2021 Congress Chairpersons

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Inside News

www.aib-congress.org • info@aib-congress.org

General Interest

Have Your Circumstances Changed since July 2020?

We understand that during the course of your career (and particularly during a global pandemic) there may be times when your personal circumstances change. Whether you’re reducing your work hours, taking a break from practice entirely, or relocating to pursue a new opportunity, we encourage you to inform the College as you may be entitled to a reduced rate for membership fees.

Break in Practice and Interrupted Training Fellows and Educational Affiliates Going on extended leave, parental leave, or experiencing health issues that will stop you from working for 6–12 months? Apply for a Break in Practice by emailing members@ranzcr.edu.au with the date you will commence your leave and intended date of return to practice, as well as evidence such as an employer letter or medical certificate. Taking a break for longer than 12 months? You can apply each year for an extension of your Break in Practice, up to a maximum of three years. Members on a Break in Practice are still required to submit pro rata CPD points. Student Members If you are taking a Break in Training (including parental leave), submit a request for a Break in Training through the Trainee Information Management System (TIMs) for approval, to be eligible to apply for a reduced rate for training fees and member subscription fees.

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 for 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 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 for your membership subscription. You must report all changes of your training status (full-time/part-time) through the Trainee Information Management System (TIMs) to be eligible for a reduced rate of fees.

Moving overseas? Have you relocated outside Australia or New Zealand? To access a reduced member subscription rate for overseas members*, 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 you then move back to Australia or New Zealand please update your details on the member portal. Have you moved between Australia and New Zealand? To pay your membership fees in your local currency, update your home and work address on the MyRANZCR member portal and email members@ranzcr.edu.au with the date you moved. *Applies to Fellow members only

We’re here to help Each of our members, and their personal circumstances, is 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 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 Parttime Training Policy on the College website or contact the Specialty Training Unit at radtaa@ranzcr.edu.au for clinical radiology students and ronctaa@ranzcr.edu.au for radiation oncology students. Please note: Fee reductions can only be applied for the current or future financial year; and cannot be applied for fees billed in a previous financial year.

Reminder: the MyRANZCR login process has changed In September 2020, we made some changes to the way you access our member portal, improving the safety and security of your account. If you have not logged in to the portal since that process changed, you will need to reset your password by clicking on the “Forgot password” link and following the instructions. Your username will remain the email address that you have previously used to access the portal. Find out more about the changes

Volume 17 No 2 I March 2021

General Interest

The Australian and New Zealand Society of Neuroradiology (ANZSNR) Annual General Meeting 2021 Due to the postponement of the 2021 ASM, the Executive have scheduled a virtual AGM for members for late March 2021. A formal notice of meeting will be sent in early March and members will be requested to register to attend.

international affiliation that would benefit members of both societies. Proposed synergies include: • BSNR members to have access to the ANZSNR members benefits (ASM video content, career information— fellowships and positions vacant)

We strongly encourage all members to attend and contribute to the current and future initiatives of the ANZSNR.

• ANZSNR member to have access to the BSNR members benefits.

If you have any questions, please contact the secretariat at secretariat@anzsnr.org.au

Council ratified a formal collaboration with BSNR and will move forward with an MoU providing our members with access to these great benefits.

International affiliation with the BSNR

DNR and INR Fellowship positions

The Executive met with the President of the British Society for Neuroradiology (BSNR) to discuss a formal collaborative

ANZSNR members are invited to advertise DNR or INR positions on a new section of the website dedicated to promoting neuroradiology career

opportunities. If you are a member who would like to contribute to this page of the website www.anzsnr.org.au/fellowships please contact secretariat@anzsnr.org.au

MBS Reviews of Angiography Items The MBS Review have invited ANZSNR to propose an updated structure for DSA and procedural items performed by INRs in response to Taskforce Recommendation Seven. An ANZSNR subcommittee is working on a submission. The submission is due to the Government by 2 April 2021. If any members are interested in being involved, please get in contact with the secretariat at secretariat@anzsnr.org.au

Interventional Society of Australasia (IRSA) IRSA Annual Scientific Meeting 2021 We are busily planning for the 2021 ASM, which will be held at the Marriott Hotel on the Gold Coast from Tuesday 28 June–Thursday 1 July 2021. The Marriott has recently been refurbished and has state-of-the-art conference and social facilities making it a perfect venue for our meeting in 2021. The venue is centrally located on the Gold Coast with popular attractions and transportation links all within walking distance. The 2021 ASM will be a full three-day meeting and we are currently working with the appointed Convenors— Dr John Grieve and Dr Muddassir Rashid—on developing an innovative and exciting program for all members, with a dedicated session for nurses and radiographers.

