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Volume 12 No 2 / March 2016

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

FACING FUTURE CHALLENGES ~ Dr Greg Slater, President

Join us

in the Sunshine State No matter where you choose to live, you’ll enjoy year-round great weather and an enviable relaxed outdoor way of life.

But it’s not all about lifestyle! The I-MED Network also offers you great opportunities to advance and develop your career as a Radiologist in Queensland. I-MED Queensland has over 25 comprehensive clinics located in Brisbane, the Sunshine Coast, Wide Bay and the Capricorn Coast to Rockhampton. Our clinics include state-of-the-art equipment, quality support staff, strong referrer relationships and locations in private practice clinics and public and private hospitals. We are focused on providing the highest quality services and meeting the needs of our referring medical practitioners and patients, all backed by Australia’s largest provider of diagnostic imaging services – the I-MED Network.

Exciting opportunities currently exist for Radiologists to join our Queensland business: • MSK Specialist: Brisbane - Unique opportunity to work in a Sports Medicine Imaging Clinic servicing co-located Sports Physicians and Orthopaedic surgeons who manage many of the elite sports people in the region. - This new venture offers an MSK radiologist the opportunity to build a sports medicine imaging practice in a unique location.

• Breast Specialist: Brisbane - Opportunity to lead and grow our Breast Services across our Brisbane clinics

• General Radiologists: Brisbane, Ipswich, Bundaberg & Rockhampton - We require Radiologists with broad based experience in General Radiology including CT, US, breast imaging, MRI, plain film and basic interventional procedures for our Queensland clinics.

If you are interested in finding out more, please contact Bronwyn Nicholson General Manager, Queensland on M: 0418 450 347 E: Bronwyn.nicholson@i-med.com.au or our recruitment team on 1800 775 751

In this edition 5 COVER STORY President’s Message 6 CEO Message

Engaged Members 7 Member Engagement Survey 8 2016 Annual Scientific Meeting 10 Member Profiles Effective Governance 12 2016 Election Schedule Right Scope and Focus 13 Recognition of Training in INR Research 15 Research in Prostate Cancer Treatment 16 Research Awards and Grants Profile and Presence 17 IDOR 2015 20 Targeting Cancer Access to Quality Services 23 DI Horizon Scan update 24 Mandatory reporting Quality Practice 25 Guidelines for Volume Delineation in Radiation Oncology 27 Updated IGRT Position Paper 28 Revised Iodinated Contrast Media Guidelines Quality Training 30 RANCR Courses and Workshops 32 Examination and Assessment Review 36 Revalidation Clinical Radiology 37 Message from the Dean 39 Chief Censor 40 ADIA Update 43 Trainee News

From the

Editor’s Desk This edition showcases our progress towards our strategic priorities in many areas of College activity. We feature some of the members who are leading our organisation, highlight our ongoing advocacy activities and report on policies and guidelines designed to support our members’ quality practice. We start 2016 with our new President, Dr Allan Wycherley Dr Greg Slater, on the cover and I encourage you all to read his first address to the membership. Two other leaders who take their place on Faculty Councils this year talk about their passion for their profession and the work they do. We also introduce some hard-working Branch members who have taken on important educational roles in their state or country. When it comes to raising our profile, nothing beats a meeting with politicians in Canberra and the International Day of Radiology at the end of last year provided a great opportunity for this. World Cancer Day early in February was another opportunity, this time to highlight the Targeting Cancer campaign and the many achievements of this great initiative. We also publish a snapshot of our consumer website, InsideRadiology; who is using it and what they are looking at. Members who have been involved in developing and updating some of our guidelines provide overviews on the new publications plus we bring you the highlights of a very successful planning day held to progress our training assessments review. Once again this edition is full of varied and interesting articles written by members. We are very fortunate to have so many people willing to contribute to our publication – thank you. Allan Wycherley Editor-in-Chief editor@ranzcr.edu.au

Radiation Oncology 49 Message from the Dean 51 Chief Censor 53 Trainee News 54 TROG News

General Interest 55 New Zealand Branch News 56 Australian Branches 61 Meetings and Events

Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editors Alex Zandstra Bertha Harvey

The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street Sydney NSW 2000 Ph: +61 2 9268 9777 Fax: +61 2 9268 9799 Web: www.ranzcr.edu.au Email: ranzcr@ranzcr.edu.au

Submissions The submission of articles, letters and news items is encouraged. Submissions should be sent to editor@ranzcr.edu.au The Editor reserves the right to make literary corrections and to withhold from publication any or part of any material submitted.

New Zealand Branch Floor 6, 142 Lambton Quay Wellington, NEW ZEALAND Ph: +64 4 472 6470 Fax: +64 4 472 6474 Email: nzbranch@ranzcr.org.nz

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.

LEARN FROM THE WORLD’S BEST Access the knowledge and experience of five of the world’s leading radiology educators, and travel to some of the most exciting destinations in the world.

Upper & Lower Limb MRI Workshop Dubai. November 4-6, 2016. with Professor Donald Resnick, University of California San Diego. Aspen. January 30-February 3, 2017. with Assoc. Professor Adam Zoga, Thomas Jefferson University. RANZCR: 40 CPD points.

Body MRI Workshop Sydney. November 19-20, 2016. with Assoc. Professor Kartik Jhaveri, University of Toronto & Professor Mukesh Harisinghani, Harvard Medical School. RANZCR: CPD total points pending.

Breast MRI Workshop Brisbane. August 27, 2016. with Professor Wendy DeMartini, University of Wisconsin-Madison RANZCR: 30 CPD points.

Breast Tomosynthesis Workshop Brisbane. August 26, 2016. Noosa. November 12, 2016. RANZCR: 14 CPD points.

For more course information: www.lightboxradiology.com.au

Introduction

A Message

from the President

Dr Greg Slater

Looking ahead in times of uncertainty

Last year, in my final message as Dean of Clinical Radiology, I invited members to take the time at year’s end to reflect after a busy, exciting and occasionally challenging year. I hope you did so and you returned to work ready to take on the opportunities and challenges that 2016 has in store for us. As retiring Dean, I had plenty to reflect on and, as the incoming President, plenty to prepare for. A unique aspect of my current role is the requirement to represent all members for the next two years and work with the Board across all its activities. In reflection, I came to the view that the lesson of our 80-year history is two-fold: first, the future is never as clear as it seems; and second, as a stratagem for managing uncertainty, working together on common goals is the best way to meet the challenges that lie ahead. Some of you may be familiar with the concept of stationarity. I don’t mean the strict mathematical definition used by statisticians but rather the broader, philosophical assumption that the way the world has changed in the past is how it will continue to change in the

future. Stationarity is not the same as standing still, rather a principle that puts limits on how bumpy you can expect the ride to be. It’s the assumption that gives us terms such as a ‘one in 100 years’ flood and enables planners to design infrastructure and services to cope with extreme events. But change is a slippery customer and many— especially people working in areas such as climate science, civil engineering, design and economics—now believe that stationarity doesn’t really work as a guiding principle anymore.

Some, such as the MBS review, are better understood than others, and hence the impacts, however unsettling, can be reasonably well anticipated. But others are harder to grasp. How well, for example, do we understand the potential impacts of the revived government plans to privatise Medicare payments or, closer to home, the recent cuts to the Australian Clinical Dosimetry Service and bulk-billing incentives for diagnostic imaging and MRI?

“Working together on common goals is the best way to meet the challenges that lie ahead”

Can the College manage these challenges? Yes, I believe so, and we are well placed to do so. A lesson we can take from the past is that our founders were vigorous, committed and focused in tackling big challenges. They moved forward in uncertain times. It is this spirit we need to strengthen both within the membership and beyond in those arenas where we crave greater recognition.

Is stationarity also dead as a concept in health and medicine? Can our health planners and practitioners continue to rely on the notion that the challenges we will face in the future have predictable impacts and will submit to solutions we used in the past?

If we work together on our common goals and, as my predecessor put it, ‘look outward with vision,’ we put ourselves in the best position to cope with the bumps on our journey and ensure we get to our destination.

These, and many others, are the challenges that we face today, and they remind me how uncertain the future has become in our profession.

One thing is certain: our profession and the healthcare system we serve faces many challenges at this time.

Volume 12 No 2 I March 2016

Introduction

From the

Chief Executive Officer A New Kind of Medical College Natalia Vukolova

Organisations and their leadership go through cycles. Sometimes they play it safe, tread water and maintain the status quo, but not RANZCR. We have the ambition to lead the dialogue on imaging, interventions and cancer within the health sector—and do so with the mandate of our membership. Over the past three years we have been changing our organisation profoundly. We are creating a more valuable RANZCR for members and society. From 2013 to 2016, the new Board of Directors, Faculty Councils and Executive have focused on strengthening every facet of our organisation. We have continued to carefully keep the balance between ongoing responsibilities and new strategic projects. We have reshaped the College to focus on member services and consultation, advocacy with health decision-makers and on increasingly robust training provisions. We have positioned our organisation to work closely with governments and to have a stronger public voice. We are continuing to invest in IT infrastructure that will support members and our programs in the digital world. We run the College in a more efficient and accountable way. We have reinvigorated RANZCR in a rapidly changing environment, with challenges heaped on us even as we were building our internal capacity.

Inside News

Today, in early 2016, we offer members a strong professional organisation and a ‘home base’ in a time of change for health care and society. Our College is performing well. We are building on a foundation of great clinical leadership and strong commitment to better patient care. Our best days are ahead of us, with more innovative work, public representation and engagement with members planned for the year. The clinical leadership team, led by Drs Slater, Forstner and Slavotinek and my executive team are determined to deliver for you. Thank you to our members for your leadership, support and hard work to date and I look forward to continuing my service with the College in 2016. If you have any comments or questions, please write to me at ceo@ranzcr.edu.au

Engaged Members

Member Engagement Survey Supporting the Membership “Change is the process by which the future invades our lives” ~ Alvin Toffler The College members are both the foundation and heart of the College and it is therefore important that the work of the College, led and guided by the President and the Board, reflects the needs of the membership. The current environment is constantly changing, yet becoming subject to more and more regulation. It is important that the College continues to advocate for your profession and provide input into policy decision making, whilst keeping up to date with the current requirements and the needs of its members. This month, all active members will receive an invitation from the President encouraging your participation in the Member Engagement survey. All members are encouraged to complete this survey. The purpose of the survey is to gain further insight and provide direction for the future. The survey will provide you with an opportunity to let us know what is important to you. By completing the survey, you are providing guidance for the future in terms of areas that the College should focus on and where the College needs to direct more resources. This is an opportunity for you to voice your opinion, give suggestions and to help identify where greater focus needs to be given to support your needs. Your opinions will be kept in strict confidence and all data anonymised before appearing in reports. Your input will assist the College in remaining relevant and ensure that we are able to better understand and deal with the challenges the College and the profession faces in the future. The key findings of the survey will be shared with all participants. Thank you in advance for your participation.

If you have any comments or would like to discuss any aspect of the survey, please contact Laina De Winne, Head of Member Engagement at the College at laina.dewinne@ranzcr.edu.au or +612 9 268 9777

Grants, Awards and Prizes 2016 Applications close 8 April COLLEGE HONOURS • • • •

Gold Medal Roentgen Medal Honorary Fellowship Life Membership

Nominations to Branches close Friday 8 April 2016. Guidelines and nomination forms can be downloaded from the College website www.ranzcr.edu.au/members/awards-aprizes/college-honours Nominations for the above honours should be submitted to your Branch Committee. Please see page 58 for Branch contact details. COLLEGE AND SPONSORED HONOURS • Denise Lonergan Educational Service Award • Clinical Radiology Educational Service Award • Bill Hare Fellowship • Philips Healthcare Australasia Prize • Thomas Baker Fellowship • Rouse Travelling Fellowship Applications for the above awards, fellowships and prizes close Friday 8 April 2016. Guidelines and nomination forms can be downloaded from the College website www.ranzcr.edu.au/members/awards-aprizes/college-honours

Information on the 2016 Research Prizes can be found on page 16. If you need any further information or have any questions, please contact Member Support at the College on gaps@ranzcr.edu.au

Volume 12 No 2 I March 2016

Engaged Members

Modern Imaging and Radiation Therapy: Appropriate, Collaborative and Targeted 67th Annual Scientific Meeting on the Gold Coast On behalf of the Organising Committee, we would like to invite you to The Royal Australian and New Zealand College of Radiologists’ (RANZCR) 67th Annual Scientific Meeting to be held at the Gold Coast Convention and Exhibition Centre from 13–16 October 2016.

The meeting has received a number of high-calibre abstracts from our radiology and radiation oncology colleagues, we urge you not to miss this great opportunity to present your research at the meeting. Abstract submissions are now open and can be submitted via ranzcr2016.com/abstractinformation-2 before 8 April 2016. There are a number of great abstract prizes on offer; visit the meeting website for information and eligibility criteria. Over the four-day program, we look forward to strong collaborations with our clinical colleagues, an integral and fundamental element to the appropriate and targeted use of modern imaging and radiation therapy to produce the best patient outcomes. The program is proving to be enticing and stimulating with numerous inspirational international speakers presenting, who together with world-class local presenters, will share their vision. We are very excited about the upcoming program for the 2016 ASM on the Gold Coast and look forward to providing a mix of meaningful discussion, exchange of ideas and learning through plenary sessions, workshops and symposia.

Radiology Program The radiology program will be covering topics on musculoskeletal, breast, neuroradiology and body MRI. We have been successful in attracting eminent presenters in these fields to speak at the conference, including Prof Meng Law, Dr Russell Fritz, Prof Fiona Gilbert and Dr Claude Sirlin. This year’s conference will also focus on showcasing excellent local talent and will feature a number of high-calibre College radiologists. A preliminary radiology program is available to view via the meeting website ranzcr2016.com/scientificprogram The radiology workshops will once again feature the popular BREAST Tests, with plans to include some other highly educational workshops. Watch this space for further updates.

Radiation Oncology Program Highlights of the radiation oncology program will include lectures from invited speakers Dr Silvia Formenti, Prof William Mendenhall and ASTRO speaker Dr Colleen Lawton. The College and ESTRO will be hosting a joint symposium with guest speaker ESTRO President-Elect Prof Yolande Lievens to present as part of this interactive session. Further program details will be available via the meeting website.

MODERN IMAGING AND RADIATION THERAPY: RANZCR 2016

APPROPRIATE, COLLABORATIVE AND TARGETED

67th ANNUAL SCIENTIFIC MEETING | GOLD COAST, AUSTRALIA | 13 – 16 OCTOBER 2016 8

Inside News

Engaged Members

Social Program

Registration and Information

In addition to an outstanding scientific program, the meeting provides an excellent opportunity to catch up with old friends and network with new industry colleagues at the numerous social functions: the Welcome Reception on Thursday evening followed by the Faculty of Radiation Oncology Dinner; the prestigious Annual Ceremony and Reception on Friday; as well as the formal Gala Dinner on Saturday. This year, we welcome both radiology and radiation oncology trainees and junior consultants to the renamed Trainee and Junior Consultants Reception on Friday night.

Registrations for the ASM will open in April; register early and take up the discounted registration opportunity. For all the latest updates and hot off the press information, follow the College on Facebook, Twitter and LinkedIn using #RANZCR2016 , #RADgold or visit www.ranzcr2016.com

After a successful inaugural fun run, the Targeting Cancer fun run will again be held this year. We look forward seeing more participants this year, supporting this exciting event. Further details will be available via the meeting website.

We look forward to seeing you on the Gold Coast in October.

MODERN IMAGING AND RADIATION THERAPY:

Dr Jonathan Corness Dr Sanjay Dhupelia 2016 Radiology Co-Convenors

APPROPRIATE, COLLABORATIVE AND TARGETED

Dr Catherine Bettington Dr Jim Jackson 2016 Radiation Oncology Co-Convenors

67th ANNUAL SCIENTIFIC MEETING | GOLD COAST, AUSTRALIA

Venue The Gold Coast Convention and Exhibition Centre is the perfect location for business and pleasure, providing a professional environment for the educational program as well as close access to gorgeous beaches and popular tourist attractions. The warm October weather and wide range of activities makes it the perfect opportunity to bring the whole family.

KEYNOTE SPEAKERS

KEY DA

Radiology

Radiation Oncology

Dr Russell Fritz National Orthopedic Imaging Associates San Francisco, USA

Dr Silvia Formenti WeillVolume Cornell Medical and2016 12 No 2College I March New York Presbyterian Hospital New York, USA

Professor Fiona Gilbert

Call for

January 20

9 Call for

April 2016

Engaged Members

Dr Liz Kenny Adjunct Professor, School of Medicine, University of Queensland; Senior Radiation Oncologist, Royal Brisbane and Women’s Hospital; Medical Director, Central Integrated Regional Cancer Service (CIRCS); Medical Director, Herston Imaging Research Facility; Chair, Statewide Cancer Clinical Network, Queensland Health Co-opted member of the Faculty of Radiation Oncology Council

Dr Liz Kenny

Background When I was asked to consider being co-opted onto the Faculty Council, I gave this most gracious invitation a great deal of thought before accepting.

“It is my firm view that an emphasis on quality in every aspect of our care will underpin our future.”

Having been so involved in the College previously, I had considered it so very appropriate to have our younger colleagues with fresh ideas lead our future and I consider that they have done so with great aplomb. It has been a great source of pride and satisfaction to see the Faculty flourish. The issues that we deal with have not changed, but evolved somewhat. Governments come and go and senior bureaucrats who become familiar with the issues surrounding our complex specialty then move on, requiring a constant updating of government teams.

