Volume 13 No 2 / March 2017
Quarterly publication of The Royal Australian and New Zealand College of Radiologists
THE DIGITAL REVOLUTION Opportunities and Challenges for Radiology
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In this edition 5 President’s Message 6 COVER STORY The Digital Revolution 9 CEO Message Engaged Members 10 Member Profile 11 Grants, Awards and Prizes 12 2017 Annual Scientific Meeting Research 15 Research into Rectal Cancer Treatment 17 RANZCR Research Strategy Profile and Presence 18 InsideRadiology 19 Targeting Cancer Access to Quality Services 20 Breast Cancer Multidisciplinary Meetings 21 MRI Magnets Quality Practice 23 Clinical Radiology Written Report Guidelines 24 MBS Review Taskforce Update 25 Emerging Digital Health Environment Quality Training 27 EBIR Examinations 28 Exam and Assessment Review Update Clinical Radiology 29 Message from the Dean 31 Chief Censor 32 Prof Hillman: Big Data and Deep Machine Learning 34 IBM: A Better Imaging Experience 35 ADIA Update 36 Trainee News
Radiation Oncology 39 Message from the Dean 41 Chief Censor Hobart Hobart 42 Varian: Intelligent Treatment Delivery Hobart Hobart 43 Trainee News 47 Vale Sally Crossing 48 TROG News Hobart Hobart
rt rt rt General Interest rt Hobart Hobart 51 New Zealand Branch 52 Australian rt Hobart Hobart Branches 53 From the Archives 55 Congratulate rt Hobart Hobartyour Colleagues 57 Meetings and Events rt Hobart Hobart rt Hobart InsideHobart News is printed on Titan Satin. Titan is produced in an ISO 14001 accredited facility rt Hobart Hobart ensuring all processes involved in production are ofHobart the highest environmental standards. rt Hobart FSC mixed Sources Chain of Custody (CoC) certification ensures fibre is sourced from certified and well managed forests.
Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editors Sarah Hall Bertha Harvey
From the
Editor’s Desk We are just at the beginning of what will be a great year ahead. In this edition, we focus on the theme of eHealth and Digital Transformations. Our cover story by Sandra Keogh highlights the opportunities and challenges for radiology in the future, with her article on the Digital Revolution. Also featured in this edition is a piece from Prof Bruce Hillman on Big Data and Deep Machine Learning.
Dr Allan Wycherley
We invite you to think about which colleagues you might like to nominate for an award this year as nominations close on 10 April. It is time to start planning for the 2017 Annual Scientific Meeting which is being held in Perth, Western Australia. We find out the keynote speakers and some information about the venue. Our Inside Radiology website won the Best in Class award in the Interactive Media Awards (Medical Category). Best in Class is the Highest Honour bestowed by the IMA. Congratulations to the team for their efforts. Dr Gerard Goh discusses the successful EBIR examination initiative undertaken by CIRSE, RANZCR and IRSA while progress continues to be made in implementing the recommendations from our own examination and assessment review. The emerging digital health environment is discussed due to governments in Australia and New Zealand wanting to improve efficiency and access for consumers. All this and more in our first edition of 2017. We would like to thank everyone who has contributed to this edition and wish everyone a successful year ahead. Allan Wycherley Editor-in-Chief editor@ranzcr.edu.au
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 Office Floor 6, 142 Lambton Quay Wellington, NEW ZEALAND Ph: +64 4 472 6470 Fax: +64 4 472 6474 Email: nzbranch@ranzcr.org.nz
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Inside News © 2017 The Royal Australian and New Zealand College of Radiologists® (RANZCR®)
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Introduction
Radiology In The Second Age Of The Machine A Message from the
President Dr Greg Slater
Fear and anxiety over the impact of machines on our working lives date from the earliest days of the Machine Age. Inspired by Darwinian evolution and the rural idylls of New Zealand, Samuel Butler’s famous novel Erewhon (published in 1872) satirised our fear that the machine might learn to perpetuate itself and bring humans under its control. His ideas were to influence the 20th century dystopian visions of Nineteen Eighty-Four, Brave New World and many others. Later, the historian and philosopher Lewis Mumford added to Butler’s anxieties with what we today refer to as information and communication technology or ICT. Mumford wrote that machines, while ‘potentially a vehicle of rational human purposes, are scarcely a blessing when they enable the gossip of the village idiot and the deeds of the thug to be broadcast to a million people each day.’1 That was in 1934 when Mumford was concerned about the tabloid press and the rise of fascism, but it is a simple matter in this age of Twitter and the alt-right to see its continuing relevance today. As Sandra Keogh explains (page 6 of this issue), we live today in a second Machine Age—the age of digital technologies and Big Data. This is a time when artificial intelligence, machine learning and ubiquitous communication are transforming work and society, outsourcing and displacing the jobs of the human professional, including the health professional. We are, according to Richard and Daniel Susskind, entering a post-professional epoch where training
will focus on tasks, not occupations or careers. As I noted in the last edition of Inside News, some observers fear ‘our next radiologist may be a computer.’ Radiology is in no position to ignore these predictions. Already medical imaging and the data it produces have revolutionised healthcare delivery. According to IBM, the global volume of medical data generated to date exceeds 150 exabytes (or 150 billion gigabytes) and medical images apparently account for over 90 per cent of this deluge.2 Radiologists have adapted in numerous ways to ICT innovation, employing the computer to aid them in detection and diagnosis and improve productivity through the automation of bureaucratic and regulatory processes and billing. But, as they say in the cheesy TV commercials, ‘Wait, there’s more.’ IBM’s Watson Health and other corporate initiatives are busy developing cognitive computing technologies to tap the ‘great unknown’—that is, the estimated 80 per cent of current health data that is unstructured and hence invisible to current data integration systems. Watson Health, which apparently can read 200 million pages of text in three seconds, will perform advanced analytics on these data, generate new knowledge from it and, to quote the boffins, ‘achieve more than we ever thought possible.’3
develop a broader consultancy role in patient care. It’s a view shared by Keogh, who argues in favour of an evolution of the radiologist into an integrative diagnostician and coordinator of medical information. I strongly encourage all members to read this issue’s articles on Big Data and e-health. Your future depends on it. If we fail to understand and adapt to technological change in our profession we are surely destined to live out our days in Butler’s Erewhon (and that’s an anagram of ‘nowhere’).
References 1. Lewis Mumford, Technics & Civilization (Harcourt Inc., 1934; Chicago & London: University of Chicago Press, 2010), 301. 2. Merge Healthcare Inc. “IBM Unveils WatsonPowered Imaging Solutions for Healthcare Providers,” media release, 29 November 2016, www.merge.com/News/Article.aspx?ItemID=675 [8 February 2017]. 3. IBM webpage at www.ibm.com/watson/ health/ [8 February 2017].
Consequently, Prof Bruce Hillman (page 32) warns us that the current heavy focus in radiology on image interpretation is a business model with a limited future. The machines have that in their digital grasp. Instead the radiologist needs to
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Introduction
The Digital Revolution:
Opportunities and Challenges for Radiology In previous editions of Inside News both the President and the Dean of the Faculty of Clinical Radiology have talked about innovations in technology, particularly “Big Data” related developments, and the potential for these to impact on the work of radiologists. The exponential growth and storage of data as well as the means to store, analyse and use large volumes of data to solve problems, loosely referred to as “Big Data”, is not unique to radiology - it pervades every facet of society that uses paperless transaction models. In this edition, we look more broadly at the scope, pace and transformational impacts of today’s digital technology revolution and what skills will be required for the jobs of the future. We look at GE’s vision of “digital health” and what radiologists need to do to leverage advances in information technology in order to continue being leaders in the digitisation of medicine.
Digital Technologies Transforming Societies, Jobs and the Global Economy Current advances in digital technologies are being distinguished from earlier advances in terms of their greater sophistication and integration and the resulting transformation of societies, jobs and the global economy. This period has been referred to as “the second machine age”1 where the effect of these digital technologies will manifest with “full force” through automation and the making of “unprecedented things”. Klaus Schwab2 suggests we are at the beginning of a fourth industrial revolution characterised by a much more ubiquitous and mobile internet, by smaller and more powerful sensors that have become cheaper, and by artificial intelligence and machine learning. This fourth industrial revolution
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is not only about smart and connected machines and systems; its scope is much wider with further breakthroughs occurring simultaneously in areas ranging from gene sequencing to nanotechnology, from renewables to quantum computing. It is the fusion of these technologies and their interaction across the physical, digital and biological domains that make the fourth industrial revolution fundamentally different from previous revolutions. Further, the emerging technologies and broad based innovation are diffusing much faster than previous revolutions.
Not Man versus Machine While it is almost inevitable that these technological advances will have a major impact on labour markets and workplaces around the world, this does not mean we face a man versus machine dilemma. In fact, in the vast majority of cases, the fusion of digital, physical
“Digital health represents both unprecedented opportunities and challenges for radiologists.” and biological technologies driving the current changes will serve to enhance human labour and cognition, meaning that leaders need to prepare workforces and develop education models to work with, and alongside, increasingly capable, connected and intelligent machines3. Increasingly capable machines are already transforming many jobs, even some professional jobs like diagnosticians and lawyers may find some or all of their jobs being
outsourced. Susskind and Susskind suggest that increasingly capable, nonthinking machines will displace much of the work of human professionals; that while the technological change will be incremental and not an overnight revolution its eventual impact will be radical and pervasive; that how technology is used will be very much in the hands of the professions; and from a moral viewpoint that the professions ought to shape their own futures. Susskind and Susskind also questions how future generations of professionals will be trained and what they will be taught. They anticipate that people will be trained on a task-based basis rather than for undertaking jobs - they list the following 12 roles for the future which tentatively describe the types of role, task and activity for which human beings will be required in a post-professional society: craftspeople, assistants, paraprofessionals, empathisers, research and development workers, knowledge engineers, process analysts, moderators, designers, system providers, data scientists and systems engineers.4
“Digital Health” – Big Data, Analytics and Artificial Intelligence “We are already in the midst of the digitally enabled health revolution where the cloud connects people, data and machines and in which analytics has become a critical tool to delivering higher quality, more efficient care”5. GE’s vision of “digital health” includes the use of advanced analytics based on multi-modal data; the “Health Care Internet of Things,” which uses sensors, apps, and remote monitoring to provide continuous clinical information; and data in the cloud that enables clinicians to access the information they need to care for patients in their home, their office, remotely, and to collaborate with specialists in another country.