Inside News

The theme for the ASM is Interventional Oncology. Professor Thierry de Baere, Professor of Oncology, Interventional Radiology, France and Professor Afshin Gangi, Chief of Interventional Radiology at University Hospital Strasbourg as well as Chairman of Radiology and Nuclear Medicine, have confirmed their attendance as the key-note international speakers. The IRSA ASM Organising Committee are considering contingency plans, which include international speakers attending virtually, if international travel restrictions still apply. As always, we will have a strong mix of local speakers and an excellent social program.

Registrations are open from March 2021. For further information about the ASM, please contact the PCO, Natacha Costa at ncosta@ncevents.com.au

MBS Review of Angiography Items The MBS Review have invited IRSA to propose an updated structure for digital subtraction angiography items, performed by interventional radiologists (IRs). John Vrazas, Bill Clarke, Rob Allen and Jules Catt are working on IRSA’s submission and will liaise with the College to ensure alignment of the items. The submission is due to the Government by 2 April 2021 when further updates will be provided.

General Interest

Great Savings and Rewards for Members Member Rewards Program The program has been carefully tailored to meet your needs—automotive, insurance, legal, travel and lifestyle products and services have been included. Our Partnerships provide excellent value to members. Each Member Reward Partner is introduced based on feedback from our members and careful research, with the aim of rewarding members by providing valuable savings and unique services.

Great prices for your travel requirements The Accommodation Brokers have been achieving some amazing results for our members and we encourage you to register on their website (details below) to take advantage of this reward partnership and get some great savings on your personal travel. We thought we would include some case studies to show you the results: SAVED $1,938

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1. Go to www. theaccommodationbrokers.com.au

NobleOak is an Australian independent life insurer with more than 140 years of experience. They believe in bringing members life insurance the way it is meant to be—combining quality, nosurprises cover with personal service and lower premiums.

2. Click on LOGIN/REGISTER tab 3. Click I'M NOT A ROBOT and tick appropriate boxes

Client: submitted price they had found for The Cape at Wategos Byron Bay of $8908 Non-Refundable for a King Spa Suite with Ocean View.

4. Then click on REGISTER

Solution: The Accommodation Brokers submitted a rate back to RANZCR member – $6,970.00 – saving RANZCR member $1,938

6. In the field ORGANISATION select RANZCR

Conclusion: RANZCR member booked and extremely happy. SAVED $1,069 Client: submitted price they had found for seven nights (13–20 Feb 2021) on Hamilton Island staying at the Yacht Club Villas. "We are taking two of the kids (six and eight years of age) – the best price we could find was on Expedia for a Premium Villa at $10,850 per stay. Can you do your magic and let me know what you can do?” Solution: The Accommodation Brokers submitted a rate back to RANZCR member – $9,780.75 per stay – saving RANZCR member $1,069.25 for their seven-night stay Conclusion: “Once again you are saving me a lot money—a big thank you!!”

5. Under MEMBERS REGISTRATION please fill out all fields with your details

7. In the field BUSINESS NAME list your business name 8. Once you have filled out all fields tick I'M NOT A ROBOT and click REGISTER We hope you enjoy the savings!!

Other Member Rewards offers We also have unique Member Rewards offers from Unsworth Legal, Tesla, Mercedes Benz, Europcar, and BMW/Mini located at: www.ranzcr.com/college/ member-rewards

NobleOak has just been announced as the national winner of the prestigious 2020 Canstar Outstanding Value Award for its Premium Life Direct Life—for the fifth year in a row. RANZCR members are entitled to a 10 per cent lifetime discount on life insurance products. Get an instant quote or find out the conditions of the offer at www.nobleoak.com.au/ranzcr or phone NobleOak on 1300 108 490 and mention the code ‘RANZCR’.