Why I Am Involved With patient care central to our specialty and with sophisticated and rapidly evolving technology at our fingertips, caring for patients at a most vulnerable time of their life is a rare privilege. It is unique in medicine. Targeting cancer has never been so meaningful and through the Targeting Cancer campaign, our patients become our greatest advocates. Even though we are champions of multidisciplinary care, the importance of local cure is not well appreciated. Local therapies have been mostly overshadowed by systemic treatment, yet radiation therapy, like surgery, contributes greatly to local and hence

Inside News

systemic cure and of course to symptom control in many patients. Bringing the cancer community and our funders to rethink how cancer care and research is funded will be critical moving forward with drug expenditure spiralling steadily upwards for increasingly small gains. These are going to be difficult community discussions. The importance of effective local and systemic treatment needs to be upfront and central. There is a wonderful opportunity within our College for us to partner with our interventional radiology colleagues, who also have rapidly evolving and amazing technology at their fingertips and who can also contribute in a major way to local cancer treatment. We must be at the forefront of managing the appropriate use of all of this technology. We need to constantly refine the evidence to support patient selection and to reduce morbidity of treatment.

Encouragement to Others We are a cancer College in every respect from diagnosis though treatment. It is my firm view that an emphasis on quality in every aspect of our care will underpin our future. We need to be embedded in and champion multidisciplinary teams. We need to be experts at what we do, understand our limitations and on-refer to other expert radiation oncologists when required. We also need to ensure that our junior and regional colleagues are well supported. I look forward to supporting the Faculty in any way that I can.

Engaged Members

Dr Kate O’Connor Radiologist at Auckland District Health Board and Auckland Radiology Group Elected Fellow on the Faculty of Clinical Radiology Council

Dr Kate O’Connor

Background I have spent my career as a radiologist in New Zealand splitting time more or less equally between the private and public sectors. I have an interest in head and neck imaging but work mainly as a general radiologist.

“If you don’t participate you can’t complain! I would therefore encourage all members to contribute and support College activities.”

I began my involvement with the College when a colleague asked me about 10 years ago whether I’d be interested in being on the interview panel for registrar selection for our Auckland Regional Training Program. Since then we have seen our local interview process amalgamate with the rest of New Zealand to what is now a national MATCH trainee selection system and are prepared to face the challenges of the networked rotational system for training now in place across New Zealand and Australia. Subsequent to that initial introduction to a College role, I have gone on to become a supervisor of training and an examiner for the College Part 2 Viva exams.

Why I Am Involved I have an interest in medical regulation, professional standards and the health of medical practitioners, which developed during my time as an elected member on the Medical Council of New Zealand (MCNZ). I served three terms for a total of 10 years and during that time developed an understanding of the role that colleges play in the maintenance of professional standards, medical ethics, training and quality improvement.

That tenure also emphasised the importance of good governance and the necessity to ensure that policies are relevant, transparent and can achieve their intended purpose. I had been asked several times to be involved in the College, mostly for the New Zealand Branch, but the timing wasn’t right. When I was sounded out last year about standing, it seemed timely, nearly five years after leaving MCNZ, to experience the ‘other side of the fence’ and I am very honoured to have been elected to the role on the Faculty of Clinical Radiology Council.

Encouragement to Others The College may be perceived by its membership as not being directly relevant or, as can be heard in New Zealand, as being more focused on the Australian medical and Medicare environment. However, as the College is a member organisation it can only do what we as members prioritise as important and direct it to do. If you don’t participate you can’t complain! I would therefore encourage all members to contribute opinions, offer expertise and make time to engage in and support College activities.

Volume 12 No 2 I March 2016

Effective Governance

2016 Election Schedule

The Board of Directors

The Faculty of Clinical Radiology Council

Scrutineers appointed

18 March

Scrutineers appointed

18-19 Feb

Invitations to nominate posted by

27 May

Invitations to nominate posted by

8 July

Nominations close at 4 pm

20 June

Nominations close at 4 pm

1 August

Ballot papers posted by

1 July

Ballot papers posted by

12 August

Voting closes at 2 pm

25 July

Voting closes at 2 pm

12 September

Voting counted

29 July

Voting counted

15 September

Results declared at AGM

13 October

Results declared at AGM

13 October

Term of successful candidates commences

1 January 2017

Term of successful candidates commences

1 January 2017

The Faculty of Radiation Oncology Council Scrutineers appointed

25-26 February

Invitations to nominate posted by

8 July

Nominations close at 4 pm

1 August

Ballot papers posted by

12 August

Voting closes at 2 pm

12 September

Voting counted

15 September

Results declared at AGM

13 October

Term of successful candidates commences

1 January 2017

As per the College Election Schedule for 2016 there will be one position up for election on the Board of Directors and three on each Faculty Council. Each position is a three year term, and commences 1 January 2017. The positions of Faculty of Clinical Radiology Dean and Faculty of Radiation Oncology Dean will require an election, both positions will commence 1 January 2017. If you have any questions about these elections, please contact Danielle Callahan, Executive Assistant to the CEO, at the College on danielle.callahan@ranzcr.edu.au

Notice of termination of membership At a meeting of the RANZCR Board of Directors held on Friday 30 October 2015, the directors voted that the membership of John Henry Kearsley be terminated with immediate effect pursuant to Article 5.1.2(b) of the RANZCR Articles of Association, following his suspension from practice by the Medical Council of New South Wales. He has returned his Fellowship Certificate as requested.

Inside News

Right Scope and Focus

Recognition of Training in Interventional Neuroradiology Update from the Conjoint Committee

CTCA Submission Deadlines The CT Coronary Angiography (CTCA) Conjoint Committee submission deadlines for applications are available via the ANZCTCA website www.anzctca.org.au Applications must be submitted prior to the deadline if specialists wish for a preliminary assessment to be completed. It is advisable for all specialists to follow the CTCA Conjoint Committee guidelines when completing applications. 2016 CTCA submission deadlines • 2 May 2016 • 5 August 2016 • 17 October 2016

The Conjoint Committee for Recognition of Training in Interventional Neuroradiology (CCINR) was formed in 2014 with the support of the Faculty of Clinical Radiology Council, to formulate guidelines for training in interventional neuroradiology. The committee has equal representation from the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Neurosurgical Society of Australasia (NSA) and the Australian and New Zealand Association of Neurologists (ANZAN). The CCINR guidelines are a benchmark for the safe performance of endovascular intracranial procedures for interventional neuroradiology (INR) practitioners in Australia and New Zealand. They were formulated with reference to existing international standards, such as those published by the European Union of Medical Specialists (UEMS). The guidelines relate to all intracranial procedures performed by the endovascular route. They do not relate to extracranial interventions with which there is overlap with other craft groups.

The CCINR guidelines have been endorsed by ANZSNR, NSA, ANZAN and the Faculty of Clinical Radiology Council, as well as the Society for NeuroInterventional Surgery (SNIS) and the European Society of Minimally Invasive Neurological Therapy (ESMINT).

Please contact the CTCA Conjoint Committee secretariat, if further information is required ctca@ranzcr.edu.au

The CCINR has invited all INR practitioners who meet the criteria for the experienced applicant pathway to apply for assessment via the CCINR website before 30 April 2016. INR practitioners who are not eligible for the experienced applicant pathway will be able to apply via the standard application pathway from May 2016. The Guidelines for Recognition of Training in Interventional Neuroradiology can be viewed at www.ccinr.org.au If you would like further information, please contact Janet Diep, Manager, Professional Development at the College at janet.diep@ranzcr.edu.au or on +61 2 9268 9702.

Volume 12 No 2 I March 2016

E RS

W E N

U O C

INTENSIVE PELVIC MRI COURSE

** U P D AT E D R E C TA L , P R O S TAT E & G Y N C A S E S **

PA R K R OYA L O N P I C K E R I N G S I N G A P O R E 12 - 14 S E P T E M B E R 2 0 1 6 Three International Faculty Fergus V Coakley Dow-Mu Koh Koenraad J Mortele

Course Director Clair Shadbolt

Local Faculty Stefan Heinze Damien Stella Andrew Dobrotwir

“

One of the best, if not the best course I've ever been to! Delegate Melbourne, Feb 2016

The highly acclaimed Melbourne Intensive Pelvic MRI Course is now being offered in Singapore. This individual Mac workstation based course incorporates a comprehensive range of pathology: •

Full day of staging of rectal cancer MRI including TRG post treatment cases

•

Full day of Prostate MRI including Prostate MRI biopsy

•

Full day of GYN MRI including a broad range of benign and malignant pathologies

www.tni-australia.com/singapore

Research

Study Aims to Progress Prostate Cancer Treatment The Radiation Oncology Research Committee is committed to promoting the critical importance of research as part of good practice through the administration of grants and awards. In 2014, the committee awarded the Ferring Pharmaceuticals Research Grant to Dr Kumar Gogna and his team for their research study ‘A single arm, prospective Phase II study of Split-Course Pelvic Radiotherapy for patients with Locally Progressive Castrate Resistant Prostate Cancer’.

Background In a majority of the patients with castrate resistant prostate cancer (CRPC) who in the past have principally been managed with androgen deprivation, skeletal metastases usually dominate the clinical picture. However, about 10-18 per cent 1, 2 of these patients can present with disconcerting morbidity from locally progressive disease, usually characterised by significant urinary symptoms. Some patients may also present with pelvic pain and/or rectal symptoms. Managing the urinary symptoms may require multiple surgical interventions. Response can be short lived and repeat procedures can be challenging. Pelvic exenteration3 is an option, but clearly difficult to justify in the majority. The effect of newer systemic therapies on locally progressive disease has not been defined. Whilst there is a lack of prospective data, the utility of pelvic radiation therapy (RT) in effectively palliating locally progressive CRPC is supported by a number of retrospective case series 4-9 with most suggesting improved results with higher doses and possibly longer courses of treatment. This includes our own experience with a high dose hypo-fractionated split course regimen10 based on the following principles: • Prostate cancer has a low α/β ratio and therefore one would anticipate a better response with hypofractionation. • A break in treatment may assist in minimising acute toxicity. Accelerated re-population11 is usually not an issue with prostate cancer and therefore unlikely to compromise local control.

•O verall treatment is shortened and inconvenience to patients and carers is minimised. • I f clinically dictated, the second half of RT course may be omitted in the knowledge that the initial course is likely to provide some benefit at least in the short term12.

Summary The current Phase II trial is a single arm locally based study designed to prospectively investigate the split course regimen further with the hypothesis being that it (i) results in improved bladder and bowel related quality of life (measured on the EPIC QoL instrument),12 (ii) has low acute toxicity, (iii) is effective and results in a durable response, and (iv) further local interventions are likely to be minimised. Treatment Regimen: 3D conformal RT/IMRT: 55Gy in 22 fractions given as two courses of 25Gy and 30Gy in 10 and 12 fractions respectively separated by a one week treatment break. The initial aim is to accrue 20 patients and based on the results, the subsequent plan would be to undertake an extended study either in its original format or with modifications through the auspices of the Trans-Tasman Radiation Oncology Group and the ANZUP Cancer Trials Group. To date, 10 patients have been accrued and it is hoped that the target accrual will be reached in 12-15 months’ time.

continued over... Volume 12 No 2 I March 2016

Research

The investigators are extremely grateful to the Radiation Oncology Research Committee, the College and Ferring Pharmaceuticals for this grant which has made it possible for the study to be undertaken. The investigators are: N. Kumar Gogna1, Catherine Bettington3, Tanya Holt1, Brigid Hickey1, Margot Lehman2, Adrienne See2 and Lee Tripcony3. 1) Radiation Oncology Mater Centre (PAH) Brisbane, Qld. 2) Princess Alexandra Hospital, Brisbane Qld. 3) Royal Brisbane Hospital, Brisbane Qld.

References: 1. Otnes B, Harvei S, Fossa SD. The burden of prostate cancer from diagnosis until death. British Journal of Urology 1995;76:587-94. 2. Fossa SD, Dearnaley DP, Law M, Gad J, Newling DW, Tveter K. Prognostic factors in hormone-resistant progressing cancer of the prostate. Annals of Oncology 1992;3:361-6. 3. Kamat AM, Huang SF, Bermejo CE, et al. Total pelvic exenteration: effective palliation of perinealpain in patients with locally recurrent prostate cancer. Journal of Urology 2003;170:1868-71. 4. Hindson B, Turner S, Do V. Palliative radiation therapy for localized prostate symptoms in hormone refractory prostate cancer. Australas Radiol 2007;51:584-8. 5. Furuya Y, Akakura K, Akimoto S, Ichikawa T, Ito H. Radiotherapy for local progression in patients with hormone-refractory prostate cancer. International Journal of Urology 1999;6:187-91. 6. Hernes EH, Linja M, Fossa SD, et al. Hormone-resistant prostate cancer with symptomatic pelvic tumours: patient survival and prognostic factors. BJU International 2000;86:240-7. 7. Fossa SD. Palliative pelvic radiotherapy in patients with hormone-resistant prostatic cancer. Progress in Clinical & Biological Research 1987;243B:479-85.

8. Lankford SP, Pollack A, Zagars GK. Radiotherapy for regionally localized hormone refractory prostate cancer. Int J Radiat Oncol Biol Phys 1995;33:907-12. 9. Gogna NK, Baxi S, Hickey B, Baumann K, Burmeister E, Holt T. Split-course, highdose palliative pelvic radiotherapy for locally progressive hormone-refractory prostate cancer. Int J Radiat Oncol Biol Phys 2012;83:e205-11. 10. PP, Pilepich MV, Krall JM, et al. The effect of overall treatment time on the outcome of definitive radiotherapy for localized prostate carcinoma: the Radiation Therapy Oncology Group 75-06 and 77-06 experience. Int J Radiat Oncol Biol Phys 1991;21:925-33. 11. Din OS, Thanvi N, Ferguson CJ, et al. Palliative prostate radiotherapy for symptomatic advanced prostate cancer. Radiotherapy & Oncology 2009;93:192-6. 12. Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 2000;56:899-905.

Research Awards Applications Closing Please visit the College website for guidelines and application forms www.ranzcr.edu.au/members/awards-aprizes/research-awards-a-grant • Clinical Radiology Early Career Researchers Prize • Varian Medical Systems Educational Grants • Ferring Pharmaceuticals Grant • Genito-Urinary Fellowship Grant • Withers and Peters Grant • Windeyer Fellowship • Bourne and Langlands Prize Guidelines and nomination forms can be downloaded from the College website www.ranzcr.edu.au/members/awards-aprizes/research-awards-a-grant Applications for the above research awards close Friday 8 April 2016.

Inside News

RANZCR Research Grants 2016 – Clinical Radiology and Radiation Oncology The College’s research grants are to support Fellows, Educational Affiliates and student members of the College engaged in research. Recipients will be determined by the Research Committees for clinical radiology and radiation oncology. Guidelines and application forms can be downloaded from the College website: www.ranzcr.edu.au/members/awards-aprizes/research-awards-a-grant Applications for RANZCR Research Grants close Thursday 30 June 2016.

Further Information If you need any further information or have any questions, please contact Manager, Research Co-ordination at the College on research@ranzcr.edu.au or +61 2 9268 9732

Profile and Presence

International Day of Radiology 2015

Dr Greg Slater, Ms Pattie Beerens, Dr Darren Ault, Ms Karen McNamara MP, Ms Maria Vamvakinou MP, Mr Jason Clare MP, Dr Christian Wreidt, Dr Manish Jain.

On Tuesday 10 November, 2015, The Royal Australian and New Zealand College of Radiologists (RANZCR) attended a morning tea organised by the Australian Diagnostic Imaging Association (ADIA) at Parliament House in Canberra to celebrate the 4th annual International Day of Radiology (IDoR). International Day of Radiology celebrates the anniversary of Wilhelm

Conrad Roentgen’s discovery of the existence of X-rays on 8 November in 1895. The annual event is celebrated around the world to build a greater awareness of the importance of radiology in the community and the significant advances that have been achieved in the healthcare system through diagnostic imaging.

The theme for the fourth year of IDoR was paediatric imaging. The day was dedicated to highlighting the crucial role that radiology has in the detection, diagnosis and management of a wide variety of diseases affecting children and the specialised treatment required for younger patients. continued over...

Volume 12 No 2 I March 2016

Profile and Presence

The morning tea was attended by RANZCR President A/Prof Chris Milross, incoming RANZCR President Dr Greg Slater, RANZCR CEO Natalia Vukolova and SEO, Faculty of Clinical Radiology Mark Nevin. Members of Parliament in attendance included the Hon Jason Clare MP, Member for Blaxland – New South Wales, Mrs Karen McNamara MP, Member for Dobell – New South Wales as well as Ms Maria Vamvakinou MP, Member for Calwell – Australian Capital Territory. Many stakeholders from various health and consumer associations were also present.

Dr Rebecca Read, Breast Surgery ANZ, A/Prof Chris Milross, Ms Natalia Vukolova

Two short video presentations on the improvements achieved in prostate and breast cancer imaging were shown during the event. The videos, available at www.adia.asn.au/media-resources/ international-day-of-radiology-2015/, captured the valuable role diagnostic imaging plays in detecting and monitoring cancers that affect thousands of Australians each year.

In the lead up to IDOR 2015, the College prepared to celebrate the day by encouraging radiologists and practices in Australia and New Zealand to promote their work. An information pack filled with promotional and educational material for radiology practices to send to referrers and to distribute to members of the public in their

practices was produced by the College in collaboration with the Australian Commission on Safety and Quality in Health Care.

Cardiac CT Training 2016 We go beyond simply meeting training requirements: 2016 Course Dates:

5 Day Level A Course 19th - 23rd May 2016

$8,000 +GST $6,000 +GST for first 4 Fellows

3 Day Refresher Course 21st - 23rd May 2016

$4,000 +GST $3,500 +GST

for previous AICCT students

For more information and online registration log on to:

www.aicct.com.au or contact us at:

info@aicct.com.au

Inside News

Participants eligible to claim 124.75 RANZCR CPD points for the 5 day course and 72.5 CPD points for the recertification course. Maximum allowable course based live and library cases for ANZ credentialing.