Introduction
It embraces the machine as an integral part of the health care team; automates routine procedures and processes so clinicians can focus on the most complex and critically ill patients; and uses deep learning platforms to provide actionable tools at the point of care so clinicians can more efficiently and effectively diagnose and treat patients. It automates billing, documentation, and regulatory processes so that the clinicians can focus on meeting every patient’s needs. It means shifting from sick care to wellness preservation. The shift to a system-based approach to medicine relies on the ability to collect, organise, store and analyse huge volumes of data. Digital health represents both unprecedented opportunities and challenges for radiologists.
Can Radiologists Continue to be Leaders in “Digital Health”? Medical imaging technologies have revolutionised health care delivery over the past 50 years. Radiology had its first “Big Data“challenge when the utilisation of cross sectional imaging began to soar in the 1970s. It met that challenge by developing and embracing PACS and a new method for visually analysing large imaging datasets – volumetric interpretation. Radiology has led the field by developing innovative ways to archive, index and efficiently deliver and interpret large datasets. Technological innovation in imaging continues to deliver new tools for diagnostic accuracy with ever higher resolution images. However, with rapidly increasing computing power enabling greater analytical capability in machines, the endpoint is changing dramatically – technological innovation is now being used to change patient management, outcomes and satisfaction as well as the cost of healthcare. Melding radiological
advances with the power of digital and information technology can deliver greater efficiency, quality and value in health care. As leaders in the digitisation of medicine and the development of medical informatics, radiologists have already formed relationships with computer scientists, informatics specialists, physicists and technology manufacturers that will be crucial in designing and implementing new diagnostic and information technologies. They already have the skills and technology in place to deal with the volume of data that will be generated by the trend towards “systems diagnostics” – the complete integration of the many available digital resources and the standardised characterisation of the radiologic information6. To remain leaders in the digital reshaping of health care, radiologists need to embrace the challenges and opportunities that digitisation holds. In the near term the greatest
opportunity in imaging informatics is enhancing the communication between radiologists and all the groups with which they interact, especially referring practitioners, patients, other health care providers and the government. Leveraging technologies to re-establish radiologists in the mind of patients as physicians who are directly involved and critical to their care should be a priority, using mobile communication tools to help achieve this. The greatest near term challenge is to shift reliance on radiologic pathologic correlation as the basis of image interpretation to one of systems diagnostics. While this shift will require a fundamental change in research, training and continuing education, it is an opportunity for radiologists to form new alliances and relationships with other disciplines and specialties, and to lead the way in ushering in a new era of patient-centred, collaborative and team-based care.
continued over... Volume 13 No 2 I March 2017
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Introduction
It is information technology that will help radiologists to demonstrate their value in the patient’s continuum of care. Imaging informatics is at the core of many of the creative concepts being developed, tested and validated in areas of medical science including biomedical informatics, precision medicine, artificial intelligence and deep learning. Radiologists have an opportunity to evolve from image interpreters into integrative diagnosticians who are the primary providers and coordinators of medical information. Recent developments in efficient systems and reports that integrate imaging with cogent clinical and laboratory data will pave the way for radiologists of the future to become information consultants as well as image interpreters.
In shaping the future of artificial intelligence and radiology, radiologists will need to depend on new machine learning technology to augment, not replace, the unique skill set of the expert, ultimately creating greater value for the patient and the patient’s care team. New and evolving skill sets will be required that will not need radiologists to surrender their individual clinical acumen and capabilities to a library of machine-learning algorithms, but will require a variety of additional skills as machine learning matures and integrates more readily into practice.
References
Developments in machine learning that make radiologists safer, more efficient and smarter need to be embraced.
6. Digitization of Medicine: How Radiology Can Take Advantage of the Digital Revolution. King C. Li et al. Acad Radiol 2013; 20:1479-1494
Is Machine Learning a Real Threat to Radiologists?
In the face of new and potentially highly disruptive technology, radiologists need to ensure the profession is leading, and not following, what will be a significant transformation of their work.
Machine learning is already a part of radiology practice, helping in computer-aided detection (CAD) and computer-aided diagnosis (CADx) and in many applications these systems have shown comparable, or even higher, performance compared with welltrained and experienced radiologists and technologists7 Machine learning is expected to become a powerful force in radiology in the next five to ten years, with many non-traditional companies looking to take advantage of this opportunity with sophisticated analytics they promise will deliver financial and clinical benefits by mining metadata. “The true threat is not the encroachment of further machine learning applications but rather how radiologists respond to, adapt to and integrate the new technology in a way that demonstrably improves imaging’s overall value” 8
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Inside News
What do Radiologists Need to do Now?
There are a range of obstacles to be overcome as the digital revolution in health advances. The pace of technological change is accelerating and while it may be premature to suggest that big changes will occur soon, they will evolve and radiologists need to be proactive in exploiting the opportunities that present and addressing the challenges they are facing. Sandra Keogh, BSc Policy Advisor, The Royal Australian and New Zealand College of Radiologists
1. Erik Brynjolfsson and Andrew McAfee, The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies, W.W. Norton & Company, 2014. 2. The Fourth Industrial Revolution, Klaus Schwab, World Economic Forum, 2016 3. ibid 4. The Future of the Professions: How Technology Will Transform the Work of Human Experts, Richard Susskind and Daniel Susskind, Oxford University Press, 2015 5. Big Data, Analytics and Artificial Intelligence, The Future of Health Care is Here, GE and UCSF, 2016
7. Wang S, Summers RM. Machine learning and radiology. Med Image Anal 2012;16:933-51 8. 3 questions to shape the future of AI and radiology by Dr Christopher Austin, Aunt Minnie accessible at http://www.auntminnie.com/index.
Introduction
From the
Chief Executive Officer
Ms Natalia Vukolova
The start of 2017 has probably been the most intense that I have experienced in the College: from government reforms to new initiatives in training to winning media awards, we have been striving and achieving across all areas of the College’s work. Our ambition to lead the dialogue on imaging, interventions and cancer within the health sector means we have to think smart, and work hard and stay on top of current developments. Here are some of the things that will occupy your College, clinical colleagues and our staff in 2017. This year will see the national election in New Zealand towards which we are preparing a policy platform with a focus on radiation oncology workforce shortages and better regulation of teleradiology workforce. Across the Ditch, the Australian Government’s Medicare reforms are generating much work for the many members who have volunteered for the committees – a slow and difficult process but one we must stay involved in. We have successfully advocated for imaging and radiation oncology throughout the process, but the vagaries of political approvals require us to remain vigilant and active. The implementation of recommendations from the review of our training programs and assessments (aka ACER/Prideaux review) is nearing the end of its first year. Although we have envisaged that the implementation will take at least three years, many improvements to examinations and processes have
already been implemented. The move of the radiology viva examinations to a new (and state-of-the-art) home in the AMC Assessment Centre in Melbourne is an exciting new phase in our assessments area. In February, we hosted the inaugural meeting of the Interventional Radiology Committee and anticipate much leadership and good thinking to emerge from that committee. In early 2017, the updated and beautified Inside Radiology website, which provides information to patients and GPs about imaging procedures, has won a Best-In-Class Award from the Interactive Media Awards, fantastic achievement that showcases the exemplary work we are doing on our digital platforms. Next step is the update to the College’s main website, due in mid-2017, and I personally can’t wait. Our members will be enjoying an increased number of courses and events this year and our flagship conference is going to be fantastic (although it is hard to imagine anything beating the Gala Dinner at Gold Coast last year – the stuff of legends).
“Our ambition to lead the dialogue on imaging interventions and cancer within the health sector means we have to think smart, work hard and stay on top of current developments.”
With that (much abridged) list of some of our key priorities, I would like to extend a heart-felt thank you to all the members who have been leading College work areas and contributing their time and expertise. An exciting year ahead. If you have any comments or questions, please write to me at ceo@ranzcr.edu.au
Volume 13 No 2 I March 2017
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Engaged Members
Dr Craig Hacking Consultant Radiologist and Director, Royal Brisbane and Women’s Hospital, QLD Managing Editor Radiopaedia.org Founding Executive Committee Member for ANZERG Co-Lead Anatomy Examiner
Dr Craig Hacking
Background I graduated medical school at the University of Queensland (UQ) in 2005 after an undergraduate anatomy degree, which fuelled my curiosity and motivation in the anatomy-based specialties, surgery and radiology. I found radiology more enjoyable and imaging anatomy was brilliant, so I wanted to do more. I trained in radiology at the Royal Brisbane and Women’s Hospital (RBWH) and then undertook a general MRI fellowship at Nambour in 2012. As a trainee, I was drawn to the organisation of the training program and trainee administration. I wanted to pull together my experiences from training all around the Queensland network and improve the way we structured training. So as a junior consultant, I was an assistant Director of Training (DoT) at RBWH for a few years, and I am now the current DoT. At the same time, the College anatomy examiners group were short on members so Prof Alan Coulthard at RBWH nominated me. I was interested in the transition to electronic exams and it is a great way to keep my anatomy knowledge up to date. Recently, I observed the viva examinations to become an examiner in 2017. This is a great time to be involved with the viva examination as we are about to move to a purpose built test centre and electronic vivas are around the corner.
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Inside News
I spent a year at the Royal Melbourne Hospital in 2015 and worked with A/ Prof Frank Gaillard, the founder of Radiopaedia.org. I quickly became involved with the site as I readily identified with their philosophy of ‘FOAMed’ (free open-access medical education) and I have since become a managing editor and a course presenter.
“I feel I am a better radiologist, DoT and teacher when I am involved with the College and Radiopaedia.”
Why I Am Involved A mentor of mine said ‘the world is run by people who show up’. Or like I put it ‘don’t complain if you are not involved’. This is the reason I do what I do. I feel I am a better radiologist, DoT and teacher when I am involved with the College and Radiopaedia.
Encouragement to Others My training gave me the skills to work as a radiologist in a fun and dynamic, broad specialty, with great people and I make a good living whilst doing so. I enjoy knowing that my many extracurricular activities can help others to achieve the same goals. This is why I encourage everyone to do something for the College. To help shape the system that gave us so much.
It has become a fulfilling part of my work, allowing me to contribute not only to the training of my trainees and Australian candidates around the country but also to radiology education on a global scale. I am also a senior lecturer at UQ, and I hope to find time in the future to increase my university teaching whilst using Radiopaedia. As a result of my interest in emergency and trauma radiology I recently helped the current Chief Censor A/Prof Dinesh Varma create the ANZERG (Australian and New Zealand Emergency Radiology Group) Special interest Group in 2015. Although young, we aim to promote emergency radiology as a subspecialty.