If you have any questions or suggestions about the RANZCR Member Rewards Program, or would like to make suggestions of potential member rewards partners, please do not hesitate to contact us at  members@ranzcr.edu.au

Volume 17 No 2 I March 2021

General Interest

2021 Branch Events

QLD Branch Events QLD Branch held their first Academic Evening on 23 February 2021. It was such a pleasure to see everyone in person, we had our best turnout ever. All 70 places were booked up within a week of opening registration and we had minimal no-shows. Everyone on the night was just so glad to be out socialising with the colleagues they have not seen in a long time.

WA Branch Events The Western Australia Branch Committee have organised a few events for this year, here are the details of the three Monthly Professional Meetings already organised. Monthly Professional Meeting Wednesday 21 April Royal Perth Hospital, Bruce Hunt Lecture Theatre, Perth WA.

Inside News

Our new Secretary Dr Arjuna Somasundaram was excellent at hosting the evening as well as all our guest speakers: • Dr Annah Lane – Adnexal masses on Ultrasound: New IOTA/ORADS guidelines • Dr Theodore Lau – Hot N Cold: The intersection of molecular, metabolic, and morphological imaging in neuroendocrine tumours • Dr Bradley Wray – EOS for the general radiologist

Online access will be organised via MS TEAMS. Guest Speaker: Prof Paul Effler Monthly Professional Meeting Wednesday 19 May Royal Perth Hospital, Bruce Hunt Lecture Theatre, Perth WA. Online access will be organised via MS TEAMS. Guest Speaker: Dr James Seow

Don’t miss out on the events that the QLD Branch have organised for the rest of this year. Keep an eye out for an email that will be coming to you soon with more information. Queensland ASM Saturday 5 June Sofitel Gold Coast Broadbeach Queensland Academic Night Tuesday 28 September Hillstone St Lucia, Rosewood Room

Monthly Professional Meeting Wednesday 16 June Royal Perth Hospital, Bruce Hunt Lecture Theatre, Perth WA. Online access will be organised via MS TEAMS. Guest Speaker: Dr Conor Murray: “Artificial Intelligence or: How I learned to stop worrying and love the machine” If you have any queries, email us at branches@ranzcr.edu.au

General Interest

Branch of Origin 2021

Participating Branches of the College hold an annual local trainee presentation event, and the most outstanding presentation from each participating Branch is awarded a prize of up to AU$1,200 to compete in the Branch of Origin session, usually held as part of the College’s Annual Scientific Meeting (ASM). At the Branch of Origin session, trainees from each participating state battle it out for a prize of up to AU$5,000 to assist with attendance at the Radiological Society of North America (RSNA) meeting the following year.

Who can participate? This opportunity is open to all clinical radiology trainees in Years 1–5; however, trainees in Years 1–3 are encouraged to consider this an essential part of their learning process for Project 1.

Interested? Your local Branch will be hosting a trainee presentation event in the coming months, so be sure to keep an eye out on your emails for the call for abstracts.

Our 2020 Branch of Origin Winner Due to the cancellation of our ASM last year, in 2020 our Branch of Origin event was held virtually. Trainees from five branches presented their research to attendees and our guest judges, Prof Paul Parizel and A/ Prof Helen Moore. The winner was Dr Tahleesa Cuda from Royal Brisbane And Women's Hospital with their presentation ‘Theranostics: Molecular Imaging and Radionuclide Therapy for Metastatic Colorectal Cancer Targeting CDCP1’. Congratulations Dr Cuda!

Thank you to all the trainees who participated and to our judges. If you have any queries, please email branches@ranzcr.edu.au

~ In Memoriam ~ The College notes with regret the death of the following members: Dr Norman Douglas Johnston Fellow VIC Dr Gerald Shnier Life Member VIC Dr Hermann van der Vyver Fellow NZ

Volume 17 No 2 I March 2021

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