Clinician led teaching by high volume operators.

State of the art low dose, High Definition imaging.

Unrivalled venue and catering optimises the learning experience.

Course Director Dr. Daniel Friedman is a fellow of the Society of Cardiovascular CT, a current member of the ANZ CTCA Conjoint Committee and was the founding chairman of the ANZ International Regional Committee of SCCT. He has been an invited speaker at numerous National and International meetings. He is the Chief Executive of Spectrum Cardiac Imaging and has vast experience in Cardiac CTA. He was instrumental in establishing the collaborative approach to Cardiac Imaging in Australia.

Profile and Presence

InsideRadiology

is the College’s consumer information website. It provides consumers and referrers with information about radiology procedures and interventions that is easy to use and understand. The tests, procedures and interventions on the website have been chosen because they represent the more commonly used radiology procedures and those of particular interest to consumers and referrers. There are now a total of 190 information items covering 98 topics on the website developed by over 80 contributors since 2008.

Traffic By Month

Traffic By Year Over

3500000

50000

3000000 Unique visitors

2500000

40000

Sessions

2000000

Pages

1500000 30000

3 million pages

Over viewed during 2 million sessions

1000000

increase

An in traffic of 81% since 2014

500000 20000

Dec-15 Nov-15 Oct-15 Sep-15 Aug-15 Jul-15 Jun-15 May-15 Apr-15 Mar-15 Feb-15 Jan-15

Sessions

38 million hits

2009 2010 2011 2012 2013 2014 2015

Pages

Accessing the site

Who is using InsideRadiology

45.35%

 41.46% 344,554 SESSIONS FROM 161 CITIES AND REGIONAL CENTRES

12.89% 2,159

230 COUNTRIES (18,930 CITIES)

visitors via social media

Gadolinium Contrast Medium Iodine-containing contrast medium

NM Bone Scan Transvaginal Ultrasound

Arthrogram Bursal Injection NM Renal Scan CT Saline Infusion Sonohysterography VQ Scan The Radiographer The Radiologist Coronary Artery Calcium Scoring

Ultrasound MRI

Australian visitors (compared to 2014)

64.21%

What are they looking at on InsideRadiology 18-20 Week Pregnancy Ultrasound

75.20%

Breast Fine Needle Aspiration Breast Core Biopsy Radiation Risk of Medical Imaging X-rays Nuclear Medicine Contrast Medium Iodine-131 Therapy Cardiac MRI Joint Injection Biliary Drainage NM Cardiac Stress Test

Thyroid fine needle aspiration Radiation Risk of Medical Imaging During Pregnancy

Traumatic Vascular Injury Nuchal Translucency Scan

New Zealand Visitors

Approx. 1 out of 5 page views from an Australian or New Zealand visitor



70,000

Over items downloaded

13.5%

of the total traffic is for the contrast information items

www.insideradiology.com.au Volume 12 No 2 I March 2016

Profile and Presence

Targeting Cancer Raises the Profile of Radiation Oncology more people to our website and trigger more conversations between cancer patients and GPs on whether radiation therapy is a suitable treatment option.

World Cancer Day Our first TV Documentary on Radiation Therapy The Targeting Cancer campaign team, driven by clinical lead, A/Prof Sandra Turner, worked in collaboration with Tonic Health Media (THM)* to produce the documentary Below the Radar, with the assistance of the College. The 28-minute documentary shows real patient stories about the value of radiation therapy and delivers the campaign messages about safety, effectiveness, cost effectiveness and the sophisticated technologies involved with radiation therapy. The College is permitted to use this documentary for advocacy purposes on the website and through social media and other channels.

World Cancer Day unites the world’s population in the fight against cancer and at the College, staff and stakeholders did their part to support the Targeting Cancer campaign with the “We can, I can” message. Photos of hands with inspirational messages of support and thoughts that challenged perceptions on cancer, were shared on various social media accounts

promoting the ‘Talking Hands’ initiative, using the tags @TargetingCancer #WorldCancerDay #WeCanICan. Targeting Cancer received a mention on World Cancer Day on Channel Ten’s Eyewitness News. Weather presenter Tim Bailey asked viewers in his segment ‘Pause for a Cause’ to think about cancer and told the story of three-year-old Lucas Browne, who was given radiation therapy after surgery for a brain tumour to stop the cancer coming back and who now lives a normal life. Lucas fronts the home page of the Targeting Cancer website.

*Tonic Health Media (THM) is an initiative of respected health broadcaster, Dr Norman Swan, and is an evidence-based patient education and entertainment system for GPs, other clinicians and hospital waiting areas. The content produced by THM is designed to improve health literacy and facilitate better outcomes for patients, doctors, and the Australian health industry. Targeting Cancer is fortunate to have entered into a partnership with THM, with generous support from Varian Medical Systems, to promote radiation therapy to the GP communities.

Below the Radar was broadcast on ABC News 24 on 6 February and 7 February, and will also be played on the THM Network. If you missed the live broadcast, please visit www.targetingcancer.com.au and www.targetingcancer.co.nz and share within your network to spread the word on radiation therapy. In November 2015, our Community Service Announcement Targets was played 148,548 times on the THM Networks across 383 waiting rooms in sites where over 2,700 GPs operate. It is estimated that the video has reached an audience of over 800,000 people. The video was played again in February and March 2016, more statistics will be available, in the next edition of Inside News. We are hoping this will direct Supporting World Cancer Day with a show of hands

Inside News

Profile and Presence

Support Targeting Cancer activities City to Surf Do you want to challenge yourself and have fun whilst promoting radiation therapy and Targeting Cancer? The 2016 City2Surf will be held on Sunday, 14 August 2016 and we are looking for participants to join our team. The City2Surf is 14km in distance starting in Sydney’s CBD before heading through Rose Bay, up ‘Heartbreak Hill’ (the toughest part of the course) and finishing at Bondi Beach. 2016 registration dates and entry fees anticipated to be available in April/May on the City2Surf website. We will keep you updated via the Faculty newsletter and the Targeting Cancer website. If you are interested in participating in this fun event, please register your interest info@targetingcancer.com.au

Macquarie University Hospital, Mater Private Hospital Springfield, and Genesis Cancer Care Shenton House in Australia and Wellington Hospital in New Zealand hosted successful GP Oncology Education Evenings in the first quarter of the year. All attendees thought highly of the event, which has improved their knowledge of radiation therapy, and would recommend it to their colleagues. Five GP evenings are already confirmed for 2016, while a further five sites have expressed interest in hosting such an evening but are yet to confirm a date.

We are always looking for patient stories, good news stories about RT, patient resources and photos that will help in raising the profile of RT. Please email us at faculty@ranzcr.edu.au to share the resources. Like Targeting Cancer on Facebook, or Follow @targetingcancer on Twitter, and help us spread the word. Please help us make Targeting Cancer THE brand to promote our fantastic treatment!

We would like to thank our members and the teams from those sites for organising these events. If you are interested in hosting a GP Oncology Education Evening, please contact us on faculty@ranzcr.edu.au and we will provide all the materials to assist you.

GP Oncology Education Evenings GP Oncology Education Evenings provide General Practitioners (GPs) with the opportunity to learn about the role of radiation therapy for their patients from the team on site in a centre close to them. The first education evening was held in October 2014 at Westmead Hospital in Sydney and since then, around 20 departments across Australia and New Zealand have hosted these sessions. Hundreds of GPs have attended the events and reported that the session significantly improved their understanding of radiation therapy and that they would recommend the session to their colleagues. We would like to sincerely thank everyone who has been involved in organising these events which have proved to be very popular among practice staff members as well.

GP evening recently held at Wellington Hospital

Volume 12 No 2 I March 2016

Access to Quality Services

DI Horizon Scanning Forum Update Much has been achieved since the inaugural forum over a year ago As you may be aware, the Faculty of Clinical Radiology hosted the inaugural Diagnostic Imaging Horizon Scanning Forum on Wednesday, 26 November 2014 at the College office in Sydney. The following nine applications were presented at the forum by their respective applicant: 1. Image guided ablation techniques: Including radiofrequency ablation, microwave ablation, cryoablation, alcohol ablation 2. Radio guided Occult Lesion Localisation Using Iodine 125 seeds (ROLLIS) 3. Autologous Blood Injection (ABI); Platelet Rich Plasma Injection (PRP); and Blood Derived Products (BDP) 4. Foetal / Uteroplacental MRI 5. MRI Pelvis Fistula in Ano 6. Magnetic resonance peripheral angiography 7. Insertion of lesion localisation markers 8. Simultaneous MR PET 9. PET scanning By way of background, the College allocated resources for the 2014–15 financial year to directly support five Medical Services Advisory Committee (MSAC) submissions that potentially offer the most benefit to our patients and that possess the necessary evidence base and cost-benefit ratios to withstand the stringent MSAC evaluation process. Of the nine applications listed above, attendees at the forum identified six applications that were deemed to have enough supporting evidence to progresses to a literature search. Following an assessment of the literature review, the following applications were chosen to be supported through the MSAC application process:

1. Image guided ablation techniques: including radiofrequency ablation and microwave ablation 2. Obstetric MRI 3. Magnetic resonance peripheral angiography 4. Insertion of lesion localisation markers. Despite the other applications not progressing at this stage, the College is looking to garner further information from the applicants with a view to future potential applications. Of particular interest are the PET/MR and PET/ CT applications, both of which were identified as essential future listings, however, further evidence is required in order to progress to an MSAC application. Since the forum, Mr Andrew Paine, Senior Analyst for Economics at the College has been working with Health Technology Assessment (HTA) expert, Dr Eugene Salole, and the respective applicants to refine the applications for the MSAC process, in line with the College’s strategic pillar Quality service delivery: Access to quality services. More recently, applications for microwave ablation liver and lung were made to MSAC by an applicant external to the College. The College has been in contact with the applicant and has offered ongoing support through the MSAC process. Although the focus of the 2014 Horizon Scan was on Australia, the principles and learnings are readily applicable to New Zealand, and the College’s Policy and Advocacy Team will be looking to take this forward in the next horizon scan commencing in the 2016–17 financial year.

MSAC Reform Process The College has provided ongoing feedback to the Department of Health (DoH) in relation to reforms to the MSAC process. This has taken the form of consultations and meetings with the department designed to outline the changes needed to streamline what is a demanding but highly necessary process for all sides. Recently, the College responded to a consultation on the department’s Segmentation Framework, a document designed to highlight new changes to the MSAC process that will assist in increasing transparency. Our submission can be found on the College website www.ranzcr.edu.au/ advocacy/submissions Although some positive steps have been made, the College continues to raise concerns that the framework is difficult to interpret and further work is needed to create a process that can be easily understood by the applicant and remain flexible enough to cope with the quickly changing nature of health technology. The College will continue to liaise with the department in order to work towards a transparent and flexible MSAC process.

If you are interested in being involved with any of the above applications, or have any questions of comments please do not hesitate to contact Mr Andrew Paine, Senior Analyst for Economics at the College on andrew.paine@ranzcr.edu.au

Volume 12 No 2 I March 2016

Quality Practice

Mandatory Reporting

Medical practitioners have certain statutory duties under legislation applicable to each individual state or territory. However, there are some overarching guidelines for both Australia and New Zealand In Australia, the criteria requiring grounds for mandatory reporting are defined as follows: • Any practitioner or employer who forms a belief that another practitioner has engaged in notifiable conduct is obliged to make a report to AHPRA as soon as practicable. • “Notifiable conduct” is defined as follows: o practised the practitioner’s profession while intoxicated by alcohol or drugs; or o engaged in sexual misconduct in connection with the practice of the practitioner’s profession; or

o placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or o placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards. • This obligation applies to all practitioners and employers of practitioners in relation to the notifiable conduct of practitioners across all health professions. Note that individual laws do vary where the notifying practitioner is also treating the practitioner and reference should be made to the regional legislation.

For more information regarding obligations in Australia The Medical Board of Australia provides comprehensive guidelines regarding mandatory reporting on their website www.medicalboard.gov.au/CodesGuidelines-Policies/Guidelines-for-mandatory-notifications.aspx. There is an interactive version as well as a downloadable pdf document. AHPRA also provides guidelines on their website www.ahpra.gov.au/ Notifications/Who-can-make-a-notification/Mandatory-notifications.aspx and links can be found there to each of the National Boards, who also provide guidelines and links to appropriate legislation for medical practitioners. The Medical Radiation Practice Board publish specific guidelines on the AHPRA website at www.medicalradiationpracticeboard.gov.au/Codes-Guidelines/Codes-andGuidelines.aspx . Departments of Health in each state are also useful resources.

Inside News

• There is also a mandatory obligation for education providers and practitioners to report a student with an impairment that may place the public at substantial risk of harm. What does reasonable belief mean? The MBA states that this must be “a stronger level of knowledge than mere suspicion” and that there is “a concern of the public being placed at risk of harm”. Failure to report may result in action by AHPRA in respect of conduct and performance.

For more information regarding obligations in New Zealand Information about when a practitioner needs to make a complaint about another can be found on the Medical Council of New Zealand website www.mcnz.org.nz/ There are several touch points listed under “Fitness to practise” including “Competence Concerns”, Health Concerns”, “Conduct Concerns” and “Making a Complaint”.

If you have any comments or would like to discuss any aspect of mandatory reporting please contact Laina De Winne, Head of Member Engagement at the College at laina.dewinne@ranzcr.edu.au or on +61 2 9268 9777

Quality Practice

Quality Guidelines for Volume Delineation in Radiation Oncology This group was led by A/Prof Shalini Vinod. One of the challenges was to produce a document that would be useful for the whole target audience— from subspecialists at larger institutions, to generalists at smaller centres, and to trainees.

New Zealand have criteria based on “Risk of harm” and “Risk of serious harm”” indicated respectively by Risk of harm • a pattern of practice over a period of time that suggests the doctor’s practice of medicine may not meet the required standard of competence; or • a single incident that demonstrates a significant departure from accepted standards of medical practice; or • recognised poor performance where local interventions have failed - this does not exclude notification of serious concerns where internal review or audit is inaccessible or unavailable to the person with the concern; or criminal offending; or • professional isolation with declining standards that become apparent. Risk of serious harm may be indicated when: • an individual patient may be seriously harmed by the doctor; or • the doctor may pose a continued threat to more than one patient and as such the harm is collectively considered ‘serious’; or • there is sufficient evidence to suggest that the alleged criminal offending is of such a nature that the doctor poses a risk of serious harm to one or more members of the public. Practitioners, in either country, who file frivolous reports for the purposes of mischief may also be subject to conduct action. Practitioners are urged to keep up to date with the current requirements by reviewing the information provided via these links.

QUALITY GUIDELINES FOR VOLUME DELINEATION IN RADIATION ONCOLOGY FACULTY OF RADIATION ONCOLOGY

THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF RADIOLOGISTS®

Modern technology allows radiation therapy to be delivered with increased accuracy. However, target delineation—a complex process involving multiple factors such as patient history, tumour pathology, known disease patterns, imaging modalities available and individual experience—is, by its very nature less accurate. Inaccuracies in target delineation can lead to a geographical miss of the tumour or increased dose to important organs at risk (OAR) resulting in poorer tumour control or increased toxicity. Finding agreement on the ‘true’ target volume is seldom possible even among experts. Minimising variation among radiation oncologists is an important goal to allow the delivery of quality treatment. The Quality Improvement Committee of the Faculty of Radiation Oncology (FRO) assembled a group of radiation oncologists to produce guidelines for volume delineation.

There was a strong emphasis on championing ongoing education, developing local contouring protocols, optimising the use of diagnostic imaging, and establishing mechanisms for volume review (including by radiologists). Although there can be no one-sizefits-all solution, it is hoped that the stepwise approach of the guidelines will allow institutions and individuals to come up with an approach that suits their own environment. An important part of the document is a table listing accessible site specific tumour and OAR atlases and contouring guidelines. The purpose was not to endorse any specific publication but to allow a framework for the development of local protocols. To access a copy of the guidelines, visit the College website www.ranzcr.edu. au/resources/professionaldocuments/ guidelines Dr Gerard Adams Consultant Radiation Oncologist Radiation Oncology Centres Bundaberg

If you have any questions about the guidelines, please contact the Faculty of Radiation Oncology on faculty@ranzcr.edu.au

Volume 12 No 2 I March 2016

What Matters Most

Established safety profile, well tolerated & approved for a broad range of clinically relevant indications and doses for adults & children ≥ 2 years#1,2

Macrocyclic contrast – belongs to class of gadolinium agents with highest stability vs ionic & non-ionic classes3

# Gadovist® 1.0 is approved for children aged 2 – 17 years; not recommended for use in children below 2 years due to a lack of data on efficacy and safety

Minimum Product Information GADOVIST® 1.0 [gadobutrol 1.0 mmol/mL] INDICATIONS: Adults, adolescents and children aged 2 years and over for contrast enhancement in cranial and spinal magnetic resonance imaging (MRI); contrast enhancement in whole body MRI including head and neck region, thoracic space, breast, abdomen (pancreas, liver and spleen), pelvis (prostate, bladder and uterus), retroperitoneal space (kidney), extremities and musculoskeletal system*; first–pass MRI studies of cerebral perfusion; contrast enhancement in magnetic resonance angiography (CE MRA); contrast enhancement in cardiac MRI including assessment of rest and pharmacological stress perfusion and delayed enhancement*. CONTRAINDICATIONS: known hypersensitivity to gadobutrol or any of the ingredients. PRECAUTIONS: Severe renal impairment and liver transplant patients (see boxed warning); pronounced states of excitement, anxiety and pain may increase the risk or intensity of adverse reactions; anaphylactoid/hypersensitivity or other idiosyncratic reactions (higher risk in the case of previous reaction to contrast media, history of bronchial asthma, history of allergic disorders); severe cardiovascular disease; patients with a low threshold for seizures; limited MRI studies of cerebral perfusion; not recommended for use in children below 2 years of age; pregnancy (Category B3). ADVERSE EFFECTS: most common: headache; nausea; dizziness. Please refer to PI for a complete list. BOXED WARNING: NEPHROGENIC SYSTEMIC FIBROSIS: Gadolinium-based contrast agents increase the risk of nephrogenic systemic fibrosis (NSF) in patients with: acute or chronic severe renal insufficiency (glomerular filtration rate <30 mL/min/1.73m2; or acute renal insufficiency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period. DOSAGE AND ADMINISTRATION: Cranial and spinal MRI: 0.1 mL/kg body weight given intravenously at a rate of 2 mL per second. Maximum total amount of 0.3 mL/kg body weight may be administered. CE MRI of the whole body*: 0.1 mL/kg body weight. Cerebral perfusion studies: for gradient echo sequences 0.1 - 0.3 mL/kg body weight given intravenously at a rate of 5 mL per second using a powered injector. CE MRA: Imaging of one field of view: Less than 75 kg body weight: 7.5 mL, greater than or equal to 75 kg body weight: 10 mL; Imaging more than one field of view: Less than 75 kg body weight: 15 mL, greater than or equal to 75 kg body weight: 20 mL. CE Myocardial perfusion imaging and delayed enhancement*: 0.05 mL/kg body weight during pharmacological stress and 0.05 mL/kg body weight at rest; for delayed enhancement only, a total dose of 0.1 mL/kg body weight. Children (above 2 years of age) and adolescents: 0.1 mL/kg body weight for all indications. Renal impairment: Do not exceed the recommended dose*. DATE OF PREPARATION: January 2015.