To get involved or to share your experiences and be featured in the member profiles, please contact Sarah Hall at editor@ranzcr.edu.au or +61 2 9268 9752
Engaged Members
Grants, Awards and Prizes 2017
Nominations and applications close soon! Do you have a colleague who you feel has made a valuable contribution to the College and/or the profession? Nominate them for a College Honour: • Gold Medal: the College’s highest accolade • Roentgen Medal: For outstanding service to the College • Clinical Radiology Educational Service Award and Denise Lonergan Educational Service Award: For valuable contributions to educational activities • Life Membership: For significant contribution to the profession and/or the College. Submit your nominations to your local Branch Committee by 10 April. Visit www.ranzcr.edu.au/members/awards-aprizes/college-honours to find out more and download a nomination form. The College also has a number of grants, prizes and fellowships available for members to access.
Technology reboot on the horizon for RANZCR
Trainee Grants and Prizes
Research Grants
• Clinical Radiology Early Career Researchers Prize
• RANZCR Research Grants: Providing support and research experience to Fellows, Educational Affiliates and trainees
• Faculty of Radiation Oncology Bourne and Langlands Prize • Varian Medical Systems Educational Grants
• Ferring Pharmaceuticals Grant: Supporting research projects in the area of prostate cancer
Fellowships
• Genito-Urinary Fellowship Grant: Supporting research projects relating to genito-urinary cancers
• Thomas Baker Fellowship: Supporting a period of study overseas • Bill Hare Fellowship: Supporting the study of a recognised radiology subspecialty • Rouse Travelling Fellowship: Supporting a clinical radiologist from New Zealand to travel to Australia to speak at the 2017 Annual Scientific Meeting in Perth • Windeyer Fellowship: Supporting a post Phase 2 trainee or junior Fellow to complete a Clinical Research Fellowship in the UK.
• Withers and Peters Grant: Supporting the most able and committed early career researchers to carry out significant research projects. Deadline 24 April 2017. Submit your applications to gaps@ranzcr.edu.au by 10 April (12 June for RANZCR Research Grants). Application forms and guidelines can be downloaded at www.ranzcr.edu.au/ members/awards-a-prizes
If you have any questions relating to the College’s grants, awards and prizes, please contact Chris Bonaventura, Administrator, Membership at gaps@ranzcr.edu.au
Just as the professions of clinical radiology and radiation oncology must adapt to and embrace technological change in order to achieve the highest standard of patient care, the College is also adopting new technologies to enhance the services we provide to our members. Work is well underway to renew our member and payment applications, and our goal this year is to provide an intuitive, accessible new website with more robust and efficient member and payment services. Stay tuned for further announcements later in the year. Volume 13 No 2 I March 2017
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Engaged Members
Perth set to Explore the Extraordinary at the 2017 ASM We invite you to ‘Explore the Extraordinary’ and join us in Perth from 19–22 October 2017 for the College’s 68th Annual Scientific Meeting. The 2017 ASM will take on a fresh look at the Crown Perth which boasts three hotels including Crown Metropol, Crown Promenade and the brand new 6 star Crown Towers, combined with an array of restaurants, bars and after dark nightlife. The Crown Metropol is particularly conducive for families, with facilities including water slides by a lagoon style swimming pool sure to keep your family occupied for hours while you hear from some of clinical radiology and radiation oncology’s leading thinkers.
Leading Clinical Radiology International Experts heading to Perth for the 2017 ASM The clinical radiology specialty has an exciting scientific program taking shape that will see interactive forums and discussions alongside streams focusing on Abdominal Imaging, Head and Neck, Interventional Radiology and MSK. Leading experts in these fields will join us in Perth to share their expertise and knowledge complemented by a local faculty that will ensure presentations are relevant to Australian and New Zealand clinical radiology. The opening session will commence with us taking a look into the future, with Dr Declan O’Regan speaking on the power of “Big Data”: a digital revolution in clinical radiology? Professor Suresh Mukherji, Chair of the Department of Radiology at Michigan State University and Walter F. Patenge Endowed Chair will speak to us on Radiology 2020 - where is our speciality heading. Professor Mukherji is the author of hundreds of peer reviewed papers and a dozen book chapters, serves as a senior editor for three journals and is a consulting editor at the Neuroimaging
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Inside News
Clinics and Magnetic Resonance Imaging Clinics of North America. His recent work focuses on biologic aspects of head and neck cancers and is specifically interested in imaging proteomics and genomics based on molecular imaging techniques. Dr Michael Federle, Professor of Radiology at Stanford University and the Associate Chair for Education for the Department will also join us in Perth. Dr Federle’s focus in clinical research and teaching is abdominal imaging with an emphasis upon CT scanning. Within this broad field he has a wide range of specific and general interests, leading to over 300 publications in peer-reviewed journals as well as hundreds of book chapters. In addition, he has been the
main editor and/or author of more than 20 textbooks of radiology. The most recent of these are the 2nd Edition of Diagnostic Imaging: Abdomen; Imaging Anatomy: Chest Abdomen Pelvis; Expert DDx: Abdomen; and Specialty Imaging: Hepatobiliary and Pancreas, all published by Amirsys. In Perth, Prof Federle will be presenting on topics including: diffuse liver disease, cystic pancreatic lesions and Focal lesions in the cirrhotic liver. Complementing Professor Federle’s presentation will be an interactive Abdominal Imaging quiz by Dr James Seow. Accomplished musculoskeletal radiologist Professor Mark Kransdorf has
expertise in radiologic pathology and is the author of four textbooks, more than twenty-five book chapters and over 150 peer reviewed journal articles. He has lectured extensively internationally and will address a number of MSK related topics including Analysis of Bone Tumors: Fundamental Concepts; The Many Faces of Osteosarcoma; and Spine Compression Fractures: When to Worry to name a few. Professor Kransdorf is a past President of the Society of Skeletal Radiology; the organisation representing musculoskeletal radiology in North America. He is currently an Editor of Skeletal Radiology, the Journal of the International Skeletal Society and the Official Journal of the Society of Skeletal Radiology. Additionally, he was a Visiting Professor in Musculoskeletal Radiology in the Department of Radiologic Pathology at the Armed Forces Institute of Pathology, Washington, DC, for more than 25 years. Rounding out our International Faculty line up is Intervention Radiologist Dr Jeff Geschwind. Dr Geschwind is the Chairman and Chief of the Department of Radiology and Biomedical Imaging at the Yale School of Medicine. Dr Geschwind’s clinical expertise focuses on treating hepatic cancer and other malignancies. He is considered a key opinion leader in the field of liver cancer and his presentations at the ASM will focus on this including TACE for patients with primary liver cancer; and the management of primary liver cancer. The program will also include insights from local radiologist Dr Fiona Bettenay who will chair the Malpractice for Radiologists forum with a legal panel. Dr Emmeline Lee will present on Emergency Radiology in Women’s Imaging as well as lead one of several interactive quiz sessions on Women’s Imaging. We will also be addressing other areas that help us be extraordinary including a session on mentorship with
Engaged Members
Dr Nicola Strickland, President of the Royal College of Radiologists; and will also be taking a look at radiology from a veterinary perspective with Belinda Hopper who will demonstrate how we can share ideas and knowledge. We encourage colleagues to complement this program and share their extraordinary work and ideas by submitting an abstract through the 2017 ASM website www.ranzcr2017.com by Friday 7 April. Start planning your leave now and be part of the 2017 ASM from 19–22 October at Crown Perth.
Michael Federle, Professor and Associate Chair for Education Department of Radiology Stanford University Medical Center, USA.
Cutting Edge Technology CyberKnife® Being Presented at the 2017 ASM In the field of radiation oncology, the CyberKnife® Robotic Radiosurgery System is universally recognised as the premier radiosurgery system capable of delivering high doses of radiation with sub-millimetre accuracy anywhere in the body. As validated and proven in numerous peer-reviewed publications, the precision and accuracy of the system combines with continual image guidance and robotic mobility to deliver treatments characterised by high
conformality and steep dose gradients. We are excited to have CyberKnife® expert Dr Joost Nuyttens join us to share his expertise and demonstrate its ability. We are also looking forward to presentations from Professor Brian O’Sullivan, Head and Neck Oncology Program Chair at Princess Margaret Cancer Centre. Professor O’Sullivan is the immediate past-Chair of the Head and Neck Oncology Committee of the Canadian Clinical Trials Group (CCTG) and current co-Chair of the US NCI Head and Neck Steering Committee of the Coordinating Center for Clinical Trials, CTEP. He is the recipient of numerous international awards and research grants. Professor O’Sullivan is best known for the randomised trial of preop vs postop radiotherapy for sarcoma which shapes our practice to this day and has published 300 papers, 50 book chapters, and has written or been editor of six oncology textbooks. Professor Lena Specht is the Professor of Oncology at the University of Copenhagen, Chief Oncologist at the Department of Oncology in the Rigshospitalet, Danish National Hospital, Copenhagen and Vice President of ILROG. Her main areas of research and clinical interest are advanced technologies in imaging and radiation oncology, with special emphasis on lymphomas, head and neck cancer, and long term complications. She has authored over 200 research articles and educational papers, including ESMO guidelines on peripheral T-cell lymphomas and cutaneous lymphomas, and ILROG guidelines on radiation therapy for lymphomas. She has authored two textbooks and numerous book chapters and is also a FALCON contouring teacher. Professor Specht will be presenting a number of lectures
during the ASM program including Modern Advanced Radiation Therapy for Lymphomas in the combined modality setting; Imaging in the Management of Lymphomas; Management of Localised Extranodal Lymphomas; Issues in a Heterogeneous Group of Disease; and Head and Neck Cancer: PET-based Dose-painting. Stay tuned as our ASTRO speaker and local faculty of experts are announced in the coming months.
Professor Lena Specht, Professor of Oncology at the University of Copenhagen, Chief Oncologist at the Department of Oncology in the Rigshospitalet, Danish National Hospital, Copenhagen and Vice President of ILROG.
for further information, contact Kylie Clarke on events@ranzcr.edu.au or +61 2 9268 9777
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What does this radiologist see? Opportunity.