Please review the full Product Information before administering. Approved PI available at http://www. bayerresources.com.au/resources/uploads/PI/file9345.pdf or upon request from Bayer Australia Ltd

Bayer Australia Ltd, ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. ® Registered trademark of the Bayer Group, Germany. LAU.MKT.DI.12.2015.0067 December 2015.

*Please note change(s) in Product Information.

References: 1. Voth M et al. Invest Radiol 2011;46:663-671 Safety of Gadobutrol, a New Generation of Contrast Agents. Experience from clinical trials and postmarketing surveillance 2. Australian Approved Product Information - Date of preparation: 14 January 2015 3. Frenzel et al. Invest Radiol 2008;43:817-828 Stability of Gadolinium-Based Magnetic Resonance Imaging Contrast Agents in Human Serum at 37°C.

Quality Practice

IGRT Position Paper Updated The increasing use of technology, such as intensity modulated radiotherapy, volumetric arc therapy and stereotactic ablative body radiotherapy, has allowed for highly conformal treatments. It has also meant that improved accuracy in the treatment room is needed. Image guided radiotherapy (IGRT), the use of imaging prior to or during treatment delivery, is an important technology that needs to be utilised with these highly conformal treatments. The Faculty of Radiation Oncology (FRO) wrote a position paper on IGRT in 2010. Since this original paper was written, a number of publications have been produced that look broadly into the quality assurance issues that need to be addressed for safe and effective IGRT. This paper has therefore been updated this year. The current update was written jointly by Faculty members in Australia and New Zealand, and wider consultation was made across the College for comment. The final draft was approved by FRO and the paper has been published on the College website www.ranzcr.edu.au/ advocacy/statements The current paper reviews and updates the evidence behind the use of IGRT. In a process driven area, it is often difficult to provide clinical evidence for the use of IGRT as there are multiple variables that can potentially impact on a patient’s

final outcome. Nevertheless, there are a number of publications, some of them originating from our region, that support the use of IGRT and these are outlined in the paper. Publications supporting the use of IGRT are strongest in urological, head and neck and lung cancers and these are used as illustrative examples. However, the evidence is by no means limited to these tumour sites. The paper also outlines some of the international publications that are important references for ensuring good IGRT practices. Finally, a number of key recommendations endorsed by FRO are listed for the safe and effective implementation and practice of IGRT in the Australian and New Zealand context.

If you have any questions about the paper, please contact the Faculty of Radiation Oncology on faculty@ranzcr.edu.au

The paper is intended to be read by all members of the FRO. In particular, it is intended to be used as a starting point when reviewing departmental IGRT processes and it is also important when considering the resources required for the safe and effective delivery of radiation therapy in the treatment room. Dr Albert Tiong Radiation Oncologist Peter MacCallum Cancer Centre

MODERN IMAGING AND RADIATION THERAPY: RANZCR 2016

APPROPRIATE, COLLABORATIVE AND TARGETED

67th ANNUAL SCIENTIFIC MEETING | GOLD COAST, AUSTRALIA | 13 – 16 OCTOBER 2016

Volume 12 No 2 I March 2016

Quality Practice

Iodinated Contrast Media Guideline, 2016 Version Revision of the contrast guidelines published in 2009 was necessary to reflect changes in the contrast administration landscape. The decision-making process around contrast administration is one of the most challenging aspects for all members of the medical imaging team. It is a topic that the College continually receives queries about. The previous Iodinated Contrast Guidelines, published in 2009, required revision to reflect the changing landscape regarding contrast administration. A working group was formed in late 2014 following expressions of interest received from eight Fellows to an advertisement on the College website. A further Fellow, a nephrologist and a radiographer also joined the group. The relevant contrast guidelines from the European Society of Urogenital Radiology, The Royal College of Radiology, the American College of Radiology and the Canadian Association of Radiologists were reviewed. The working group aimed to create guidelines that would provide our fellow health care professionals in Australia and New Zealand with contemporary information and practice guidance regarding the safe and appropriate use of iodinated contrast agents. The information and recommendations in the guidelines have been laid out in a clear and straightforward manner as we could achieve and point-ofcare tools for use by practitioners and patients have been included to facilitate implementation of the guidelines into clinical practice. The draft guidelines were published for consultation in late November 2015. Direct feedback from related medical colleges and organisations was also sought.

Inside News

I would like to take the opportunity to thank everyone who provided feedback. Each comment was reviewed by the group and the guidelines amended accordingly.

“The decision-making process around contrast administration is one of the most challenging aspects for the medical imaging team”

Although the entire contents of the new guidelines lie outside the scope of this article, major changes from the previous guidelines include: 1. A marked reduction in the recommended patient screening questions to assess risk of contrast induced acute kidney injury (CI-AKI) to: a) known kidney disease (including kidney transplant) b) diabetes, and c) use of medication containing metformin. 2. Removal of the previously recommended measurement of an eGFR within three months for stable outpatients prior to contrast administration in favour of a more tailored approach to determine what a suitable interval between an eGFR and contrast administration should be in any individual patient.

3. Inclusion of an overview of the current controversy regarding the decreasing strength of the association between iodinated contrast and AKI. The recommended management and suggested precautions for patients with impaired renal function who may benefit from contrast administration have also been expanded and changed accordingly. 4. A change to the recommended management of patients taking metformin receiving iodinated contrast. Cessation of metformin for at least 48 hours is now recommended following IV contrast in patients with an eGFR < 30mL/ min/1.72m2 or who have deteriorating renal function with an eGFR to be performed prior to restarting metformin. 5. Expanded information regarding treatment of anaphylactic reactions to contrast including an emphasis on the prompt use of IM adrenaline (0.5mg for adults) into the vastus lateralis for moderate and severe reactions. The use of IV glucagon in patients, especially those taking B-blockers, who do not respond to repeated IM adrenaline injections has also been included.

Quality Practice

Point-of-Care Tools Additional tools, which will be available for download, to help the medical imaging team implement the new guideline recommendations include: 1. A list of required drugs and equipment for the treatment of adverse contrast reactions 2. A list of recommended patient screening questions prior to contrast administration 3. Lists of medications containing metformin and B-blockers 4. A wall chart of the recommended treatment regimen for the management of anaphylaxis provided by the Australian College of Emergency Medicine 5. Patient information sheet regarding iodinated contrast 6. Sample letter for patients who require metformin cessation following contrast administration

I would urge all members of the College to read the guidelines in full and to be familiar with its contents. Adherence to the guideline ensures that practices are acting concordantly with their recognised peers and may provide significant medico-legal defence in the event of an adverse event occurring.

A new version of the Iodinated Contrast Media Guideline will be available for download from the College website www.ranzcr.edu.au/resources/ professional-documents/guidelines

I would like to personally thank all members of the working group, my radiologist colleagues Dr Christian Abel, Dr Kwang Chin, Dr Jules Comin, Dr Sarah Constantine, A/Prof Stacy Goergen, Dr Conor Murray and Dr Merle Wigeson, as well as Prof Robert Walker, nephrologist and Ms Christine Vanderley-Reichner, radiographer for their time, immense dedication, knowledge and input. I would also like to thank Ms Melissa Doyle, Manager, Standards of Practice, at the College for her help in organising us and performing much of the administration required for the guideline revision. Any questions or feedback can be directed to melissa.doyle@ranzcr.edu.au Dr Ronny Low Chair, Iodinated Contrast Guideline Working Group Chair, CT Reference Group

Volume 12 No 2 I March 2016

Quality Training

RANZCR Courses and Workshops ACR Educational Courses brought to you by RANZCR The most intensive, rewarding training for radiologists for the first time outside of North America.

The College, in partnership with the American College of Radiologists (ACR), is pleased to offer inaugural educational courses on High Resolution CT of the Chest (HRCT) and Emergency Radiology in 2016. The launch of the full three-day courses follows the successful 1.5 – 2 hour trial ‘taste tester’ the College hosted at the 2015 ASM in Adelaide. These courses were run by two ACR international faculty members and supported by an ACR technical team. Here is a small sample of what delegates said following the 2015 ASM Taste Tester Courses: “I did myself a great favour by enrolling for this course. Very rewarding indeed.” “Fantastically run course. If this is a taste tester, I cannot wait for the full course!” “Excellent talk and great cases... worthwhile for both general and subspecialist radiologists.” The full three-day courses will take place from Monday 4 July – Saturday 9 July 2016 at the Amora Hotel Jamison Sydney, Australia. The HRCT Couse will run from Monday to Wednesday, followed by Emergency Radiology from Thursday to Saturday.

High Resolution CT of the Chest

• Utilise approach to CT differential diagnosis based on pattern and distribution of abnormality • Recognise clinical features of the common interstitial lung diseases Jeffrey Kanne, MD Gerry Abbott, Co-Course Director MD, FACR This course, led by Course Directors Jeffrey Kanne, MD, FCCP, and Gerald F. Abbott, MD, FACR, is designed to provide practising radiologists with the skills and understanding necessary to interpret high resolution CT of the chest in diffuse infiltrative lung diseases. Participants will receive lectures on specific aspects of HRCT interspersed with hands-on interpretation of related cases. The faculty will provide direct supervision and assistance. The integration of clinical, radiologic and pathologic information will also be discussed. The course is targeted at general radiologists and/or non-thoracic imaging fellowship-trained radiologists who are called upon to interpret HRCT studies in their practice. At the conclusion of this course, participants will be able to:

Inside News

• State the clinical indications and optimal approach for high resolution imaging of the lung parenchyma

• Describe the importance and mechanism of multidisciplinary consultation in diagnosis of interstitial lung disease.

Emergency Radiology

Jorge Soto, MD O. Clark West, Co-Course Director MD, FACR Co-Course Director Developed in conjunction with the American Society of Emergency Radiology, this course is designed to provide the practising radiologist an intensive hands-on experience in imaging interpretation of traumatic and non-traumatic emergencies. Pertinent concepts of imaging technique will be reviewed and will motivate the casebased learning process.

Quality Training

Participants will have the opportunity to review over 300 emergent examinations covering all organ systems and modalities commonly encountered in the emergency radiology setting. Through participation in multiple interpretation sessions under the supervision of expert faculty, the participant will develop a higher level of expertise and confidence in emergent imaging. Formal lectures will cover the core concepts, organised by organ system. At the conclusion of this course, participants will be able to:

• Develop a systematic search pattern for evaluating MDCT examinations of the multiple trauma patient • Recognise common and significant injuries in trauma • Familiarise with potential sources of missed diagnoses and interpretation pitfalls in MDCT of trauma • Understand basic technical principles for proper acquisition of CT images in the emergency patient (trauma and non-trauma) • Learn characteristic appearance of various causes of acute abdominal,

chest and pelvic emergencies on plain radiography, CT and US •R eview common and uncommon fractures of the upper extremities, lower extremities, and pelvis and spine with emphasis on the easily-missed fracture. There are still a very limited number of places available for both HRCT and Emergency Radiology. Interested members who wish to attend either course are urged to register immediately at www.ranzcr.edu.au/news-a-events/ courses

Radiation Oncology Trainee Courses Phase 2 Exam Preparation Course 13 – 15 May 2016 Registration Now Open!

Phase 1 Foundation Course and Exam Preparation Course 16 – 19 June 2016 Registration Now Open!

Proudly supported by AbbVie, the Phase 2 Exam Preparation Course will be taking place at Rydges World Square, Sydney, NSW. The course is designed for trainees as they approach exam readiness.

Proudly supported by AbbVie, the Phase 1 Foundation Course and Exam Preparation Course will be taking place at Rydges World Square, Sydney, NSW. The course is designed for Phase 1 trainees who are aiming to sit the Phase 1 exams.

The course aims to provide trainees with an opportunity to: • Better understand the exam development process and how exams are marked • Simulate sitting the Viva exam and receive feedback immediately afterwards • Practice a written question from each paper, workshopping the answers with the Phase 2 examiners • Develop strategies to cope with exam stress and ensure they perform to the best of their abilities.

The intentions of this course are to: • Provide didactic lectures in the main topic areas to supplement trainee knowledge in the four basic sciences • Provide an opportunity for trainees to ask specific questions of experts in a dedicated questions and answer session, as well as informally following individual sessions • Provide specific guidance on exam preparation and techniques including mock exam on the Sunday • Provide an opportunity for you to network professionally and socially.

Course Times Friday 13 May 10:00 am – 5:30 pm Saturday 14 May 7:45 am – 5:30 pm Sunday 15 May 8:00 am – 1:00 pm

Registration Fee $1,100.00 incl. GST per trainee Registration includes morning tea, lunch, afternoon tea and refreshments throughout the duration of the course. A cocktail reception will be held on the Friday evening of the course and is included in the registration fee. To register for the course please visit www.ranzcr.edu.au/news-a-events/courses

Course Times Thursday 16 June 1:00 pm – 5:15 pm Friday 17 June 8:00 am – 6:00 pm Saturday 18 June 8:00 am – 5:00 pm Sunday 19 June 8:45 am – 12:30 pm

Registration Fee Foundation Course – $880.00 incl. GST per trainee Phase 1 Exam Preparation Course – $1,100.00 incl. GST per trainee Registration includes morning tea, lunch, afternoon tea and refreshments throughout the duration of the course. A cocktail reception will be held on the Saturday evening of the course and is included in the registration fee. For further information on the course please visit www.ranzcr.edu.au/news-a-events/courses Volume 12 No 2 I March 2016

Quality Training

Examination and Assessment Review Highly successful planning days considered recommendations and strategy for renewal of our training programs

A/Prof Dinesh Varma

A/Prof Margot Lehman

Pamela Taylor

In early February, the College held Specialty Training planning days for both clinical radiology and radiation oncology. In total, these events brought together over 70 dedicated clinicians who contribute to the College through governance and education, including Board members, office bearers, committee members, examiners, directors of training (DoTs) and trainees. Attendees discussed the current strengths and challenges of their respective Faculty’s Specialty Training programs, and considered the College’s strategy for their continued improvement and renewal over the next few years. The Faculty Deans, Prof John Slavotinek and Dr Dion Forstner led their respective days, with support from the Chief Censors A/Prof Dinesh Varma and A/Prof Margot Lehman. The discussions were informed by presentations from Emeritus Professor David Prideaux of Flinders University and Dr Jacob Pearce and Mr Daniel Urbach of the Australian Council for Educational Research (ACER). As many members will be aware, Prof Prideaux and the ACER team conducted a full review of the College’s assessment and examination processes for Fellowship training in 2015, involving extensive consultation with College stakeholders and thorough observation and analysis of our examination and assessment processes.

Prof Prideaux presented his findings on the alignment of the assessment programs to their respective curricula, and made recommendations for the adoption of a more programmatic approach to assessment. The concept of programmatic assessment is at the leading edge of contemporary approaches in medical education, and allows for a more holistic and progressive system for assessment of competency in trainees. See diagram below. Prof Prideaux made recommendations for improvements to the workflows and structures of the educational sub-committees, aimed at enhancing the College’s capacity for ongoing improvement and providing greater support to the Chief Censors and other key clinicians. ACER’s findings focused on recommendations to enhance the systems and processes used in the various barrier examinations, increasing their efficiency and providing greater ability to gather and interpret useful information. ACER took attendees through a textbook example of a robust examination cycle, as illustrated on Page 33, and made recommendations to bring the College into line with this model.

Define skills and competencies as measurable learning outcomes Identify specific assessment criteria for each learning outcome Map assessment tools (exams & work-based) to assessment criteria Use tools to collect progressive assessment data for each trainee Analyse assessment data to evaluate trainee competency Programmatic Assessment Model

Inside News

Quality Training

Assessment framework / blueprinting Exam development, iterative and collaborative

Item analysis, Exam review

Scoring processes

Standard setting

Reporting to candidates

ACER suggested initiatives in the areas of exam development, exam review and data collection and reporting that will result in increased educational expertise and resources across the College’s committees, examiner teams and staff. This will enable the College to consistently deliver examinations of the highest standard and to provide trainees with more meaningful and comprehensive feedback on their performance. Certain elements of the proposals have already commenced, with ACER running a workshop on exam development, psychometric analysis and scoring processes with a number of lead examiners in clinical radiology. These will continue to be rolled out in both Faculties throughout 2016 and 2017. The review highlighted the need for improved software capabilities in the area of examination design and delivery.

Exam delivery / Data collection

From ACER presentation to Clinical Radiology and Radiation Oncology Planning Days, Feb 2016 In 2016, the College will be exploring options for a system that allows for centralising and streamlining of the exam development cycle, resulting in a reduction in workload and complexity for examiners and College staff. Clinical leaders who attended the workshops have spoken strongly and consistently about the need to streamline program requirements and clarify the purpose of different assessments and training requirements. Time was devoted to discussion about trainee workload, alignment of training and work-based requirements and clarifying expectations of trainees. The tenor of discussion was similar regarding the role and support for directors of training and clinical supervisors. The planning days highlighted the need for better alignment across College training requirements and increased support for trainees, directors of training and supervisors.

At the conclusion of each planning day, a list of priorities was generated, to be incorporated into the College work plan. Moving forward, it is envisaged that a task force will be formed under the auspices of the College Board with strong leadership by the Chief Censors, to plan and oversee the ongoing implementation process. The Chief Censors, on behalf of the College, would like to assure all trainees, DoTs and supervisors that the matter of assessment alignment and training program workload are at the centre of the review and the proposed work plan. Any forthcoming improvements to the training programs will be communicated well in advance of their introduction to give all clinicians an opportunity to provide feedback. The reviews made special mention of the level of commitment of the Fellows in both Faculties, and emphasised that the great strength of the Specialty Training programs lies in the dedication and expertise of those involved. The College would like to thank all of you who contribute to training the next generation of radiologists and radiation oncologists, and we look forward to an exciting new phase of development in 2016.

If you have any questions regarding the project, please contact the Chief Censors, C/O Ms Pamela Taylor, Head of Specialty Training, and Mr Adam Rayment, Instructional Designer, Specialty Training Unit at the College on adam.rayment@ranzcr.edu.au or +61 2 9268 9706.

Volume 12 No 2 I March 2016

Michelle Gianferrari Relationship Manager

STARTING TREATMENT EARLY WORKS FOR FINANCES TOO. As a specialist, life gets more complex, not less. And as for the future, few have time for that. With the right advice, you can have the lifestyle you want. Based on a deep understanding of medical specialists’ needs, we develop a financial plan as unique as you are. It may cover ways to minimise tax, manage investments, safeguard you against litigation or even how to wind down your hours while maintaining your income. You may be surprised how cathartic it is, having your future under control. To speak with an adviser who specialises in specialists, please contact Michelle on 0421 446 513 or michelle.gianferrari@perpetual.com.au

Financial Advice | Investments | Trusts Perpetual Private advice and services are provided by Perpetual Trustee Company Limited (PTCo) ABN 42 000 001 007, AFSL 236643. This information has been prepared by PTCo. It contains general information only and is not intended to provide you with advice or take into account your objectives, financial situation or needs. You should consider whether the information is suitable for your circumstances and we recommend that you seek professional advice. To the extent permitted by law, no liability is accepted for any loss or damage as a result of any reliance on this information. 2116-1115

Quality Training

Oncologic Imaging Fellowship in the US An overseas fellowship following completion of his training was the ideal opportunity for Dr Mitchell Raeside body imaging radiologist upon my return to Australia. I have had the opportunity to work with and learn from radiologists who are expert in their field, who are well-regarded researchers and publishers in the radiology and oncology literature, and who are soughtafter international speakers on these topics.

Dr Mitchell Raeside with Dr Richard Do, Radiologist (Hepatobiliary)

Undertaking an overseas fellowship at the completion of my training was one of my goals throughout my radiology training. As a radiology registrar, the biggest initial challenge in preparing for a fellowship in the United States was studying to pass the United States Medical Licensing Exams (USMLE) in order to secure a licence to practise there. Somehow I managed to remember enough biochemistry, physiology and pharmacology to pass the written exams, borrowed a stethoscope from a friend for the clinical exam, and with a bit of a revision, acted like I knew exactly what I was doing examining the chest and abdomen of a standardised patient for the first time in five years. With my license in hand and our three young children packed up and ready, we made the move to New York City to begin my fellowship in oncologic imaging at Memorial Sloan-Kettering Cancer Center (MSKCC). MSKCC is ranked among the top cancer hospitals in the USA, serving a population in excess of 20 million in

the tri-state area, as well as receiving many referrals for patients across the US and internationally. Situated on the Upper East Side of Manhattan, it is conveniently located to many of the attractions of New York City (NYC). Living only a few blocks away from the hospital in one of the many high-rise apartment buildings in the area allowed us to adopt a change in lifestyle and truly experience life in NYC. The oncologic imaging fellowship provides extensive experience in body imaging using various modalities but with a particular focus on magnetic resonance imaging (MRI). In combination with the large patient population, there is never a shortage of work to be done and experience to be gained.

Other opportunities have included participation in research projects, including pre-operative prostate MRI and pancreatic MRI screening in BRCA patients, participation in disease management team meetings, and experiencing the US healthcare system as a whole. Working together with 17 other fellows in the body and breast imaging programs has been a privilege and afforded the opportunity to develop friendships which will last long after the fellowship is over. A fellowship at the completion of training as a registrar—either interstate or overseas—is an ideal opportunity to develop new skills, subspecialise in an area of interest, experience a different environment and way of doing things, learn from distinguished radiologists in the field, and form professional relationships that will last throughout one’s career. For our family, it has been an adventure that has created memories we will remember for the rest of our lives. The fellowship ends in July this year when we will return to Adelaide and I will continue my career in Australia. Dr Mitchell Raeside

One of the attractions of the fellowship was the opportunity to see and report a large volume of sometimes complex body imaging cases, particularly in MRI, over a relatively short period of time, thereby gaining the necessary experience and expertise to lay a foundation for future practice as a

Volume 12 No 2 I March 2016

Quality Training

Revalidation – What Next? “The future belongs to those who prepare for it today.” ~ Malcolm X (1925 - 1965) The Medical Board of Australia (MBA) and the Medical Council of New Zealand (MCNZ) recently invited representatives from the medical colleges to attend a meeting to discuss revalidation and other topics. The meeting was well attended, with myself and Dr Mike Nowitz representing the College members, accompanied by Laina De Winne and Wendy Frazer from the College secretariat. Presentations were given by both the MBA and MCNZ. The key intelligence brought away from the meeting is given below. Revalidation will be introduced to promote safety, professional standards and confidence. It was confirmed that neither the UK nor the US model are proposed but there could be similarities to Canadian models, and that the model could be based on principles similar to CPD. Additionally, it was identified that New Zealand has a risk-based approach to recertification, which includes a Professional Development Plan and Multi Source Feedback to be undertaken once every three years. The MBA anticipates introducing a similar model in Australia. It was clearly stated by both the MBA and MCNZ that Australia and New Zealand would align processes and systems except where legislation prevented this. It was noted that non-compliance does not and would not necessarily mean de-registration. Investigations generally revealed specific issues which could frequently be resolved. The MBA is appointing an Expert Advisory Group to provide technical advice to be headed up by Prof Liz Farmer; a Consultative Committee to provide feedback on issues within Australia; and is commissioning research into expectations of the profession and community. The three groups are to

Inside News

report back within the year. Further information can be found on the MBA website www.medicalboard.gov.au/Registration/ Revalidation.aspx MCNZ website www.mcnz.org.nz/maintain-registration/ Consultation will continue and, through the Continuing Professional Development Committee and Post Fellowship Education Committee, the College will continue to advocate on behalf of members and keep you informed. Dr Robin Harle Chair, CPD Committee

If you have any questions or comments about revalidation, you can contact the chairs of the CPD committees via the College on cpd@ranzcr.edu.au

Clinical Radiology

A Message

from the Dean

Prof John Slavotinek We are at a key juncture in clinical radiology. A number of initiatives are being driven by external bodies and these are likely to exert significant influence upon our future. In Australia, major arenas of engagement with government include the Medical Benefits Scheme (MBS) reform process and consultation around implementation of the Quality Framework. In New Zealand, Choosing Wisely and telehealth issues will be important, and in both countries the development and adoption of appropriate imaging guidelines to support our referring colleagues will become increasingly important. Other College projects include ongoing improvement of systems, processes and policies in the area of education, assessment and training as well as implementation of the recent governance review undertaken to improve relevance and efficiency of activities being undertaken by various bodies within the Faculty of Clinical Radiology. The Faculty Council met in February to assess the overall landscape, discuss key risks and opportunities, and plan the year’s activities within the Faculty. I was impressed to see the depth and range of activities planned by standing committees within the Faculty. All such activities are important to delivering the College’s Strategic Plan to 2017. A little more detail regarding just a few of these topics follows.

Medicare Benefits Schedule Review Late 2015 and early 2016 has seen a series of meetings by the Diagnostic Imaging Clinical Committee and associated working groups to review the Diagnostic Imaging Services Table, notably including bone mineral density, knee imaging, pulmonary embolism and deep vein thrombosis. Several Fellows we nominated to MBS Review Committees have worked very hard to ensure that the right outcomes for our patients emerge from these deliberations. The Review Taskforce also issued a consultation on obsolete items to which the Faculty has responded. The College’s submission can be downloaded from the College website /www.ranzcr.edu.au/advocacy/ submissions. I am pleased to say that during the MBS review process, clinical radiologists are being included in all key committees that impact upon clinical radiology services. Six more clinical committees are in the process of being established under the MBS review taskforce, which the Faculty will monitor closely to ensure appropriate advocacy for the interests of our patients and College members. Last but not least, along with the Australian Medical Association and on behalf of its members, the College has expressed considerable displeasure at the unilateral decision by the government to remove the bulk billing incentive for many Australian patients.

continued over... Volume 12 No 2 I March 2016

Clinical Radiology

We will continue advocacy to minimise the impact of these changes on patient access to quality services.

Coal Workers Pneumoconiosis Late 2015 saw the re-emergence of coal workers pneumoconiosis (CWP), which has been adeptly and diplomatically handled by the former Dean, now President, supported by the Policy and Advocacy team. As many of you will have seen, we have issued press releases and engaged in coordinated advocacy to lay to rest misunderstandings by external entities who felt that screening chest X-rays for CWP should be read overseas. In order to assist key stakeholders in finding a clinical radiologist in their area, the Faculty has developed a register of members who are available and able to commit to reporting screening X-rays for CWP in accordance with the ILO Classification. I would like to thank those members who responded promptly to our expression of interest seeking readers over the summer break.

with consumers about the overuse of tests, treatments and medical procedures. The College has been among the leaders in this program, having developed educational modules and clinical decision rule based tools to support implementation of radiology aspects of Choosing Wisely. The role of Dean in Clinical Radiology is a busy and complex one with multiple challenges, significant responsibility and a variety of duties that I will discharge to the best of my ability. Although I have been involved in College work for many years, I look forward to contributing to the management of the diverse range of current issues in collaboration with the excellent team within the College office. I would like to express my gratitude to Dr Greg Slater not only for his wise leadership during the previous two years as Dean but also for supporting the Faculty as Acting Dean and President during January, prior to the commencement of my term.

Choosing Wisely The College was one of the first five Colleges to participate in the inaugural launch of the Choosing Wisely initiative within Australia in April 2015. Objectives of this high profile program include reducing the ineffective use of healthcare resources and encouraging clinicians to engage in conversations

If you have any feedback or comments on any of the above, please contact the College on fcr@ranzcr.edu.au

Patient & Referrer Information in one convenient website: • Information about radiology tests and procedures • Items written for consumers and health professionals

• Fully searchable with printer friendly downloads • Written by experts and reviewed by GP and consumer writers

Developed and maintained by the RANZCR

Inside News

Clinical Radiology

Chief Censor in Clinical Radiology

A/Prof Dinesh Varma

Let me start by thanking our outgoing Chief Censor Dr Gabes Lau for all his hard work and the contribution he made during his term. As the incoming Chief Censor I am somewhat uncertain where to begin, but it is probably best to start with our trainees, as the core business of the Clinical Radiology Education and Training Committee is to ensure that the College delivers a world-class training and assessment program. This activity of the College is also one of the strategic pillars of the College’s 2014– 2017 strategic priorities and I am very honoured to have been appointed the custodian of this pillar. Our trainees are the future assets of our profession and we have produced worldclass specialists who continue to uphold the high standards expected from our profession. We provide one of the best diagnostic and interventional services within Australia and New Zealand. However, we must never think that we are perfect. Rapid evolution in our profession also requires us to keep pace with the constant changes we face in the way we train and assess our trainees. My term kicked off with four very busy days planning our activities for this year and beyond. The first day was around strategic planning followed by numerous workshops. There were excellent presentations on the planning day from guest speakers Prof David Prideaux, Emeritus Professor of Medical Education, Prideaux Centre for Research in Health Professions Education, Flinders University, and Dr Jacob Pearce and Mr Daniel Urbach from the Australian

Council for Educational Research. These events were very well attended and I thank Prof John Slavotinek, Dean, Faculty of Clinical Radiology for facilitating the day. Among the attendees were Dr Greg Slater, College President; Dr Lance Lawler and Prof Vin Massaro, Board members; examiners and committee members; trainee representatives; Natalia Vukolova, College CEO; Pamela Taylor, Head of Specialty Unit, and other College staff. The workshops focused on the examinations and were well attended by radiodiagnosis and pathology examiners. See page 32 for more detail.

Ms Pamela Taylor has been appointed as Head of Specialty Training Unit and I congratulate her. She is very well known to most of us from her previous senior roles in the College. A team of very competent, diligent and dedicated staff supports her and I am looking forward to working with them.

Besides conducting the examinations, numerous other activities are being planned for this year. These include Director of Training and examination related workshops, preferably held in various jurisdictions including New Zealand. We will attempt to conduct other workshops that will provide opportunities to upskill Fellows who generously contribute their time and expertise in these areas. Workload for everyone participating in training, assessments and examination related activities is increasing and I will be personally engaging with more Fellows seeking their participation and assistance. I would like to take this opportunity to once again bring to attention that due to circumstances beyond the College’s control we have had to move our Part 2 second series examinations to Melbourne. I will be writing to each trainee regarding this and we do not expect any significant impact due to this change.

If you would like any further information or would like to comment on any of the above, please contact the College on radtaa@ranzcr.edu.au

Volume 12 No 2 I March 2016

Clinical Radiology

ADIA Update Let’s correct the debate on bulk billing rebates the upfront costs will only be out of pocket for a few days, but patients who can’t afford them effectively have their healthcare access reduced.

In the debate over the Federal Government’s rebate cuts for diagnostic imaging (DI), a number of central points have become confused. So the Australian Diagnostic Imaging Association (ADIA) has been working with journalists and politicians to ensure the facts are clearly understood. For example, the bulk billing (so called) “incentive” for DI is not a separate payment but rather is paid as part of the Medicare patient rebate.

This payment discrimination means breast and many interventional procedures are already out of reach of many patients. If practices that bulk bill a lot of general patients need to transition from bulk billing to private billing then equitable patient access to diagnostic imaging will be put at risk with some services available only to those with the financial means to pay the high out-of-pocket and up-front costs. This is a significant danger which ADIA has had to communicate. Also, there has also been confusion over the rebates and indexation.

Similarly, the claim that bulk billing rates for DI have only grown by about 1 per cent since the incentive was introduced are wrong—the Medicare statistics show rates increased from 66.1 per cent in 2008–09 to 76.9 per cent in 2014–15.

In 2010, Access Economics found that Medicare rebates did not cover the costs of delivering DI services. And because DI rebates have not been indexed for 17 years, the real value of the rebates has fallen between 20 and 40 per cent.

Another misconception is that the bulk billing incentive is “just a few dollars”.

ADIA has consistently argued that patients must be able to access affordable, high-quality DI services so they can benefit from early diagnosis and treatment.

For DI, bulk billing rebates are 10 per cent higher than non-bulk billing (15 per cent for MRI) - on average $6 for X-ray, $12 for ultrasound, $34 for CT and $62 for MRI. When patients need more than one DI service, these costs are multiplied.

To ensure that, we need sensible policy based on accurate information. Dr Christian Wriedt ADIA President

For instance, a patient presenting with suspected breast cancer might have a diagnostic mammogram, a breast ultrasound and possibly a core biopsy or fine needle aspiration. A general patient (previously bulk billed) can expect to pay $282 to $554 up-front, and $29 to $302 in gaps for these services. Patients who can afford

Inside News

The views expressed are those of ADIA and publication of this article does not in any way constitute an endorsement by The Royal Australian and New Zealand College of Radiologists (RANZCR).