Everlight Radiology is always recruiting. That’s because our team of more than 100 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 to report on the most varied and interesting cases. Our global network offers the opportunity to relocate and work from overseas. 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 New Zealand, Australia, South Africa, Europe, UK, North America … 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 50 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
Research
Multi-parametric MRI for Prediction of Treatment Response in Rectal Cancer with a clinical complete response to chemoradiotherapy, substitution of surgery with a ‘watch-and-wait’ approach has emerged as a management option; however, the appropriate selection of patients is crucial.
In 2014, I was privileged to have received the Withers and Peters Grant to support my PhD research, assessing the role of multi-parametric MRI for prediction of radiotherapy response in rectal cancer. There is tremendous scope for MRI to improve radiotherapy response prediction and targeting, and I am fortunate to have found a research area that I find fascinating. Functional MRI can provide ‘virtual’ whole tumour biopsy, providing information on tumour function and heterogeneity that can provide clues on biologic factors that predict for a good or poor radiotherapy response. Diffusion Weighted MRI (DWI) allows assessment of tumour cellularity, whilst Dynamic Contrast Enhanced (DCE) MRI allows assessment of factors of tumour perfusion and angiogenesis. In addition, a 3-dimensional voxelwise analysis of the entire tumour region ensures that information on tumour heterogeneity is captured. In rectal cancer, response to neoadjuvant chemoradiotherapy is variable, and functional MRI has the potential to improve prediction of therapeutic response, enabling individualisation of patient management. In patients
The aim of this study was to assess the role of multi-parametric MRI, combining DWI and DCE, in the prediction of treatment response in patients with locally advanced rectal cancer undergoing neoadjuvant chemotherapy followed by surgery. All MRIs were acquired on our dedicated radiotherapy 3 Tesla MRI-Simulator at Liverpool Hospital. The study protocol consisted of multi-parametric MRI, with DWI and DCE, performed before, during week three, and after chemoradiotherapy (one week prior to surgery). Histopathology analysis was standardized, with chemoradiotherapy response defined according to AJCC 7th Edition Tumour Regression Grading criteria (modified Ryan et al). We have developed a 3-D voxel-wise histogram analysis strategy for the quantitative assessment of tumour heterogeneity and its response to chemoradiotherapy. Preliminary analysis has demonstrated this to be a promising and feasible method for the clinical prediction of chemoradiotherapy response. To date we have recruited 36 patients, and expect the study to be completed in early 2017.
Figure: Multi-parametric scatterplots for a rectal cancer patient with a pathologic complete response (pCR) (AJCC 7th Edition TRG0) to chemoradiotherapy. The Ktrans increased during week three of treatment, suggesting increased vascular permeability in response to chemoradiotherapy. In the post treatment scatterplot, the majority of voxels had high ADC (free diffusion), and low Ktrans (low perfusion) values. The combination of free diffusion and low perfusion suggests complete response to chemoradiotherapy.
Dr Trang Pham FRANZCR
I am very thankful to my PhD supervisors Professor Michael Barton, Associate Professor Gary Liney and Dr Karen Wong for being great research mentors.
For more grants, awards and prizes, visit: www.ranzcr.edu.au/members/ awards-a-prizes or contact Chris Bonaventura at gaps@ranzcr.edu.au
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What’s in Issue 2? Medical Imaging Review Article: The role of imaging in the surveillance and diagnosis of hepatocellular cancer Corresponding author: Dr Gurjeet Dulku, Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, WA, Australia. A decision support tool has been developed as part of a suite of on-line evidence-based and consensus-based guidelines Diagnostic imaging Pathways (DIP): www.imagingpathways.health.wa.gov.au) in the form of an algorithmic flow chart with supporting evidence and consensus to inform referrers to diagnostic imaging and radiologists as to the optimum strategy for surveillance and diagnosis of primary hepatocellular cancer (HCC) in those patients with risk factors of this disease. A literature review, including reference to several international consensus-based expert guidelines, has been employed to develop this tool.
Medical Imaging Technical Article: Transcaval core biopsy in malignant superior vena cava obstruction: Potential for single stage diagnosis and treatment Corresponding author: Dr Julian Maingard, Austin Hospital, Heidelberg, Victoria, Australia Superior vena cava syndrome (SVCS) is secondary to obstruction of venous flow from the superior vena cava to the right atrium. Endovascular stenting is particularly useful when severe or rapidly progressive disease requires urgent treatment. In suspected mediastinal malignancy, transcaval biopsy can be combined with endovenous stenting to provide diagnosis and treatment in a single procedure. Three patients were referred for investigation and treatment of SVCS over a 20 month period. Under fluoroscopic guidance Cook Medical transjugular biopsy sets (with 20-gauge QuickCore biopsy needles) were used and two or three core biopsy samples were obtained. Stents were utilised to treat SVC obstructions in two of three patients. Obtained samples were adequate for histological diagnosis. Diagnoses included small cell and small cell neuroendocrine carcinoma of the lung. No procedural complications were encountered. Importantly, no further invasive diagnostic procedures were required. This is a safe and effective alternative to obtain a histological diagnosis in malignant SVCS and in the appropriate clinical setting biopsy can be combined with SVC stenting in a single procedure.
Radiation Oncology Original Article: Radiotherapy in anaplastic thyroid carcinoma: An Australian experience Corresponding author: Associate Professor Sidney R Davis, Alfred Health Radiation Oncology, The Alfred, Prahran, Australia. Introduction: Anaplastic thyroid cancer is a rare and fatal malignancy, associated with significant local tumour and often treatment related morbidity. We report our experience in treating this cancer over a 20-year period. Methods: A retrospective review of prospectively collected data from a single Australian Institution (Alfred Health Radiation Oncology) was carried out on patients referred with anaplastic thyroid carcinoma between 1992 and 2013. Results: Thirty patients (17 females and 13 males) were identified with a median age at presentation of 72 years. At presentation, six (20%), 14 (47%) and 10 (33%) patients had stage IVA, IVB and IVC disease respectively. Thirteen patients underwent radical surgical resection with five having microscopic residual (R1) and eight having macroscopic residual (R2) disease. Twenty-eight patients were offered radiotherapy with 27 proceeding with treatment. Of those who received radiotherapy, three, six and 18 were treated with adjuvant, definitive and palliative intent respectively. Six patients had concomitant chemotherapy of which three received trimodality therapy. Only one patient experienced a grade 3 toxicity (oesophagitis). Median survival was 5.3 months and at last follow-up or time of death, 19 of 27 (70.4%) maintained loco-regional control. All patients who had R1 surgical resections and radiotherapy had loco-regional control. Seven of nine (77.8%) and 12 of 18 (66.7%) achieved loco-regional control after receiving definitive or palliative radiotherapy, respectively. Conclusions: Our study suggests that radiotherapy with or without surgery or chemotherapy is well-tolerated and results in durable loco-regional control in a high proportion of patients with anaplastic thyroid carcinoma.
Radiation Oncology Original Article: Sparing healthy lung by focusing the radiation beam flow onto the emphysematous regions in the treatment of lung cancer Corresponding author: Dr. Raphaël Jumeau, Centre Hospitalier Universitaire Vaudois (CHUV), Département de radio-oncologie, Rue du Bugnon 21, 1011 Lausanne, Switzerland. Introduction: Currently, routine radiotherapy (RT) planning for locally advanced lung cancer (LC) does not take into consideration the functional state of the lung. The goal of this study was to determine if it is technically feasible to integrate the sites of pulmonary emphysema (PE) into the RT planning process. Methods: Ten patients with LC and PE treated with helical Tomotherapy© were retrospectively included. After extraction by Myrian© software based on diagnostic CT (DCT), the PE data were transferred to the treatment planning system (TPS). PE-optimized plans were performed for patients with significant PE, where the dose was focused onto the PE. We compared the PE-optimized RT plans to the initial RT plans. Results: The median dose to the planning target volume (PTV) was 52 Gy (range, 36–66) in fractions of 2–3 Gy. The median PE volume was 220 cm3 (range: 12–1394), and six patients were eligible for a PE-optimized RT plan. Considering the lung without PE, the V20 and V30 variations were not significant (P > 0.05), the V5 decreased from 50% to 44% after re-planning (P < 0.05). The mean PTV D98 was 50 Gy versus 48 Gy (P < 0.05). Conclusion: Focusing the RT beam flow on the PE structure rather than the healthy lung appears feasible, and may be a promising technique to help preserve pulmonary function and minimize RT-related pulmonary toxicity.
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!
Research
Consultation on the RANZCR Research Strategy 2017-2020 The current RANZCR Strategy to 2017 articulates 11 College-wide Strategic Pillars. Pillar 7, Research, states that:
target resources, and to work towards embedding a culture of research among the professions.
Clinical radiology and radiation oncology are recognised as professions characterised by a research ethic, and Australia, and New Zealand become more competitive internationally.
In the September 2016 edition of Inside News we reported that a research strategy forum had been held at the College office in Sydney. The membership and research committees from both faculties were well represented. Since then a draft research strategy document has been developed and has passed through two rounds of comments from the research forum participants.
To achieve this goal, the College embarked on a process to develop a College wide Research Strategic Plan to provide direction in respect of priorities and focus. This will enable both the Faculties of Clinical Radiology and Radiation Oncology to better
where it can benefit from input of the wider membership.
We are keen to get your feedback on the RANZCR Research Strategic Plan now. Closing date for submission of comments is 27 March 2017. Please visit the consultation page on the RANZCR website: www.ranzcr.edu.au/resources/ professional-documents/consultations to view the consultation
The strategy document is at a stage
The Journal of Medical Imaging and Radiation Oncology is Celebrating 60 years of Publications With Impact Factor measuring starting in 2009, a steady increase over the past few years shows just one of the successes JMIRO has achieved.
Stay tuned for more throughout 2017!
Volume 13 No 2 I March 2017
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Profile and Presence
Inside Radiology Top of Mind – Gadolinium InsideRadiology website wins international award
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Promoting InsideRadiology in your professional networks.