Clinical Radiology

Musculoskeletal Imaging AMSIG is diversifying into a more political and consultative role Once again it has been a busy year for the Australasian Musculoskeletal Imaging Group (AMSIG), one that has seen the executive move from its traditional educational role and diversifying into a more political and consultative role with the College, Medicare and the Federal Government. The AMSIG executive team has liaised with the Faculty of Clinical Radiology Council and the Ultrasound Reference Group on important issues such as sonographer guided musculoskeletal injection courses, which has been opposed in the interest of safety to the public and ensuring quality in the provision of interventional services. Other agenda items that have arisen over the last 12 months have included the appropriateness of the recent expansion of GP referred MRIs, specifically in the imaging of the knee. I would like to thank Drs Sanjay Dhupelia and James Linklater for their assistance on this matter

to attend this useful event. As it evolves, musculoskeletal imaging is moving to provide pain management diagnostic and interventional services, so the importance of this course cannot be over emphasised. I would like to thank all the AMSIG members as well as the members of the executive team for their support during the two years that I have been president. Finally, I would like to encourage all to become AMSIG members, so that AMSIG can continue to expand upon its role and function. Information on AMSIG, the benefits of AMSIG membership, as well as information on meetings can be found on www.amsig.org Dr George Koulouris AMSIG President

Our Annual Scientific Meeting promises to be an exciting event, to be held at The Royal Prince Alfred Hospital in Sydney on Saturday 30 April. The event has been kindly organised by co-convenors Drs Ron Shnier and Phil Lucas, who have arranged a quality group of speakers to present on the theme Topics in Sports Medicine. Following this, I am excited that AMSIG has also organised a radiofrequency ablation (RFA) workshop the following day. In order to provide the educational opportunity, the course had to be limited to 10 delegates and it was sold out within the day of announcement of registrations being open. AMSIG looks forward to hopefully providing a similar course later in the year or next year in order to allow those members who missed out, the chance

Volume 12 No 2 I March 2016

What does this radiologist see? Opportunity.

Everlight Radiology is always recruiting. That’s because our team of more than 70 FRANZCR radiologists are providing valuable support to clinicians and healthcare professionals every minute, 365 days a year. We’re looking for radiologists with emergency and trauma experience, and with availability to work after hours and weekends – the times when there are opportunities to report on the most varied and interesting cases. Are you up to the challenge? Everlight is a global radiology partner providing reporting services to enhance patient care and clinical outcome. Each month we deliver more than 40,000 reports. We operate from various international locations, including Auckland, Belfast, Brisbane, Cape Town, Geneva, London, Melbourne, Perth, Sydney and Tel Aviv… and we’re still expanding. As part of our team, you’ll have the opportunity to work among other high-calibre radiologists in a close-knit, supported environment. To suit your lifestyle, our flexible arrangements offer the freedom to set your own hours in your preferred location, and change either at any time.

Flexibility

Quality

Hours Occasional, regular, while on Fellowship or sabbatical

Efficiency State-of-the-art equipment and dedicated support

Location 18 reporting centres and hubs worldwide

Assurance Embedded peer review and feedback

Terms Casual, contract, permanent

Support Guided by Everlight’s Medical Leadership Council

Are you open to opportunity? We offer uniquely rewarding roles for FRANZCR radiologists worldwide. Contact us today: opportunity@everlightradiology.com.au Australia United Kingdom South Africa New Zealand

everlightradiology.com.au

Clinical Radiology

Radiology Trainees News

The Radiology Trainees Committee (RTC) represents trainees at all levels of the College and has formed again this year with representatives from nearly all branches. I’d like to thank departing committee members and welcome the following new members: Dr Cara Odenthal (Secretary, QLD) Dr Dave Eriksen (SA) Dr Felix Paterson (SA) Dr Anthony Cardin (VIC) Dr Naomi Anning (TAS) Dr Ben Addison (NZ) Dr Amy Stringer (NZ) As the new year shifts into full gear, many trainees around Australia and New Zealand will be knuckling down for the biannual Part 1 and 2 examinations taking place in March and April. Needless to say it is a stressful time for candidates as well as for the support staff within the College and radiology departments across both countries. The digitisation of the written exams has progressed steadily over the last few years with Part 1 exams now completely electronic as well as the film reading and multiple choice portions of the Part 2 exam. Notwithstanding a few technical hiccups over the last few sittings, feedback from trainees has been generally positive.

progress to date with the formation of three statewide networks. Challenges remain, though networked training offers significant benefits for trainees in terms of exposure to a variety of clinical environment and learning opportunities. If you have any comments or issues that you would like brought to the committee’s attention, please contact your branch trainee member, or you can contact me directly on julescatt@gmail.com Dr Jules Catt Chair, RTC

Please note the two venues for the Viva examinations this year Part 2 Series 1 VIVA Examinations 2 June and 3 June 2016 – Rydges World Square, Sydney Part 2 Series 2 VIVA Examinations 10 and 11 November 2016 – Novotel St Kilda, Melbourne

Although many Fellows and trainees would consider a switch from film to screen to be the ideal format for the Part 2 Vivas, reflecting on how radiologists function on a day-to-day basis, the substantial infrastructure and technical considerations appear likely to limit the transition in the near future. The formation of training networks continues apace in accordance with the Australian Medical Council directions. NSW in particular has made significant

Volume 12 No 2 I March 2016

MODERN IMAGING AND RADIATION THERAPY: APPROPRIATE, COLLABORATIVE AND TARGETED 67th ANNUAL SCIENTIFIC MEETING | GOLD COAST, AUSTRALIA

KEYNOTE SPEAKERS Radiology

Radiation Oncology

Dr Russell Fritz National Orthopedic Imaging Associates San Francisco, USA

Dr Silvia Formenti New York Presbyterian Hospital New York, USA

Professor Fiona Gilbert Cambridge University Hospitals Cambridge, UK

Professor William Mendenhall University of Florida Florida, USA

Professor Meng Law University of Southern California Los Angeles, USA

Dr Colleen Lawton Medical College of Wisconsin Wisconsin, USA

Dr Claude Sirlin University of California San Diego, USA

RANZCR 2016 ranzcr2016.com

KEY DATES Submit Your Abstract Now ranzcr2016.com/abstract-information

Call for Abstracts Close April 2016

REGISTRATIONS OPEN April 2016

Details published are correct at the time of design and are subject to change without notice. For up to date information please visit ranzcr2016.com

INTERESTED IN SPONSORING AND/OR EXHIBITING? Contact Helen McGowan at Helen@wsm.com.au or +61 3 9645 6311

13 – 16 OCTOBER 2016 GOLD COAST CONVENTION & EXHIBITION CENTRE ranzcr2016.com

Clinical Radiology

The Australian and New Zealand Emergency Radiology Group

A group of radiologists and registrars with a special interest in emergency and trauma radiology met at the 2015 RANZCR Annual Scientific Meeting (ASM) in Adelaide to establish the Australian and New Zealand Emergency Radiology Group (ANZERG). This is a special interest group under the auspices of the College and we are very excited to get this off the ground. Thanks to the Faculty of Clinical Radiology Council and the College staff for the assistance and support they have provided. Such subspecialty groups or societies are well established in North America, Europe, Canada and more recently in the UK, the oldest being the American Society of Emergency Radiology (ASER, established in 1988). We are pleased to join our global colleagues with similar interests. Several objectives were discussed at the inaugural meeting in Adelaide including establishing a network of like-minded members interested in emergency and trauma radiology. Other activities the group intends to undertake include: • Conducting regular educational sessions at the College ASM

• Advising the College on matters relating to emergency and trauma radiology on scientific, educational and patient-centered operational issues • Liaison with similar international bodies and societies. The group will endeavour to raise awareness of emergency and trauma radiology among the medical fraternity, particularly emergency physicians and trauma surgeons. The group will promote the importance of the clinical role of the radiologist in providing valuable, time-critical opinions on the choice of appropriate imaging, consultations and diagnosis, as well as advising on and providing interventional services as appropriate. The concept of “horizontal integration” and working collaboratively as an integral member of a multidisciplinary team will be actively encouraged.

assurance, and teaching modules for the Key Conditions of Training prescribed by the College for first year trainees. Medium to long-term objectives will be working towards promoting fellowships in the field of emergency and trauma radiology and thus creating generations of emergency radiologists.

Anyone interested in further information about the special interest group, or who would like to become a member, please contact Member Support on anzerg@ranzcr.edu.au Contributors A/Prof Dinesh Varma – Chair, ANZERG Committee members: Dr Craig Hacking (QLD), Dr Meredith Thomas (SA), Dr Sean Skea (NZ), Dr Gerard Goh (VIC).

We are looking forward to our first meeting in 2016 to discuss the initial focus of the group. Potential projects in the short term include systems-focused rotations for Year 4 and 5 registrars in emergency and trauma radiology, teleradiology audit and quality

Volume 12 No 2 I March 2016

SEEKING RADIOLOGISTS Integral Diagnostics has exciting opportunities for quality focussed radiologists in Vic, WA and Qld. We offer the opportunity to work with modern equipment in private and public environments with a high quality, supportive peer group.

WHO WE ARE Integral Diagnostics is Australia’s fastest growing clinician driven provider of quality, patient focussed medical imaging. We oversee three clinical brands in varied geographical locations. South Coast Radiology is based on the Gold Coast, Toowoomba and Northern Queensland. Lake Imaging operates in metropolitan and regional Victoria (including Ballarat, Geelong and Melton). Global Diagnostics is located in Western Australia (including Bunbury and Bussleton).

Bussleton Jetty, Western Australia

WHAT WE OFFER A supportive, collaborative working environment with flexible working hours and peer reviewed education programs. We provide a full spectrum of radiology services with the most advanced imaging technology including: • • • • •

Gold Coast, Queensland

PET/CT 3T and 1.5T MRI Dual Energy CT Tomosynthesis Mammography State of the art RIS/PACS network Bellarine Peninsula, VIctoria

www.integraldiagnostics.com.au For further information on joining Integral Diagnostics please contact:

Mr Greg Hughes - Chief Operating Officer Email : hughesg@integraldiagnostics.com.au

imaging

Clinical Radiology

ANZSPR News ANZSPR 2015 Annual Scientific Meeting Over 50 delegates gathered in Adelaide last October at the iconic Adelaide Oval for the annual Australian and New Zealand Society of Paediatric Radiology (ANZSPR) meeting. The meeting had a focus on paediatric neurological imaging and other general facets of paediatric radiology. Our invited speakers—Prof Manohar Schroff (Toronto) and Dr Owen Arthurs (UK)—along with our talented local faculty, gave excellent and informative lectures. Many thanks to the delegates and sponsors who made the ANZSPR meeting in Adelaide a fabulous event.

Expansion of Services at the Royal Children’s Hospital, Melbourne The Medical Imaging Department at The Royal Children’s Hospital is set to expand their services with the newly acquired PET MR, (Siemens Biograph mMR), and SPECT CT, (Siemens Intevo), currently being installed in the newly refurbished Nuclear Medicine department.

X-rays of Button Batteries In June 2013, the first Australian child died after ingesting a 2cm active disc battery. Despite symptoms, the ingestion and oesophageal lodgement of the battery went unrecognised. She collapsed two weeks post battery ingestion following a large oesophageal bleed. The disc battery was discovered on a post intubation chest film. Injury occurs when an active disc battery (>1.2V) is placed in an internal orifice (ingested/inserted) or any moist environment (e.g. under a plaster cast) and remains in one position for a prolonged period. Tissue destruction occurs within two hours and can continue for hours/days even after battery removal. Lithium batteries >/=2cm in diameter are more likely to lodge in the oesophagus and cause serious injury. Many disc batteries on X-ray have a radiolucent ring around the perimeter; however, this may not always be present. Any staff member who sees a (possible) disc battery on X-ray should report this immediately to the senior treating clinician.

The PET-MR was funded by the Royal Children’s Hospital Good Friday Appeal and RCH is the first children’s hospital in the southern hemisphere to acquire one.

The current ANZSPR committee will serve from January 2016 until December 2018: President: Prof Michael Ditchfield (Monash Children’s Hospital, Monash Health and Monash University, Melbourne) Secretary: Dr Jenny Bracken (Royal Children’s Hospital, Melbourne)

Sheraton Mirage Gold Coast Register Now: www.anzspr16.com Join us for a three day program featuring local and international speakers, focusing on topics including musculoskeletal, gastrointestinal and genitourinary imaging. The program and content is suitable for radiologists, radiology registrar and fellows, radiographers and specialists with an interest in imaging. Along with the academic program, delegates will be able to enjoy a social program comprising of a welcome reception at Glass Dining and Lounge Bar and the conference dinner to be held at Fellini Restaurant, both conveniently located at the Marina Mirage Shopping Centre just a five minute walk from the resort. We look forward to seeing you on the Gold Coast.

Image courtesy of Nationwide Children’s Hospital

ANZSPR Committee

Upcoming Paediatric Imaging Conference 16 – 19 October 2016

Dr Jenny Bracken ANZSPR Secretary

Executive: Prof Lee Coleman (Royal Children’s Hospital, Melbourne) Dr Muddassir Rashid (Gold Coast University Hospital, Gold Coast; Lady Cilento Children’s Hospital, Brisbane) Dr Padma Rao (Royal Children’s Hospital, Melbourne) Dr Helen Bird (Starship Children’s Hospital, Auckland) Dr Jean Murdoch (Wellington Hospital, Wellington) Dr Peter Shipman (Perth Radiological Clinic, Perth)

Information about ANZSPR can be found on the College website at www.ranzcr.edu.au/ organisation/specialinterest-groups/anzspr

Volume 12 No 2 I March 2016

What’s in Issue 2? Medical Imaging Review Article CT perfusion in acute stroke calls: A pictorial review and differential diagnoses Corresponding author: Dr Albert H Chiu, Neurological Intervention and Imaging Service of WA (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA CT perfusion is increasingly utilised in hyperacute stroke to facilitate diagnosis and patient selection for reperfusion therapies. This review article demonstrates eight examples of how CT perfusion can be used to diagnose stroke mimics and small volume infarcts, which can be easily missed on non-contrast CT, and to suggest the presence of an ischaemic penumbra. Radiologists involved in stroke management must understand the importance of rapid imaging acquisition and be confident in the prospective interpretation of this powerful diagnostic tool as we move into a new era of hyperacute stroke care.

Medical Imaging Original Article Radiology in the Christchurch earthquake of 22 February 2011: Challenges, interim processes and clinical priorities Corresponding author: Dr Jude Gregan, Radiology Department, Christchurch Hospital, Christchurch, New Zealand. Introduction: The Canterbury earthquake of 22 February 2011 initiated a mass casualty event for Christchurch Hospital, which suffered damage itself, and faced logistical difficulties in continued operation. Radiology was part of the hospital-wide response. This paper reviews the radiology department response and surveys opinions of emergency doctors to provide an overview of events of the day and thoughts regarding any potential future response. Methods: Two main approaches were undertaken: (i) informal data gathering and discussions with staff including radiographers, sonographers, radiologists, emergency doctors and others present on the day regarding their experiences; and (ii) survey of emergency doctors regarding their experiences and recommendations. A comparison with other similar events was also conducted. Results: (1) Diagnostic radiology services were initially constrained by a lack of power and lift access. Usual imaging and reporting pathways were interrupted. Alternative processes were initiated to ensure an ongoing radiology service with available resources. Lessons were learned and changes implemented locally.(2) Survey data confirmed several primary outcomes: (i) Ultrasound was crucial while CT was down; (ii) all available imaging modalities remain important in a disaster response; and (iii) preliminary reports from radiologists in the emergency department (ED) were useful in the immediate post-earthquake period.

Radiation Oncology Article Original Article Predictors and rate of adjuvant radiation therapy following radical prostatectomy: A report from the Prostate Cancer Registry Corresponding author: Dr Christopher P Daniels, Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC. Introduction: Long-term data from three randomized trials have demonstrated that adjuvant radiation therapy (ART) reduces the rate of biochemical failure in high-risk men following radical prostatectomy (RP). One of these trials has shown a survival advantage. We investigated the rate of ART in Victoria and the predictors for this treatment. Methods: We analysed data from eligible patients who were notified to the Victorian Prostate Cancer Registry (PCR) by 37 Victorian hospitals between 1 August 2008 and 31 October 2011. We defined ART as radiation therapy (RT) delivered within 6 months of RP. Predictors of ART receipt were modelled using adjusted and unadjusted logistic regression. Results: There were 4626 eligible cases from which 2018 underwent RP with recorded date of surgery. Of these eligible prostatectomy cases, a total of 89 received ART. A subgroup of 833 men had an adverse pathologic feature, of whom 78 received ART. In a multivariate model, pathologic tumour stage pT3a (odds ratio (OR) 2.64; 95% confidence interval (CI) 1.4–5.00; P = 0.003), pT3b (OR 4.58; 95% CI 2.12–9.89; P = 0.000), a positive surgical margin (OR 8.91; 95% CI 4.61–17.2; P = 0.000) and pathologic Gleason grade >7 (OR 7.18; 95% CI 1.54–33.6; P = 0.012) predicted receipt of ART. Conclusion: Adverse pathologic features and high pathologic Gleason score predict for receiving ART in Victorian men after RP, but overall, ART is not commonly prescribed. This finding is consistent with other published series and may reflect clinician scepticism regarding the benefit of ART over salvage RT and concern about toxicity and the risk of over treatment.

Radiation Oncology Article Original Article Stage IB cervix cancer with nodal involvement treated with primary surgery or primary radiotherapy: Patterns of failure and outcomes in a contemporary population Corresponding author: Dr Carminia Lapuz, Alfred Health Radiation Oncology, The Alfred, Road, Melbourne, VIC Introduction: The purpose of this study is to evaluate patterns of failure, overall survival (OS), disease-free survival (DFS), prognostic factors and late toxicities in node positive International Federation of Gynaecology and Obstetrics (FIGO) stage IB cervix cancer treated with curative intent. Methods: Patients with FIGO stage IB cervix cancer and positive nodes were identified from the Peter MacCallum Cancer Centre prospective gynaecology database. Patients were treated with primary surgery and adjuvant radiotherapy (S + RT) or primary radiotherapy (primary RT). Prognostic factors examined were tumour size, histology, grade, lymphovascular invasion or corpus uterine invasion, MRI tumour volume, number of nodes involved, highest site of nodal involvement, treatment modality, age and smoking. Results: Of the 103 eligible patients, 43 patients had S + RT and 60 patients had primary RT. Tumours were significantly smaller in the S + RT group (mean 3.0 cm vs. 4.5 cm, P < 0.001). Five-year OS (95% confidence interval) and DFS (95% confidence interval) for the whole cohort was 67.6% (56.5–76.4%) and 66.1% (55.7–74.6%), respectively. Tumour diameter and number of positive nodes were significant prognostic factors for OS and DFS and smoking was related to DFS. Treatment modality was not a significant prognostic factor in OS and DFS. Of 33 patients that relapsed, 32 patients relapsed outside the pelvis. One patient failed in the pelvis only. Conclusions: Early stage cervix cancer with nodal involvement is associated with excellent pelvic disease control following curative intent treatment. Almost all relapses occurred beyond the pelvis and therefore more aggressive local treatment is unlikely to improve survival in these patients.

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!

Radiation Oncology

A Message

from the Dean

Dr Dion Forstner

I am pleased to report that much progress has been made in the past 12-18 months, through the active participation of the Faculty Council, its standing committees, special interest groups and working groups. I anticipate 2016 will be a year full of opportunities and challenges for the Faculty of Radiation Oncology. I look forward to working with all members to help achieve our profession-specific strategic priorities. I encourage those members who have not read our Code of Ethics to read and reflect on these, particularly in light of the increased scrutiny and issues in the media in 2015 that many of you will be aware of. It was heartening to see Fellows stand up for what is right. Advocacy for appropriate funding for radiation oncology in Australia will be a top priority for the Faculty. We are expecting a large amount of work around the review of the Medicare Benefits Schedule (MBS) and the Health Program Grants (HPG) Scheme. All Standing Committees have developed their work plans for the near future, which are focused on achieving the strategic priorities of the Faculty. The Faculty Council also had a planning day on 25 February, which was an opportunity to review the current risks facing our sector, identify any new risks, as well as review the Faculty’s current initiatives and priorities for the year ahead.

I would like to extend a warm welcome to A/Prof Margot Lehman, and Dr Liz Kenny as new members of the Faculty Council, and thank all other Councillors for staying on and providing ongoing support to the Faculty. The 2016 Council is enthusiastic and committed to working towards access to high quality radiation oncology services, best practice training and increased awareness of radiation therapy in both Australia and New Zealand.

Profile and Presence of Radiation Oncology Raising the profile of radiation oncology remains a key focus for the Faculty through the Targeting Cancer campaign. We were very pleased with the documentary on radiation oncology, Below the Radar, which was developed in collaboration with Dr Norman Swan and Tonic Health Media. It is an excellent piece to help spread the word on radiation therapy, and I congratulate A/Prof Sandra Turner and the Targeting Cancer team on this initiative. The documentary is now available on www.targetingcancer.com.au/our-stories/ our-first-tv-documentary-on-radiationtherapy/ Several of the other Targeting Cancer activities will continue this year, including the GP Oncology Education Evenings, ongoing update of the website with new content and information, and engagement with consumers and other stakeholders. I encourage all members to participate in this important initiative, to help raise the profile of our profession, and ultimately increase the utilisation rate of radiation therapy.

Please contact faculty@ranzcr.edu.au if you are interested in getting involved.

Funding for Radiation Oncology in Australia Intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT) are finally recognised in the Medicare Benefits Schedule (MBS) effective 1 January 2016. This is the result of several years of work by many individuals, and I would like to thank our members who had provided input and contributed to the success of this advocacy effort. I would appreciate feedback if there are any issues with these item numbers. We have also been notified that the Oncology Clinical Committee of the MBS Review Taskforce is being established, and it is likely that a few radiation oncologists will be part of that committee. The Radiation Oncology Health Program Grants (ROHPG) scheme was introduced in 1988 to help ensure the regular replacement of radiation therapy equipment. In 2015, the Australian National Audit Office (ANAO) conducted an audit of the ROHPG scheme, which the Faculty provided input into. In February this year, the Department of Health (DoH) announced a further review of ROHPGs, to specifically look at the purpose, benefits and limitations of the scheme, equipment eligibility and alternative funding models. continued over... Volume 12 No 2 I March 2016

Radiation Oncology

It is the Faculty’s view that maintaining the ROHPG scheme is vital to keep the nation’s fleet of linacs within its agreed lifespan. We will seek the support of cancer consumers and other stakeholders in the cancer community to help us advocate for continuation of this scheme, to ensure that radiation oncology centres have current, reliable equipment, capable of delivering the latest treatment techniques. The Faculty will continue to work closely with the DoH and the MBS Review Taskforce in 2016 to hopefully ensure the ongoing provision of accessible and affordable quality radiation oncology services to our patients.

The Faculty’s Position Paper on Particle Therapy was also published late last year. This document aims to inform cancer professionals, health professionals, health administrators, consumers and interested individuals about the current status of particle therapy internationally, the evidence for their use and the target population. All these documents are available from the College website. I would like to take this opportunity to thank all our members who have volunteered their time in developing and/or reviewing these important papers.

The Faculty views the implementation of those recommendations as a priority for this year, and I am confident this task is left in capable hands of the Radiation Oncology Education and Training Committee, under the leadership of A/Prof Margot Lehman. The Faculty also remains committed to fostering a culture of research in radiation oncology. I thank the Radiation Oncology Research Committee for their initiatives in this regard. We are also keen to continue and formalise our close collaboration with the Trans-Tasman Radiation Oncology Group (TROG).

Training and Research for Radiation Oncology

Quality Assurance for Radiation Therapy Services The Faculty published the Quality Guidelines for Volume Delineation in Radiation Oncology and Position Paper on Image Guided Radiation Therapy (IGRT) 2015 in December last year. I encourage all members to read the ‘Policy in Action’ pieces on pages 25 and 27 in this edition of Inside News, and to incorporate these documents into their everyday practice.

The Faculty Council is committed to producing excellent radiation oncology specialists, and appreciates the need for continuous improvement of the training curriculum and assessment tools. In 2015, the College engaged the services of Prof David Prideaux and the Australian Council for Educational Research to conduct a review of the training and assessment involved in both faculties. The final report, including a list recommendations, has been presented to the Board and Faculty Councils.

If you have any feedback or comments on any of the above, please email faculty@ranzcr.edu.au.

1 in 2 people with cancer would benefit from radiation therapy Greater awareness that radiation therapy is safe and provides good clinical outcomes will improve utilisation. Sign up at targetingcancer.com.au to show your support. @TargetingCancer

Inside News

RadiationOncologyTargetingCancer

Radiation-Oncology-Targeting-Cancer

Radiation Oncology

Chief Censor in Radiation Oncology

A/Prof Margot Lehman

I have assumed the role of Interim Chief Censor following the resignation of Dr Sean Brennan from the position due to personal reasons in December 2015. I had the pleasure of working with Dr Brennan as a member of the Radiation Oncology Education and Training Committee (ROETC) and as a Phase 2 examiner. I would like to thank Dr Brennan for the tremendous leadership he showed during his tenure as Chief Censor and the support he provided on a personal level to all those who worked with him. Moving forward, I have been appointed as Chief Censor until Dec 2016, following a call for expressions of interest to fill the casual vacancy from the ROETC and support for the appointment from the Faculty Council. An expression of interest will be circulated to the College radiation oncology membership for the role of Chief Censor for 2017–2018. Over the next 12 months, the ROETC and its subcommittees will continue to implement the workplan established by Dr Brennan and the members of the Specialty Training Unit. Core business includes: 1. The delivery of trainee examinations with the following dates established: Phase 1 Examination: Friday 9 September Phase 2 Series 1 Exam: Written 22–23 February; Vivas 6-8 April in Wellington

Phase 2 Series 2 Exam: Written 18–19 July; Vivas 31 August – 2 September in Townsville

I am delighted to write that in 2016 our training program welcomes its first Indigenous trainee into one of our Sydney networks.

2. Oversight of workshops and events with the following dates established:

In closing, I would like to take this opportunity to welcome all new trainees entering the training program and wish you all the very best in your chosen career.

DOT workshops – May 2016, October 2016 ESTRO Evidence Based Radiation Oncology course 19–22 November 2016 in Sydney 3. Accreditation where, alongside the ongoing schedule of site visits, a review and update of the radiation oncology accreditation standards will be undertaken. In addition, a review of the College’s examination and assessments was undertaken by Prof David Prideaux, Emeritus Professor of Medical Education at Flinders University and a team from the Australian Council for Educational Research (ACER) with their report received in late 2015. A planning day was held in February to inform members involved in training, examination and assessment activities of the review and its recommendations. It was pleasing to see so many members are engaged and keen to support our specialty training program. It is anticipated that a list of priorities and actions will subsequently be decided upon, which will form the basis for the work of the ROETC in 2016 and beyond.

If you would like further information on any of the above topics, please contact the Specialty Training Unit on ronctaa@ranzcr.edu.au

Volume 12 No 2 I March 2016

Radiation Oncology

College ‘Young Leader’ Attends World Cancer Leaders’ Summit On 17-18 November 2015, I attended the World Cancer Leaders’ Summit in Istanbul, Turkey. The summit is run by the Union for International Cancer Control (UICC) and is an annual policy meeting dedicated to discussing emerging global cancer issues. I was given the opportunity to attend in the capacity of a ‘Young Leader’, along with seven others from the USA, Chile, Switzerland, Nigeria and El Salvador. The UICC invited us to attend through their scholarship program, as they were keen to encourage the next generation in global cancer to contribute to the high-level discussions at the meeting. The theme of the meeting was ‘Effective International Collaboration’ and was attended by over 200 delegates from national governments, international organisations, academia and the private sector. What I found particularly interesting was the diversity in ideas on how to harness funding for global cancer. In particular, there was a focus on the need to increase the engagement of private enterprise. In line with this, a number of patrons also attended the meeting, including the Sheikha Jawaher bint Mohammed Al Qasimi of Sharjah, who has recently established an international fund for childhood cancers, together with the UICC. Attending the meeting provided a unique opportunity for me to form a network within global cancer circles. Since the meeting, I have been continuing to work with the other young leaders to help develop global cancer education pathways within UICC, as well as collaborate on research. I have also been able to gain more ideas for globalRT, the online global radiotherapy advocacy project that I lead, together with Dr Danielle Rodin from Princess Margaret Cancer Centre in Toronto.

Inside News

There was a strong Australian presence at the meeting, including Prof Sanchia Aranda, President elect of UICC, and the Hon Nicola Roxon. It was great to witness the fact that Australia is very well respected for our leading example of anti-tobacco policies and campaigns. In continuing these successes, it was fabulous to see our very own Dr Bronwyn King speak on her work in her Tobacco-Free Investment Initiative. I would like to express sincere thanks to RANZCR College staff for encouraging me to apply for the UICC Young Leaders Scholarship. If other College members are interesting in applying for the Young Leaders Scholarship or are interested in contributing to globalRT.org, please email me on the address below.

Young Leaders’ welcome dinner with member of the UICC Board, including Prof Sanchia Aranda, President elect of UICC and current CEO of Cancer Australia (first left).

Dr Mei Ling Yap Radiation Oncologist at Liverpool and Macarthur Cancer Therapy Centres and CCORE, Ingham Institute for Applied Medical Research mei.yap@sswahs.nsw.gov.au

The eight young leaders with HRH Princess Dina Mired from Jordan

GlobalRT is a virtual platform for education, exchange, and action around the need for equitable access to radiotherapy services. Web: www.globalrt.org Facebook – globalRT, Twitter @cancerrt

Radiation Oncology

Radiology Oncology Trainees News Welcome to the 2016 Radiation Oncology Trainees Committee I would like to extend a warm welcome to the incoming Radiation Oncology Trainees Committee (ROTC) for 2016. This year we are fortunate to have trainees who have sat on the ROTC in previous years as well as many new faces. I am looking forward to working together with such an enthusiastic and committed group of trainees and I am anticipating a very productive and exciting year ahead.

Radiation Oncology Trainees Committee 2016 Left to Right: Esther Sim; Eunji Hwang; Tristan Shaw; Janice Yeh; Michelle Tseng; Gina Hesselberg; Feng-Yi Soh; Michael Huo

ROTC Communication A key focus for the ROTC this year is to improve communication with the wider trainee group. We welcome any contributions or suggestions and more importantly, we would like to hear if you have any concerns regarding your training or wellbeing in general. Particularly if you are at a peripheral training site or feeling unsupported in any way, please know that the ROTC can advocate on your behalf. The names, positions and contact information for the 2016 ROTC are listed. A new communication initiative in development is a quarterly newsletter directed

specifically towards current trainees. The aim of this newsletter is to provide you with a quick snapshot of any relevant issues, important projects and upcoming events—watch this space for further information. continued over... NAME

NETWORK

POSITION

Gina Hesselberg

NSW South

Chair

ginahesselberg@gmail.com

Janice Yeh

VIC/TAS

Radiation Oncology Research Committee Secretary

jsyyeh@gmail.com

Michael Huo

QLD

Economics and Workforce Committee

michaelhuo@live.com.au

Eunji Hwang

NSW South

Education and Training Committee

eunji87@gmail.com

Tristan Shaw

NSW North

Medial and Profile Committee

shawry27@gmail.com

Esther Sim

QLD

Annual Scientific Meeting Committee

esther.h.sim@gmail.com

Feng-Yi Soh

New Zealand

Education and Training Committee New Zealand Trainee Representative

fengyisoh@gmail.com

Michelle Tseng

Singapore

Quality Improvement Committee Singapore Trainee Representative

msftseng@gmail.com

Volume 12 No 2 I March 2016

Radiation Oncology

Workforce Concerns There is ongoing concern among current and recently graduated trainees in regards to future job security. This growing sentiment may be one of the driving factors for trainees who have taken up alternative pathways away from radiation oncology. This is a priority issue for the ROTC and is similarly on the radar of multiple College committees. The Economics and Workforce Committee will be conducting a survey this year to tease out the specific details of the employment statuses for recent graduates. This information will be crucial if measures are to be implemented to protect current trainees and future Fellows of the College.

Important dates for 2016 Please be sure to diarise the dates below. Good luck to those trainees sitting the upcoming Phase 2 examinations. Don’t miss out on the Phase 1 and 2 Foundation and Exam Preparation Courses.

Important Dates 2016 Phase 2 Examination Series 1 Written Examinations: took place in February VIVA Examinations: Wednesday 6 April, Thursday 7 April and Friday 8 April 2016 Vivas Location: Wellington Hospital, New Zealand Applications Closed: Friday 11 December 2015

Phase 2 Examination Preparation Course Friday 13 May to Sunday 15 May 2016 (See page 31 for more detail)

Phase 1 Foundation and Examination Preparation Course Thursday 16 June to Sunday 19 June 2016 (See page 31 for more detail)

Phase 2 Examination Series 2 Written Examinations: Monday 18 and Tuesday 19 July 2016 VIVA Examinations: Wednesday 31 August, Thursday 1 Sept and Friday 2 Sept 2016 Vivas Location: Townsville Hospital, Queensland Applications close: Friday 20 May 2016

Phase 1 Examination Friday 9 September 2016 Applications close: Friday 22 July 2016

Dr Gina Hesselberg Chair, Radiation Oncology Trainees Committee

TROG Cancer Research 2016 promises to be another eventful and fruitful year for Trans-Tasman Radiation Oncology Group (TROG) Cancer Research Our 28th Annual Scientific Meeting was held at Brisbane Convention and Exhibition Centre earlier this month. The TROG 2016 ASM theme was: ‘Value for Money in Oncology Research’ and provided a unique opportunity for health professionals with an interest in radiation oncology to engage in learning, networking and collaboration. The meeting featured subspecialty group sessions, as well as the return of our full-day, interactive research workshops, which were well received. Planning has been underway for a TROG Consumer Advisory Panel. A Consumer Training Workshop will be held in April

Inside News

2016 to provide training on the basics of radiation therapy and clinical trials, as well as involvement in the TROG Board, Scientific Committee, cancer advocacy, fundraising or by sharing their own cancer journey. From the discussions on these topics during the workshop, TROG will develop online consumer learning modules. These modules will be used in conjunction with the Cancer Australia eLearning website to provide relevant information to all consumers interested in radiation oncology clinical trials. Earlier this year we farewelled our Chief Financial Officer, Mark Rembish. Mark has been an integral member of the group for the past three years and we wish him all the best. We have now welcomed our new TROG Financial Controller and Company Secretary, Andrew Jenkins, to the team. Andrew will manage TROG’s finances and is a part of the executive management team preparing forecasts and budgets,

assisting in the allocation of resources and strategic planning. We have also welcomed back Melissa Crain to the role of TROG QA and Grants Manager, following her maternity leave.

We are excited to announce our newest fundraising event which will be launched in May 2016. Art4TROG—an exhibition supporting TROG Cancer Research, which will feature a diverse collection of works from established and emerging Hunter artists who have been touched by cancer. Opening night will be on Friday 6 May 2016 at Newcastle Art Space gallery. For further details and to purchase tickets visit www.trog.com.au

General Interest

New Zealand Branch News Is the art of communication the response that is received? If the answer is yes, then as a medical specialty we have much work ahead to ensure that radiology and radiation oncology are recognised to the level that they contribute to the health system. This represents a challenge to both the College and us as individual clinicians. Simply put, we need to better communicate our story and what value we add to the health care of each New Zealander. Dr Lance Lawler

Choosing Wisely I am pleased to be able to say that a good response was received to the Choosing Wisely survey that was circulated by the Branch pre-Christmas. The responses have laid the foundation for the adoption of six interventions that will allow the profession to communicate with the public and other medical specialties about radiology. It is my hope that we will be able to utilise this tool moving forward. The Branch is also represented on the Council of Medical Colleges’ subcommittee and is working on innovative and creative methods to disseminate this information.