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Inside News
InsideRadiology, a trusted source of information on clinical radiology tests, treatments and procedures, continues to see increased views. All information is written by clinical radiologists or other health professionals who are experts in their field. It provides information for both health consumers (63% of users) and health professionals. There are over 90 information items available. Gadolinium Contrast Medium (MRI contrast agents) continues to be one of the most viewed items. Over the December-January period, this item has been viewed over 33,000 times—or over 500 views each day. The health consumers section on Gadolinium Contrast Medium covers the what, why, how and who. Written in consumer-friendly language, it is a good starting area for consumers with questions or concerns. Accepted indications for a gadolinium contrast medium injection: The gadolinium contrast agent increases the signal from tissues where there is increased blood flow, particularly in the setting of inflammation or neoplasm. The resulting improvement in contrast between normal and pathological tissue is often much higher than can be achieved with iodinated contrast at computed tomography (CT).
inflammatory and neoplastic conditions of bone, muscle, and connective tissue. A second category of uses exploits the greatly increased signal from blood vessels themselves, to allow the production of MR angiograms. This works best in the arterial phase of the contrast injection, meaning the scan must be completed very quickly (2–3 minutes). This technique (‘contrast-enhanced MRA’) is used outside the head; intracranially, slower non-gadolinium techniques produce better resolved images of the intracranial circulation. Along with the indications, other topics covered within the health professionals item include: • Prerequisites for having a gadolinium contrast medium injection done • Absolute and relative contraindications for a gadolinium contrast medium injection • Adverse effects of a gadolinium contrast medium injection. Further information on this topic can be found at www.insideradiology.com.au/ gadolinium-contrast-medium
This is most useful in the brain and spinal cord, where the blood–brain barrier might be disrupted by the pathology, and the signal increase is therefore particularly strong. It is also useful in suspected inflammatory joint disease, inflammatory bowel disease, and inflammatory and neoplastic conditions of solid organs, such as the liver and kidney. It is sometimes useful in
If you need further information or have any questions, please contact Camilla Baker, Projects Officer, Quality and Standards at the College on insideradiology@ranzcr.edu.au or on +61 2 9268 9741.
Profile and Presence
Targeting Cancer Supports World Cancer Day will provide the best support to make these events successful. 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. We are continuously seeking other opportunities to reach out to the larger GP community, and would be grateful for any ideas or recommendations in this regard.
We Need Your Input Coordinated by the Union for International Cancer Control (UICC), World Cancer Day this year took place under the tagline ‘We can. I can.’ It was an opportunity to explore how everyone – as a collective or as individuals – can do their part to reduce the global burden of cancer. Just as cancer affects everyone in different ways, everyone has the power to take action to reduce the impact that cancer has. World Cancer Day is a chance to reflect on what you can do, to make a pledge or take action large or small. The theme this year was ‘Support through Sport’. The Targeting Cancer team supported World Cancer Day by participating in the ‘Support through Sport’ initiative. College staff and radiation oncologists came to the office in their sporty/casual gear, and shared their photos and videos on social media. Many others sent in photos or shared pictures though social media including our campaign ambassadors.
Targeting Cancer gets the Consumer Included ‘Tick’ We are proud to announce that the Targeting Cancer campaign has been given the “Consumers Included” seal of approval from Cancer Voices Australia, in recognition of our commitment to involving cancer consumers in the campaign.
Cancer patients, our consumer representatives and Julie McCrossin, our patient ambassador, are critical in assisting us to share information, take part in advocacy activities and develop new resources. We are committed to ensuring patients are informed especially in relation to all aspects of radiation therapy, are involved with decision-making and have access to high quality cancer care. The campaign team continues to work with cancer organisations and passionate consumer advocates to ensure the patient’s voice is heard.
General Practitioner (GP) Education Programs Improving GPs knowledge of radiation therapy is one of the key priorities of the campaign, and GP Oncology Education Evenings continue to be the mainstream activity. We have already received a number of requests from radiation therapy centres to host a GP evening this year. We are grateful for the interest and enthusiasm and the campaign team
In 2017, Targeting Cancer will focus on advocacy for prostate cancer, in particular the problem of men not routinely accessing radiation oncologist opinions prior to decision-making about prostate cancer treatment i.e. before radical prostatectomy. A workshop involving radiation oncologists, GPs, consumers, and other stakeholders, that was facilitated by external consultants, was held on 20 March 2017 – to formulate the strategy and develop a practical plan for implementation. We are calling for support from all our members to share prostate cancer resources, including data, information, patient stories/photos, to help strengthen the evidence for this particular campaign initiative. Please email us at faculty@ranzcr.edu.au to share any resources or ideas.
Please help us make Targeting Cancer THE brand to promote our fantastic treatment! Like Targeting Cancer on Facebook, or follow @targetingcancer on Twitter, and help us spread the word.
For more information on Targeting Cancer please contact Legend Lee at faculty@ranzcr.edu.au Volume 13 No 2 I March 2017
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Access to Quality Services
Breast Cancer Multidisciplinary Meetings Dr Paul Tauro joins surgical colleagues to deliver lecture series in Solomon Islands In February this year I had the pleasure of being invited to join my surgical colleague, Associate Professor Hamish Ewing, to deliver a lecture series and help set up a local breast cancer multidisciplinary meeting in the Solomon Islands under the auspices of the Royal Australasian College of Surgeons Pacific Islands Program. The initial invitation was made by the surgeons and radiologist at the National Referral Hospital (NRH), Honiara, to deliver an educational package to the NRH doctors to help them understand the philosophy and practice of multidisciplinary care for treating women with breast cancer. This was in the setting of increasing numbers of women presenting, usually late, with breast cancer. In addition, NRH had a new mammography machine that they were keen to fully utilise. Honiara, the capital, is a three-hour flight north of Brisbane on the island of Guadalcanal in an archipelago of hundreds of small islands in the Solomon Islands group. The hospital has three operating theatres, and a pathology department able to provide a local cytology service. Up until this year, all histology was sent to Brisbane with a four-week turnaround time. The radiology department has a new digital mammography unit, an ultrasound
National Referral Hospital, Honiara, Solomon Islands
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Inside News
machine of some age, and two plain X-ray machines with one full-time radiologist and two radiology registrars. One of the most important elements of multidisciplinary meetings (MDM) is the bringing together of ‘a team’ of health professionals to best manage cancer care. Importantly, the success of our trip centred around planning an appropriate educational package best suited to the requirements of the team and resources at NRH. We exchanged many emails in the months prior to the trip which meant that we thought we had the correct ‘recipe’. To this end, the key elements to our visit were: • Lectures on reading breast imaging • Training of radiology registrars in ultrasound guided biopsy techniques • Lectures and discussion on the philosophy and practical aspects behind the team approach as utilised in the MDM model • Delivery of a mock breast MDM using Australian case material • Running an actual breast clinic with the local surgeons and radiologists directly consulting radiologists ‘in real time’
• Subsequent running an MDM the next day informed by the results from the prior day’s clinic. A/Prof Ewing consulted in the clinic while I worked with the radiologist and his trainees to ‘work-up’ the women the surgeons were referring to us. As a direct result of the demonstrations in ultrasound cytology biopsy techniques, NRH had positive cytology results available in 24 hours for the first time. On the following day we held a demonstration MDM using case material directly from the prior day’s breast clinic. On the final morning we were invited to make a presentation to the NRH Grand Round for the whole hospital on future developments for breast cancer care and the theory of MDM care. On reflection it occurred to us, that the multidisciplinary approach to breast cancer management that we had spent our time exploring with the Solomon Island clinicians was easily translatable to many other disciplines of their medical practice, beyond just cancer management. Dr Paul Tauro Director of Radiology The Northern Hospital, Epping, Victoria
Radiology registrars
Access to Quality Services
The Magnet Is Making Me Sick As increasing numbers of 3 Tesla (3T) MRI systems are being used in clinical practice, we can expect to see more side-effects related to exposure of both patients and MRI workers to higher field strengths. There seems to be a considerable range of individual sensitivity to the effects of strong magnetic fields, and actual exposures can vary substantially with seemingly minor alterations in position and velocity within the field. There are now a substantial number of research MRI systems operating at 7T or higher, and experience on these systems gives some insight into the effects that we might less commonly (and usually with lower severity) see at 3T. The most commonly reported minor side-effects of high-field exposure are dizziness (up to 30 per cent of scanned subjects at 7T), abnormal (usually ‘metallic’) taste sensation, nausea, phosphenes (illusions of flashing lights), and sensations of heat, which appears to be considerably less common. None appear to be associated with any lasting ill-effect. Dizziness associated with MRI is attributed to the induction of tiny
electrical currents, and/or endolymph flow, within the semicircular canals, by the static magnetic field. It is made worse by rapid motion within the field; for this reason, table movements on 7T scanners are deliberately slow, and workers are advised to move slowly when close to the magnet.
For more information please contact Philip Munro at standards@ranzcr.edu.au or +61 2 9268 9777
In a minority of subjects, the dizziness is associated with nausea; though actual vomiting appears rare, even at 7T. However, the College is aware of a recent clinical case in which the companion of a patient developed quite severe nausea while sitting next to the patient table. Although it is impossible to determine for certain whether this particular case was due to the magnetic field or not, it is a reminder that even at 3T a proportion of patients and subjects will experience some nausea. There is some small-scale trial evidence that antihistamines such as diphenhydramine can reduce this effect in those known to be susceptible. A/Prof. Nick Ferris Chair, MRI Reference Group
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
Volume 13 No 2 I March 2017
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Stepping out of the Shadows – Collaboration and Communication Rutherford Hotel, Nelson, New Zealand
Radiology Invited Speakers Professor Jeffrey Kanne MD
Chief of Radiology and Thoracic Imaging, Vice Chair of Quality, University of Wisconsin, School of Medicine and Public Health, Madison, USA
Professor Suresh Mukherji
Chairman, Department of Radiology Walter F. Patenge Endowed Chair Chief Medical Officer & Director of Health Care Delivery Michigan State University Health Team, Northville, Michigan, USA
Associate Professor Ronil Chandra
Head, Neurovascular Imaging, Monash Health Joint A/Professor Department of Surgery and Department of Medicine, Monash University, Melbourne, Australia
Professor Johan Van Goethem
Professor of Medical Imaging, Antwerp University Departmental Head, Antwerp University Hospital Senior Staff Member, General Hospital AZ Nikolaas, Antwerp, Belgium
Radiation Oncology Invited Speaker Associate Professor Jarad Martin MB ChB, FRANZCR Director of Research Calvary Mater Newcastle, NSW, Australia
www.ranzcr2017.co.nz
Quality Practice
Clinical Radiology Written Report Guidelines The written report is the dominant means by which clinical radiologists communicate their interpretation of imaging findings. The quality of the report has a direct impact on the safety and appropriateness of decisions about treatment and further investigations that the healthcare team makes about patient management. The written report also may be used in education or research, serve as a legal document or provide billing information. The Clinical Radiology Written Report Guidelines provide advice to clinical radiologists on best practice in the preparation and structure of written reports. Following public consultation on the guidelines in early 2016 the final version of the guideline is now available for your use. In addition to the revised guidelines, the College has commenced development of an interactive module to educate trainees on writing quality reports. The module will review important factors
that impact on report quality, with material drawn from the guidelines. The module will be released on the RANZCR Learning Portal and notice of this will be provided to members. This module will be incorporated into the Clinical Radiology Training Program in due course. We urge you to access a copy of the guidelines from the College website www.ranzcr.edu.au/resources/ professional-documents/guidelines
If you have any questions about the guidelines, or the Working Group, please contact Camilla Baker, Projects Officer, Quality and Standards at the College on quality@ ranzcr.edu.au or +61 2 9268 9741.
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Quality Practice
The MBS Review Taskforce Update The Medicare Benefits Schedule (MBS) Review Taskforce was established in 2015 under the leadership of Professor Bruce Robinson. Aiming to ensure that the MBS is fit for purpose, reflects contemporary medical practice and facilitates better health outcomes for patients, the clinician-lead taskforce is reviewing the evidence for all 5769 MBS items and the principles and rules governing their application. The College is fully engaged with the review and regularly meeting with Professor Robinson and other stakeholders to ensure that the importance of diagnostic imaging and radiation oncology is included in their considerations. Each section of the MBS is being reviewed by a clinical committee made up of clinicians from the relevant craft group as well as clinicians from related craft groups, referrers and consumers. The Diagnostic Imaging Clinical Committee (DICC) is systematically reviewing all items in the Diagnostic Imaging Services Table (DIST) and radiation oncology items are being reviewed by the Oncology Clinical Committee. College members are also contributing to a number of other clinical committees that intersect with diagnostic imaging and/or radiation oncology.
Diagnostic Imaging Due to the breadth of diagnostic imaging, the DICC is consecutively reviewing items related to specific body regions or modalities. Once completed the reports are being published for consultation. Last year the College responded to the consultation on: • Bone Mineral Densitometry • Lower Back Imaging
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Inside News
Both the Faculty of Clinical Radiology and the Faculty of Radiation Oncology made a submission to: • First Report of the Principles and Rules Committee Over the next couple of months consultations on the following reports are anticipated:
The College’s responses to MBS Review Taskforce consultations are available on the College website www.ranzcr.edu.au/advocacy/ submissions
• PE/DVT • Knee Imaging The Principles and Rules Committee is charged with reviewing the rules and legislation which are applicable across the MBS. Rules that are specific to the DIST or individual DI items will be reviewed by the DICC. Among others these include the Multiple Services Rules, NK Items and DI referrals.
Radiation Oncology The draft report from the Oncology Clinical Committee is expected to be published for consultation in the first half of the year. We are very hopeful that the recommendations will include a restructure of the radiation oncology schedule so that it will better reflect the way that treatment is planned and delivered to patients, thus streamlining the MBS. The College would like to thank the many radiologists and radiation oncologists who have already made a significant contribution to this Review. There will be more opportunities to contribute to the Review in the future and we encourage members to continue to engage in this important work. If you have any questions or comments, please contact Melissa Doyle, Policy Manager, on +61 2 9268 9777 or fcr@ranzcr.edu.au
Quality Practice
Emerging Digital Health Environment As governments across the world deal with healthcare challenges, technology is being used more and more to help resolve them. In both New Zealand and Australia, governments are turning to telehealth and digital health to improve efficiency and access for consumers. Digital health is a broad term that relates to the use of technology in healthcare. It can include concepts such as improving patient access to health information online, streamlining information sharing between providers, e-referrals and telehealth services. Governments are seeking to harness the potential of digital health technology to improve access to care while reducing costs. Telehealth relates to the use of information and communication technology to provide health care services across geographic barriers particularly in regional or rural locations. Telehealth services are rapidly advancing across New Zealand and Australia, with almost all public jurisdictions utilising telehealth in one way or another. For example in New Zealand the National Telehealth Service went live in November 2015 and had made 400,000 contacts with New Zealanders by July 2016. In Australia, certain Medicare benefits are available for consultations between specialists and patients who are located in telehealth eligible areas.
Teleradiology Teleradiology is a form of telehealth used in clinical radiology and involves the transmission of diagnostic radiological images from one location (acquisition site with the patient) to another for diagnosis. Technology allows interpretation of reports to be provided by clinical radiologists located elsewhere in New Zealand or Australia or overseas. Teleradiology can benefit patients by allowing access to better services particularly in remote areas or assisting in staffing smaller hospitals who struggle
to maintain out of hours coverage or subspecialty expertise. It is the view of the College that teleradiology should be used to complement and support on-site radiology. It should only be used to improve patient care for example, by improving access to specialist services in a remote centre that cannot support a full-time imaging specialist. The College has a new set of teleradiology standards which has been sent out for member consultation recently. In both Australia and New Zealand, the College has stated that radiologists based overseas must be required to register with the relevant government agency as local doctors must. Without registration, problems may arise with radiologists who are not suitably qualified and lack an adequate understanding of the healthcare system. Furthermore, patients should be able to submit a complaint to their own regulator in the case of malpractice.
New Zealand – Electronic Health Record Digital health remains a priority for the New Zealand Government. The Government has recently committed to Digital Health 2020 and to prioritise digital technologies. Digital Health 2020 aims to advance five areas: a single electronic health record, the creation of a health and wellness dataset, preventative health IT capability, improving the digital capability within hospitals, and supporting regional IT. Within all of this, the Government is focusing on the single health record. The Accenture/Martin Jenkins consortium has been selected as a strategic partner to support the development of a two-stage business case for a single electronic health record. Accenture will work with the Health Ministry on the indicative business case, which is
expected to be completed in early June 2017. Depending on approval by the Government, the detailed business case will be completed in late 2017.
Australia – Digital Health Initiatives Digital health will also pick up in Australia during 2017. The Australian Digital Health Agency has started work on a National Digital Health Strategy. The College responded to the related consultation which is on the Submissions page of our website. The key initiatives within this strategy for the Australian Government are electronic health records and unique identifiers for patients. The ‘My Health Record’ is essentially a personal electronic health record that was launched in 2012. Individuals can register for a My Health Record with the Government by opting in. However, this has led to slow uptake of the initiative. The Government is reviewing this and may develop an opt-out system to encourage greater participation. An individual healthcare identifier (IHI) is a unique number that is assigned to a person to ensure that the right care is provided to them and the correct information assigned to their record irrespective of whether it is delivered under Medicare, the public system or private insurance. The College has raised with the Australian Digital Health Agency that there is currently no reason to use the IHI in radiology practices and funding should be available to adapt systems accordingly.
The College has recently updated its written report guidelines for members, which reminds members that people other than the primary referrer may read reports. [See page 23 for more details]
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11th GENERAL BREAST IMAGING MEETING 5-8 April 2017 | Queenstown INVITED FACULTY Liane Philpotts | Federica Pediconi David Clouston | Erica Whineray Kelly PLUS RENOWNED AUSTRALIAN & NEW ZEALAND FACULTY
Conference Manager: Kathy Nightingale E: kathytni@gmail.com M: +61 418 515 090 Register online today at:
www.bigmeeting.com.au
Quality Training
EBIR Examinations
The Australian and New Zealand European Board of Interventional Radiology (EBIR) examination continues to be a successful initiative undertaken by CIRSE, RANZCR and IRSA. Last year at the 2016 IRSA Annual Scientific Meeting in Queenstown, New Zealand, the second Australian/New Zealand EBIR was held. Representatives from CIRSE as well as the College were present to observe the examination process and examiner training workshops. The value of the EBIR certification continues. Built on the pillars of scientifically proven assessment techniques, high-quality material and a dedicated steering committee, the examination has asserted itself as a high standard, internationally valued interventional radiology qualification that it set out to be. EBIR holders
improve their career development, whether they take the examination right at the beginning of their tenure or further down the road. Holding the EBIR allows an Interventional Radiologist to have proof and certification of their skills and training and in addition has been seen as a favourable achievement in several advertised IR consultant posts in both Australia and New Zealand. The next Australia and New Zealand EBIR will be held on 10-11 July just prior to the 2017 IRSA ASM to be held in Port Douglas, Australia. I would encourage all interventional radiologists to consider sitting the EBIR to join their colleagues in holding an internationally recognised certification in their IR skills and training. Dr Gerard Goh Chief-examiner EBIR Australia/ New Zealand
While the thought of having to prepare for more written exams and vivas invokes a run of palpitations and sweaty palms for most radiologists, interventionalists across Australia and New Zealand are embracing flashbacks to their formative years to sit the European Board of Interventional Radiology examinations. And for good reason. The EBIR gives interventional radiologists the opportunity to earn an internationally recognised subspecialist qualification, contribute to a growing global professional identity and join the largest group of IRs in the world. These letters also have important implications for hospital credentialing and local sub-specialist recognition. IRSA, CIRSE and the RANZCR are to be congratulated for collaborating to
Register for the EBIR Examinations: www.cirse.org/ index.php?pid=1277
If you have any questions regarding the EBIR examinations, contact Hilary Baldwin at the College on hilary.baldwin@ranzcr. edu.au or on +61 2 9268 9739
make this a possibility. The exam comprises elements that are familiar to general interventionalists, and tests knowledge and experience of a range of procedures that would be commonly performed in most departments. It is also an invaluable opportunity to refresh or update knowledge of what should be in the interventionalist’s playbook. Many candidates find the familiarity and practicality of the exam content reassuring, which lessens pre-exam anxiety, and even though nothing can completely overcome the Pavlovian responses induced by MCQs and vivas, the professional benefits of the EBIR are worth it. Dr Nick Brown FRANZCR and EBIR
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Quality Training
Examination and Assessment Review Update The move to a programmatic assessment approach in both of the College’s specialty training programs was a core recommendation of the 2015 ACER-Prideaux Examination and Assessment Review. Some of the key attributes and advantages of programmatic assessment are as follows: • It represents a more holistic, continuum-based approach to assessment. • Competency is measured based on essential themes or attributes of practice. • Multiple sources and methods are used for assessment data collection. • Clearer milestones for progression can be defined. • Assessments and outcomes are more closely integrated with work activities. • Performance in both formal examinations and work-based assessments are considered when determining overall competency. In June 2016, the Examination and Assessment Review Taskforce appointed a steering committee in each Faculty, headed by the Chief Censors, to oversee and guide the transition to a programmatic approach. Since their first meetings in July 2016, both steering committees have reviewed the existing components of their respective curricula, and worked to identify a manageable number of core ‘domains’ of knowledge and skills for assessment purposes. These have formed the foundation for a draft programmatic framework in each training program, in which trainees are assessed across six to seven core program areas or streams as they move through their training. The committees have given ongoing consideration to the purpose and utility
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of the existing assessment tools, as well as considering potential new or modified tools. As the various program areas are developed in detail, all assessments will be mapped to learning objectives to ensure the assessment load for trainees is focused, relevant and provides meaningful feedback on progress. Trainee and supervisor workload is a key factor to be addressed in both Faculties.