CT Colonography As most of you will be aware, CT Colonography (CTC) has been utilised in New Zealand for well over a decade now, and has been validated as an excellent non-invasive investigation for bowel cancer in numerous local and overseas studies. Despite this, it has struggled to gain wider acceptance in the surgical and gastroenterological communities. After years of tireless work by radiologists on the National Bowel Cancer Working Group and within other groups, there has been a major shift this year with newly released guidelines for the investigation of suspected bowel cancer that now include CTC alongside optical colonoscopy (OC) for many indications. The same document also recommends a common triage point for CTC and OC.

The Branch Committee will work on disseminating this information over the next couple of months.

Teleradiology The Medical Council of New Zealand is currently reviewing its statement on telehealth. The revised statement is intended to apply to doctors registered in New Zealand and practising telehealth in New Zealand and/or overseas, and doctors who reside overseas and provide health services through telehealth to patients in New Zealand. This review may have consequences for radiology and the wider issues we face around teleradiology. The Branch will be actively involved and make a submission to Council.

Save the Date Lastly, to help provide an opportunity for Branch members to catch up with each other, a function is being planned for 22 September 2016 in Auckland. The idea at present is to start at 6pm and have a tour of the Auckland Art Gallery, along with some refreshments. Please consider placing this event in your diary. As always, I am happy to talk to anybody about Branch matters, or issues that they might have. Please feel free to contact me at lance.lawler@ranzcr.org.nz

Volume 12 No 2 I March 2016

General Interest

Australian Branch News This year, we’d like to introduce you to some of the people who work hard to represent the interests of Branch members and trainees. In this edition, we meet three Branch Education Officers from Western Australia, New Zealand and New South Wales.

Dr Fiona Bettenay Branch Education Officer, WA

institutions including the Princess Margaret Hospital, King Edward Memorial Hospital, Royal Perth Hospital, Sir Charles Gairdner Hospital, BreastScreen WA and in private practice. My subspecialist areas of interest are paediatrics, breast imaging and medico legal work. Since 1996, I have worked for MDA National in various roles including a Councillor and a Director of MDANI the captive insurer. As a local trainee I undertook a twoyear fellowship at the Royal Children’s Hospital Melbourne with the fellowship being conferred in 1987.

I am the new incumbent to the dual role of WA Branch Education Officer and WA Network Director of Training, with both positions historically being performed by the same person. An examiner for the College for many years, I am also actively involved in registrar teaching and training. With the support and advice of highly skilled Fellows, I look forward to the challenges of planning and delivering a comprehensive education program and representing the WA Branch on the Clinical Radiology Education and Training Committee and other sub committees. I have been the Head of Department, Diagnostic Imaging at Princess Margaret Hospital (PMH) for Children since 2008 and will remain so until the Perth Children’s Hospital is completed (approximately end of 2016). As a result of being both Head of Department (PMH) and WA Branch Education Officer/WA Network Director of Training, a potential conflict of interest has been disclosed to the College. As a West Australian consultant radiologist, I have worked in various

Inside News

Contact details Email: fiona.bettenay@health.wa.gov.au or through the WA Radiology Training Office +61 8 9224 2129.

which is helpful as feedback to my department and the pre-Part 2 registrars. Our Branch is occupied with establishing network training throughout New Zealand. This has come with a number of continuing challenges, not the least of which is trying to source funding for administrative support. Hopefully the networks will help with collegiality between our training centres, and widen the experiences of our trainees. Contact details I can be contacted through my work address Lisa.Sweetman@ccdhb.org.nz

Dr Pramod Phadke Branch Education Officer, NSW

Dr Lisa Sweetman Branch Education Officer, New Zealand

I am a general radiologist, with an interest in head and neck imaging. I have a long-standing interest in registrar training, and have been the alternate Branch Education Officer for the last six years, and have just taken over as Branch Education Officer (BEO) for the New Zealand Branch. I have previously been Director of Training for Capital and Coast District Health Board. I am excited about the role of BEO, both in terms of contributing to future policy development within the College and supporting centres around New Zealand in training registrars. I have recently started as a Part 2 College examiner,

I have been the director of training at Nepean Hospital in Western Sydney since 2007. Diagnostic neuroradiology, musculoskeletal radiology and emergency radiology are my clinical subspecialty interests. I am one of the Part 2 musculoskeletal viva examiners and I have participated in the curriculum development process as a reviewer of the musculoskeletal section of the curriculum. I have a keen interest in all aspects of health profession education. In order to establish a theoretical and practical foundation to my interest in health education, I have completed a Graduate Certificate in Health Professions Education (GCHPE) at Monash University. My current research interests are in the area of workplacebased assessments and entrustable professional activities in radiology training.

General Interest

I stepped into the role of NSW Branch Education Officer towards the end of 2014. With the 2015 introduction of radiology training networks in NSW, I am ready for the new challenges and opportunities. I will be actively involved in facilitating appropriate governance structures and curriculum delivery for both the local area networks and the wide area network within NSW, so that radiology networked training in NSW is successfully implemented. Radiology networked training is a collaborative effort and its success depends upon robust participation by the Directors of Training, clinical supervisors and trainees. Please contact me if you wish to discuss any aspect of radiology training networks in NSW or any other issue related to radiology education in NSW. Contact details Email: Pramod.Phadke@health.nsw.gov. au or work phone +61 2 4734 3192

Australian Branch Meeting Dates Overview 2016

NSW

VIC

QLD

Branch Scientific Video Presentations The Victorian and New South Wales Branch meeting presentations are available to view on Vimeo. Have a look at their case presentations by visiting www.vimeo.com/ranzcr/portfolios

Academic Meeting (ACI Lecture Series) Tuesday 5 April Tuesday 26 July Tuesday 8 November

Location Kerry Packer Lecture Theatre RPA Hospital Missenden Road, Camperdown, NSW 2050

Monthly Scientific Meeting (MSM) Thursday 21 April Thursday 19 May Thursday 16 June Thursday 21 July Thursday 18 August Thursday 15 September Thursday 20 October Thursday 17 November

Location Charles La Trobe Lecture Theatre, Ground Floor, Royal Melbourne Hospital City Campus, 300 Grattan St, Parkville, VIC 3050

Academic Nights Tuesday 7 June

Location Hillstone St Lucia Carawa St St Lucia, QLD 4067

Branch Committee Meetings Thursday 21 July Monthly Professional Meeting (MPM) Wednesday 18 May Wednesday 15 June Wednesday 20 July Wednesday 17 August Wednesday 21 September Wednesday 16 November

Teleconference Location Bruce Hunt Lecture Theatre Block A, Level 2, Royal Perth Hospital 197 Wellington St, Perth WA 6000

Meeting dates are subject to change. For further information about Branch activities and event locations please visit: www.ranzcr.edu.au/organisation/australian-branches or contact Sarah Hall on: sarah.hall@ranzcr.edu.au Ph: +61 2 9268 9752.

~ Death Notices ~ The College notes with regret the death of the following members: Dr Maurice Nathan – Life Member, WA A/Prof Lindsay Rowe – Fellow, NSW

Volume 12 No 2 I March 2016

General Interest

Branch Contacts 2016 ACT Chair: Dr Murali Guduguntla E: Murali.Guduguntla@act.gov.au Honorary Secretary: Dr Mervyn Despois E: mervyn.despois@act.gov.au Meeting Convenor: Dr John Cockburn E: john.cockburn@act.gov.au NSW Chair: Dr Lourens Bester E: lourensb@bigpond.net.au Honorary Secretary: Dr Chee-Chung Hiew E: chee-chung.hiew@sesiahs.health.nsw.gov.au Meeting Contact: Ms Annie Hutton E: Annie.Hutton@aci.health.nsw.gov.au NSW Radiotherapy Club Ms Legend Lee E: faculty@ranzcr.edu.au

NZ Chair: Dr Lance Lawler E: lance.lawler@ranzcr.org.nz Honorary Secretary: Dr Ben Wilson E: ben.wilson@southerndhb.govt.nz

VIC Chair: Prof Stephen Stuckey E: slstuckey@mac.com Honorary Secretary: Dr Gerard Goh E: G.Goh@alfred.org.au

QLD Chair: Dr Jonathan Corness E: jon_corness@yahoo.com Honorary Secretary: Dr Sanjay Dhupelia E: secretaryranzcrq@gmail.com

MSM Convenor: Dr Bhaveen Marne and Dr Wayland Wang E: msm.convenor@gmail.com

SA Chair: Dr Chris Pozza E: cpozza@usa.net Honorary Secretary: Dr Thuc Wilson E: thucwilson@gmail.com

WA Chair: Dr Neil Powers E: neil.powers@health.wa.gov.au Honorary Secretary: Dr Richard Ho E: richard.ho@health.wa.gov.au Meeting Convenor: Dr Fiona Bettenay E: Fiona.Bettenay@health.wa.gov.au

TAS Chair: Dr Rajendra Doolabh E: Rajendra.Doolabh@regionalimaging.com.au Honorary Secretary: Dr Jonathan Shulman E: Jonathan.Shulman@regionalimaging.com.au

Congratulate your Colleagues We would like to congratulate the following members for their Australia Day awards.

Dr Peter Pratten AM

Dr Richard Waugh AM

Dr Pratten was named a Member of the Order of Australia in the 2016 Australia Day awards for significant service to medicine, particularly in the field of radiology as a practitioner, to education, and to professional bodies.

Dr Richard Waugh was named a Member of the Order of Australia in the 2016 Australia Day awards for service to radiology as a practitioner and educator.

Director, RANZCR Board

Inside News

Director of Radiology, Royal Prince Alfred Hospital

General Interest

From the Trainor/Owen Collection What’s in the Box? With a collection of material an archivist can make the past come to life.

Professor HR Withers The Kidman/Cruise letter This year in Inside News, we will be showcasing recently donated material that adds to the story of radiology and radiation oncology and the people who gave the specialties personality.

Diving into just one of the boxes within the collection, it is overflowing with praise flooding in from around the world—peers, friends, followers and family.

A recently acquired collection of manuscripts, papers, note books, newspaper clippings, biological samples, bag tags and correspondence belonging to Prof HR Withers was kindly donated by the MD Anderson Cancer Centre in Houston, Texas. This remarkable collection re-creates his life, providing insight into who he was, his character, his thought processes, his private and professional life, not to mention worldwide achievements and accolades.

Two items in particular stand out, one is an official press release from The White House, another because of the quality of paper and the correspondents themselves—Nicole Kidman and Tom Cruise—which as a standalone piece showcases a synergy between modern medical scientific research and pop culture.

Prof Withers was an Australian born radiobiologist whose research revolutionised the way cancer is treated. He was recognised and presented with many awards for his discoveries including: the Kettering Prize of General Motors Cancer Research Foundation (1998), RANZCR Gold Medal (1998), Order of Australia (1999), The Enrico Fermi Award (1997) and many more.

What is the connection between medical science and A-list celebrities? How do they know each other, and to what degree? Where did they meet? What was their relationship like? Does radiobiology have celebrity status? Or was it simply a case of two Australian expats finding common ground? Maybe tomorrow’s box will unravel the mystery.

White House Press Release

Interested in learning more? Want to learn more about the HR Withers collection or other collections including MD Owen, PD Cashman, HR Sear, WR Bennett and RK Scott? Why not make an appointment to visit the Trainor/Owen Collection—a unique archive, museum and library, recording the history of radiology and radiation oncology. Contact the College Archivist on the details below.

Did you ever want to be an archivist? Solving mysteries, piecing together a story from a variety of sources? Well here is your chance! We are always looking for volunteers to help with the collection. Please contact Eva Stokes-Blake, Archivist, Project Manager at the College on +61 2 9268 9725 Monday – Wednesday, or email Eva StokesBlake archives@ranzcr.edu.au Volume 12 No 2 I March 2016

General Interest

Professional Documents and Publications Professional documents are developed by the College to support the specialties of clinical radiology and radiation oncology in Australia and New Zealand. They define the standards of training and practice that guide the provision of quality and safe patient care. The documents are reviewed regularly to ensure they reflect best practice. The College also releases major reports and other publications that inform governments, healthcare organisations and members of the public.

New Professional Documents Quality Guidelines for Volume Delineation in Radiation Oncology Minimising variation in target volume delineation is an important quality standard in the delivery of radiation therapy. The aim of this document is to provide consensus guidelines on measures that can be undertaken by radiation oncologists, trainees and radiation oncology departments to achieve this aim. (See article page 25 for more information on these guidelines)

Corporate Members of the College Alpenglow Pty Ltd www.alpenglow.com.au Bayer Australia Ltd www.bayer.com.au Brainlab Australia www.brainlab.com/en/ ChoiceOne Pty Ltd www.choiceone.com.au Comrad www.comrad.co.nz Elekta Pty Ltd www.elekta.com Everlight Radiology www.everlightradiology.com.au Everx www.everx.com

Inside News

Position Paper on Particle Therapy This document aims to inform cancer professionals, health professionals, health administrators, consumers and interested individuals about the current status of particle therapy internationally, the evidence for their use and the target population.

All College standards, policies and guidelines are available on the College website www.ranzcr.edu.au/resources/ professional-documents

Position Statement on the Provision of Ultrasound Guided Injections

If you have any enquiries about these documents, please contact the College on +61 2 9268 9777

It is The Royal Australian and New Zealand College of Radiologists’ (RANZCR) position that ultrasound guided injections are a medical intervention that can only be performed by a medical practitioner.

All College position statements and reports can be found here: www.ranzcr.edu.au/advocacy/statements

Updated Professional Documents Position Paper on Image Guided Radiation Therapy (IGRT) 2015 (see article on page 27) RANZCR Iodinated Contrast Media Guideline, 2016 Version (see article page 28)

GE Healthcare www.gehealthcare.com.au/ Genesis CancerCare Queensland www.genesiscare.com.au/ Health Imaging Solutions www.healthimaging.com.au Hologic Australia www.hologic.com/ Integral Diagnostics www.integraldiagnostics.com.au Ipsen Pty Ltd www.ipsen.com.au/ I-MED Network Radiology www.i-med.com.au InSight Oceania Pty Ltd www.insight.com.au Lightbox Radiology Education www.lightboxradiology.com.au/

Pacific Radiology Group www.prg.co.nz Philips Healthcare www.philips.com.au/healthcare Quantum Health Group www.qhealthcare.com.au Sectra www.sectra.com/medical/ Tolmar Australia Pty Ltd www.tolmar.com.au/ Toshiba Medical www.medical.toshiba.com.au Varian Medical Systems www.varian.com Wiley Publishing Asia www.wiley.com

General Interest

Australasian Meetings 2016 April ARGANZ Meeting Fremantle, WA – 1-3 April 2016 www.arganzmeeting.com ANZGOG ASM Sydney, NSW – 16 April 2016 www.anzgog.org.au USANZ ASM Gold Coast, QLD – 16-19 April 2016 www.usanz2016.com

RANZCR Annual Scientific Meeting Dates ASM 2016 Gold Coast, Queensland 13-16 October 2016 www.ranzcr2016.com 2016 NZ Branch Annual Scientific Meeting Wellington, New Zealand 5-7 August 2016 www.ranzcr2016.co.nz ASM 2017 19-22 October 2017 Perth, WA

ANZSNM 2016 Rotorua, New Zealand – 22-25 April 2016 www.anzsnm2016.com AMSIG Annual Meeting Camperdown, NSW – 30 April 2016 www.amsig.org

May IRSA Registrar Meeting Sydney, NSW – 28-29 May 2016 www.irsa.com.au/meetings

July 2nd Australian Breast Conference Auckland, NZ – 7-10 July 2016 www.asbd.org.au

August IRSA Meeting Queenstown, NZ – 2-4 August 2016 www.irsa.com.au

October

ARRS Annual Meeting Los Angeles, USA – 17-22 April 2016 www.arrs.org APCCVIR 2016 Suzhou, China – 21-24 April 2016 www.apccvir2016.org/en

May ACR 2016 Washington, USA – 15-19 May 2016 www.acr.org/Annual-Meeting ASNR 2016 Washington, USA – 23-26 May 2016 www.asnr.org/2016 ESTRO 35 Turin, Italy – 29 April – 3 May 2016 www.estro.org

College Meetings 2016

June

Board 13 May 14 June (telco) 5 August 13 September (telco) 17-18 November

ESGAR 2016 Prague, Czech Republic 14-17 June 2016 www.esgar.org/annual-meeting/ esgar-2016

Annual General Meeting 13 October 2016 Faculty Council – Clinical Radiology 28 April (telco) 7-8 July 1 September (telco) 29-30 September Faculty Council – Radiation Oncology 29 April (telco) 22 July 2 September (telco) 21 October

ANZSPR 2016 Gold Coast, QLD – 16-19 October 2016 www.anzspr16.com ANZHNCS Annual Scientific Meeting and IFHNOS 2016 World Tour Auckland, New Zealand – 25-27 October 2016 www.ifhnosauckland2016.org

International Meetings 2016

ASUM 2016 Brisbane, QLD – 28-30 October 2016 www.asumconference.com.au

April European Lung Cancer Conference Geneva, Switzerland – 13-16 April 2016 www.esmo.org/Conferences/ELCC-2016Lung-Cancer

World Congress of Brachytherapy San Francisco, USA – 27-29 June 2016 www.americanbrachytherapy.org/ meetings/annual2016/index.cfm

August AOCR 2016 Beijing, China – 18-21 August 2016 www.aocr2016.org

September RCR 2016 London, UK – 12-14 September 2016 www.rcr.ac.uk/college/annual-scientificmeeting-2016 ICR 2016 Buenos Aires, Argentina 21-24 September 2016 www.icr2016.org/ ASTRO 2016 Boston, USA – 25-28 September 2016 www.astro.org/Meetings-andEvents/2016-Annual-Meeting/Index.aspx

November RSNA 2016 Chicago, USA – 27 Nov – 2 Dec 2016 www.rsna.org

Volume 12 No 2 I March 2016

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