Clinical Radiology The seven draft program areas for clinical radiology are: Key Conditions in Year 1 of Training Foundation Sciences • Anatomy • Applied Imaging Technology Pathology Image Reading and Analysis/Clinical Decision-making Procedures Research Non-Medical Expert The Clinical Radiology Steering Committee has identified the key conditions in year one of the training syllabus as a priority area for development, and has commenced work on formulating an approach that will provide more direction for sites assessing trainees’ first year progress, including their readiness to go on-call. When completed, the Key Conditions program will function as an exemplar for subsequent working groups to refer to when designing the other programs. In 2016, the Clinical Radiology Curriculum Assessment Committee (CAC) established a small working group to review the Research component, and that group’s scope has been aligned with the outcomes of the overall project.
The CAC will also provide expertise to other program working groups, and these are scheduled to commence forming in mid-2017.
Radiation Oncology The six draft program streams for radiation oncology are: Oncology Sciences Tumour-site Specific Knowledge • Anatomy, Contouring and Plan Evaluation • Clinical Assessment and Decisionmaking RO Clinical Oncology Leader/Health Advocate/Professional Communicator/Collaborator Scholar The Radiation Oncology Steering Committee identified two programs as priorities. Oncology Sciences was chosen to establish an effective and targeted assessment program for foundational training, while Anatomy, Contouring and Plan Evaluation will provide a clearer and more explicit pathway for radiation oncology trainees to develop the essential skills of their specialty throughout years one to five. Two working groups were established in December 2016 to begin the task of developing these streams. Oncology Sciences will be led by Dr Matthew Seel and Anatomy, Contouring and Plan Evaluation will be led by Dr Andrew Potter. A number of additional Fellows have already volunteered to work on the remaining programs, and their activities will be rolled out over 2017-2018. The programmatic working groups will require the expertise and collaboration of many members from across both Faculties. Anyone interested in being part of this exciting project is encouraged to contact the College to learn more.
If you would like more information about being involved, please contact the Chief Censor c/o Adam Rayment, Manager Special Projects, at the College on adam.rayment@ranzcr.edu.au or +61 9268 9706.
Clinical Radiology
A Message
from the Dean
Prof John Slavotinek
Digital Health As I mentioned in the last issue of Inside News, digital health will feature as a major area of interest and work for the Faculty of Clinical Radiology this year and it rightly features prominently in this edition of Inside News. The Australian Digital Health Agency (ADHA) is a new statutory authority that was formed in July 2016. It has the responsibility of improving health outcomes for Australians through the delivery of national digital health services and systems and a national digital health strategy for Australia. The formation of ADHA has brought new impetus to this arena and given the extensive use of digital technology within radiology this has significant implications for the FCR. Although we have considerable work to do, we are well positioned with respect to the digital changes on the horizon. Fortunately, we have clear proposals in relation to digital health, centring on electronic referral, sharing of reports and access to historic images. Firstly, the College’s Standards of Practice have dedicated sections relating to digital records, image transfer and information sharing with our fellow clinicians. Secondly, we have recently completed a review of the College’s teleradiology position statements, which should come to you for comment through member consultation just before this issue of Inside News reaches you. This position statement covers a range
of technical, clinical and governance matters, underpins the quality of service delivered and safeguards patients. The Teleradiology Standards Working Group will likely propose that the teleradiology standards be incorporated into our Standards of Practice, to reflect the contemporary role of teleradiology in imaging care. Finally, we have very experienced clinical leads within the Faculty’s eHealth Reference Group to whom I am most grateful. Diagnostic imaging globally has been at the forefront of the digital revolution, with the development of RIS/PACS
“Formation of the Interventional Radiology Committee marks the beginning of a process to better support IR across the spectrum of activity in this field.” systems and digital transmission and storage of imaging data. The College has therefore been active in the digital health space for many years. We have worked closely with other stakeholders to develop policy positions on relevant issues.
For example, the ADIA-RANZCR Roadmap to Systemised Access to Diagnostic Imaging outlines a comprehensive pathway to image and report sharing via digital communications. We recently responded to the Australian Digital Health Agency’s consultation on its draft strategy and will follow up to progress key work, which I encourage all of you to read on the Submissions page of the College website www.ranzcr.edu.au/ advocacy/submissions A key stumbling block to progress within the health system has been the siloed healthcare systems across public and private providers and, for Australia, the disjointed federal and state systems. At present the array of IT systems and patient identifiers means that interoperability is challenging, to say the least. There is still much foundational work to be done to facilitate the uptake of digital communications across the health system. If this area piques your interest, please consider joining and contributing to the Faculty’s eHealth Reference Group. Through that, you would also gain access to the network of clinical radiologists who inform our standards and policy work in IT. I encourage all of you to continue to take an interest in digital health in your local practice or hospital and attend relevant conferences and events as this arena will continue to exert great influence on how we deliver services to our fellow clinicians and patients. continued over... Volume 13 No 2 I March 2017
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Clinical Radiology
Interventional Radiology Committee In November an expression of interest was released inviting members to join the newly formed Interventional Radiology Committee. Just less than 40 applications were received and I was pleased to see such strong interest from colleagues in contributing to the future of Interventional Radiology (IR). Formation of this committee marks the beginning of a process to better support IR across the spectrum of activity in this field. The first meeting of the committee took place in mid-February and I look forward to providing information regarding progress of this committee.
Changing World of Politics The last few months have seen major changes on the political landscape globally, new ministers for health for Australia and NSW, and an election called in New Zealand. While political revolution on either side of the Tasman is not anticipated, RANZCR is preparing election asks for the major parties in New Zealand and engaging with the new Australian ministers. We are also following up the successful meetings we had in Canberra to mark the International Day of Radiology. With respect to the latter, I hope practices are still using the breast imaging leaflets we prepared that were intended for ongoing use. If you would like to have an electronic copy of the leaflet, please contact fcr@ranzcr.edu.au
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Written Report Guidelines Elsewhere in this edition we feature updated Written Report Guidelines and a newly designed education module for trainees and CPD. The revised Written Report Guidelines set out the Faculty’s expectations with respect to quality reporting and provide a timely reminder that patients and others often read our imaging reports, as such, reports should be scripted with that in mind. I recommend the new guidelines to all College members and other providers of diagnostic imaging services.
If you have any questions or comments about this article, please contact Mark Nevin, Senior Executive Officer, the Faculty of Clinical Radiology on fcr@ranzcr.edu.au
Clinical Radiology
Chief Censor in Clinical Radiology
A/Prof Dinesh Varma
At the outset I would like to welcome all the new trainees to the training program. You have embarked on an exciting journey and conscientiously made the decision to peruse a career in clinical radiology. Specialist training comes with hard work and diligence in acquiring newer skills and knowledge and to some extent some sacrifice but the reward of becoming a specialist at the end outweighs all of this. It is pleasing to be able to share with you some of the developments our College has and will be undertaking over the next few years within education and training. College education has been embracing technology for some time including, electronic examinations (E-Exams) a Trainee Information Management System, CPD managements and even online learning within our Learning Management System. Last year the College embarked on implementing the recommendations from the examination and assessment review (ACER/Prideaux Review) which aims to ensure that the College’s training program reflects current best practice in medical education and that we be prepared for the future (you can monitor our progress through the Examination and Assessment Review Progress Report which is available on the College website). We all recognise that technology continues to evolve and that within our clinical practice we are often introduced to new technologies and equipment. The same can be said for technology within education. This is why, as part of the review being undertaken, the infrastructure utilised to deliver support for our training program will be analysed against what is needed to best support
the program for the future. Currently a review of our Learning Management System is being undertaken. The aim of the review is to evaluate the educational needs of the membership and determine how best to support this for the future. The review is due to be completed in March. Our College was one of the first to embrace new technologies for electronic examinations (E-Exams). While the current system has served us to date, it is limited by its inability to have more than one examination operating at any one time. For the future the College is seeking to be able to provide a more versatile system that will allow multiple examinations to be prepared, flexibility around system build capabilities and availability so that examinations may operate in multiple locations. This year the Clinical Radiology VIVA examinations will move to the AMC National Testing Centre, a purpose built clinical examination facility. The move is the first step in preparing our examinations for electronic delivery, an initiative that the College will embark on as the review progresses and the future needs of the VIVA’s are determined. It is anticipated that as part of the procurement of electronic support for examinations an item bank for test items (i.e. exam questions), providing centralised storage of examinations material and information such as history, versioning, status and categorisation will also be sourced. The information being returned to examination candidates and supervisors following an examination is also improving, following improvements in collating and analysing examination
data and the method of creating result letters. Following the Series 2, Part 2, 2016 examination, candidates result letters included the examinations pass mark, their own pass mark and overall examination result. Following the review and alignment of all of the Part 1 examination data and changes to the Clinical Radiology Format Marking and Pass Fail Criteria for the Part 1 and Part 2 Examinations Policy (available on the College website), it is planned that these improvements will extend to the Part 1 examinations in 2017. The monitoring and evaluation of Training Sites and Networks through our accreditation program is also being reviewed and prepared for electronic migration. The provision of online accreditation will make accreditation significantly easier in that training sites will be able to readily know if training standards are being met or yet to be achieved against the training standards. The system will be piloted within radiation oncology in 2017 before being available to clinical radiology. All of these activities have been positively embraced across the educational and examination bodies of the College. There is a very busy year ahead with much work still to be undertaken. This work cannot progress without the involvement of members and I sincerely thank those that are currently engaged and assisting with many of these project. All members are welcome to become involved, if you are interested please contact Pamela Spoors, Head of Specialty Training at pamela.spoors@ranzcr.edu.au
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Clinical Radiology
Big Data and Deep Machine Learning – Radiologists and the Coming Age of Computerized Diagnosis Look at you, Hacker, a pathetic creature of meat and bones panting and sweating as you run through my corridors. How can you challenge a perfect immortal machine? – Ken Levine, video game developer
My first trip to Australia was in 1991, at the invitation of Dr. Ross Glassen, who had been one of my instructors during my residency in Boston. I had recently published some research in the New England Journal of Medicine demonstrating much higher utilisation of imaging among US physicians who owned imaging equipment than among those who referred their patients to radiologists. As it turned out, my findings were relevant in Australia, where the same pesky phenomenon of self-referral threatened the quality of imaging care provided to patients and the economics of radiologic practice. Twenty-five years later, self-referral by non-radiologist physicians continues in the US via a loophole in anti-self-referral legislation. Now a new, potentially more potent, threat to radiologists looms on our distant professional horizon – computerized systems that developers hope will eventually become sophisticated enough in detecting abnormalities and diagnosing disease to rival the acumen of radiologists. Large and small companies around the world are actively pursuing acquiring exceedingly large data sets of images, their associated interpretations, and demographic, genetic, and other ancillary information (“big data”) to “teach” computer systems (“deep machine learning”) our craft. Publicly, large players like Google and IBM promote what they are doing as preparing computers to partner with radiologists to improve the value of imaging to patient care. Perhaps so… at least, to start. But with growing success, how likely are such Goliaths to be satisfied with a small slice if they can eat the entire pie? In this regard, consider the virtues of a well-trained machine that is: indefatigable; doesn’t complain about being overworked or underpaid; accepts uncertainty
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rather than pursuing “flat of the curve” imaging; has a virtually limitless and infallible memory; learns from its mistakes; and at least in the television ads IBM has produced for its contender, Watson, has a charming personality. Tough competition, indeed. Although there is a general consensus that the development of competitive systems and the answers to such questions as who will be legally liable for misdiagnosis or inappropriate treatment may take a decade or more to resolve, it is not too soon to consider how radiologists should respond to what is in my view a near certain eventuality. Even if one argues that machines cannot completely replace all of what radiologists currently do, the threat that they will replace critical functions begs us to reconsider what should constitute radiology training and how many radiologists we will need in the future. Although radiologists bill themselves as consultants to referring physicians and patients, growing demand for imaging services and incentives inherent in fee-for-service payment have driven radiologists to focus almost entirely on image interpretation. As machines grow more sophisticated and less expensive, they will increasingly subsume the job of detecting abnormalities and diagnosing disease. Thus, if radiology is to survive as a specialty, radiologists must find other ways to add value to their participation in patient care. Although driven by more proximal ethical and economic concerns, a major thrust of the American College of Radiology over the past three years is germane to the question at hand. A major thrust of its Imaging 3.0 initiative has been to convince radiologists of the ultimate frailty of focusing on image interpretation to the exclusion of the broader consultancy role. In any future partnership with intelligent systems, radiologists must emphasize the
Clinical Radiology
advantages of including expert human diagnosticians: radiologists’ role in ensuring appropriate and cost-effective imaging; their empathy for patients; their ability to interact with and advise referring physicians and institutional leaders; and their contributions to new technology gaining regulatory approval, acquisition, and reimbursement for use. These are potent advantages that radiologists can parlay into the future, but they are underemphasized or taught not at all in current radiology training programs. Finally, radiology’s leaders must consider how many radiologists we will need in the future. Estimating what physician
manpower will be necessary 5, 10, or 20 years from now is fraught with difficulties. In the face of a rapidly advancing disruptive technology like deep machine learning, divining how many radiologists might be necessary to fulfill currently unmanned future roles is even more difficult. Nonetheless, it is essential that we make the effort. If my predictions (which many will view as far-fetched) hold true, and even if radiologists successfully morph into their new and improved iteration as central consultants to the diagnostic process, it is likely that we will need fewer radiologists than we are training today. How and when to wean our
specialty of excess trainees so that today’s work continues to be performed in a high quality and timely fashion yet accounts for the possibility of lesser demand in the future is a tricky business that requires the attention of our best strategic thinkers. Prof Bruce J Hillman MD, FACR, FRANZCR (Hon.), FRCR (Hon.), SFR (Memb. Hon.)
ANZSPR 2016 Report The 2016 ANZSPR meeting was held from 16-19 October on the Gold Coast, with the themes of musculoskeletal, gastrointestinal and genitourinary imaging. It was attended by 48 delegates as well as five international and four local speakers in the sunny surroundings of the Sheraton Mirage Beachfront Resort, Gold Coast. The meeting commenced on Sunday evening, 16 October 2016 with a welcome function at Glass Bar where the delegates, sponsors and speakers mingled over seafood and drinks at the waterfront of the marina. A busy conference program extended over two and a half days with delegates, speakers and sponsors mingling, enjoying a wonderful conference dinner at Fellini’s Restaurant, Marina Mirage on the Tuesday evening.
Many thanks to the sponsors, Siemens, Toshiba, Bayer, Complete Financial Balance, our outstanding conference organiser, Rebecca Fielding, and the organising committee, Drs Kieran Frawley, Michael Guandalini, Umesh Shetty and Mark Phillips for a very successful meeting. Join ANZSPR for our 2017 ASM in the Margaret River Region, WA 22-25 October 2017. Contact info@encanta.com.au for information or visit www.anzspr17.com Dr Patty Connor Convenor ANZSPR 2016
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Clinical Radiology
A Better Imaging Experience Artificial intelligence—the mimicking of human cognition by computers— was once a fable in science fiction but is becoming reality in medicine. The combination of big data and artificial intelligence, referred to by some as the fourth industrial revolution,15 will change radiology and radiation oncology along with other medical specialties. Although reports of radiologists and oncologists being replaced by computers seem exaggerated, these specialties should consider a review of this technology and potential impact for their health care workforce, patients and clinical outcomes. The technology is based on Cognitive Computing (Deep Learning) which uses natural language processing and machine learning to continually learn and reveal insights from large amounts of structured and unstructured data. In simplistic terms an algorithm that uses three key elements4 1. Collecting thousands of candidate answers 2. For each answer, amassing evidence 3. Applying predictive models to funnel down answers based on probability. Several companies have embarked on this journey to develop and commercialise solutions for different industries. IBM’s Watson is widely recognised as leading edge technology which has been over a decade in making. Some examples include the legal profession where several leading firms use Watson’s natural language processing power to sift through volumes of data to discover answers to build a stronger case in their work5. Recently the Australian Open introduced a new tool, SlamTracker, which has historical analytics and forecasting capabilities. It uses realtime analytics to provide information on how a player performed against someone else in a similar situation and what they have to do to win that point. This was combined with Watson’s Visual
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Recognition software to immediately identify players from any photo taken at the tournament.2
Thanks to improved efficiency provided by machine learning, radiologists may even gain more time to talk with clinicians and be a more visible member of the care team – a very useful advantage as healthcare transitions to a value- based model globally. Thomas Vargoczky MSc Leader, IBM Watson Health Imaging, Merge Healthcare Asia Pacific
In healthcare the objective is to provide treatment and differential diagnosis insights for the physician’s consideration in the moments that matter most. It’s a tool designed to turn all of us into quiz champions or polymaths, experts in many areas.1
References
The computer is not programmed regarding what to detect but to develop algorithms necessary for anomaly detection using deep learning. Deep learning is an autodidact—like an outstanding radiology registrar, the more images it analyses, the better it gets. Watson can identify pulmonary embolism on computed tomography (CT) and detect abnormal wall motion on echocardiography.8 A practical example of an interactive case study in Breast Imaging was demonstrated at the RSNA last year which described to participants the process Watson worked through a decision tree to come up with suitable insights. 14
4. Eric Siegel, Predictive Analytics: the power to predict who will click, buy, lie or die. Hoboken: Wiley, 2016. Revised
Bridging the gap between research algorithms and their clinical application was the critical element of successful adoption of previous computer systems such as PACS and CAD in diagnostic imaging and radiation oncology 1. It’s much more likely that we’ll see continued incremental changes from machine learning algorithms. 9
What is the Power of Watson? To improve health outcomes, we must improve the lives of healthcare workers. We believe that people working with cognitive computing technology can outperform people alone or computers alone. We understand which tasks humans do best and enjoy most, and where cognitive systems can complement people in order to help people work more effectively and joyfully.
1. Dr Greg Slater, “A new Partnership with Technology,” insidenews, vol.13 No1 (December 2016) 2. IBM serves up an ace at the Open. The Australian Financial Review. January 23, 2017 p3 3. Watson vs Google: Asia fights information asymmetry, Healthcare Asia, Issue no7, 2016, p14-15
5. Outthink overload. Time. February 13, 2017 p54, www.ibm.com/outhink/uk 6. Jha S, Topol E, Adapting to Artificial Intelligence, Radiologists and pathologists as Information Specialists, [published online on November 29, 2016], JAMA. doi:10.1001/jama.2016.17438 7. Casey B, Madden Yee K et al. Top 5 trends from RSNA 2016 in Chicago, AuntMinnie.com, December 15, 2016 8. McMillan R, Dwoskin E. IBM crafts a role for artificial intelligence in medicine. Wall Street Journal. August 11, 2015. http://www.wsj.com /article_email/ ibm-crafts-a-role-for-artificial-intelligence-in-medicine1439265840-lMyQjAxMTI2NjA3NTAwMDUxWj. Accessed January 23, 2017. 9. Ridley E, Will AI soon put radiologists out of a job? AuntMinnie.com, July 11, 2016 10. Dreyer K, “Digital Revolution in Radiology – the Good and the bad.” RSNA presentation, November 27, 2016. 11. Lusted LB. Logical analysis in roentgen diagnosis. Radiology. 1960;74:178-193. 12. Wachter R, “Hope, Hype and Harm as Medicine enters the Digital Age: Lessons from (and For) Radiology,” RSNA Presentation, November 27, 2016 13. Yoke Sin C, “The Internet of Healthy Things” HIMSS AsiaPac16 presentation, August 23-26, 2016 14. Eyes of Watson – Breast cancer detection, RSNA 2016, [published January 12, 2016 on YouTube], https://www.youtube.com/ watch?v=ZltHo8e3hEU&feature=youtu.be 15. The return of the machinery question. The Economist. June 25, 2016. http://www.economist. com/news/special-report/21700761-after-many-falsestarts-artificial-intelligence-has-taken-will-it-causemass. Accessed January 15, 2017. 16. Chockley K, Emanuel E. The end of radiology? three threats to the future practice of radiology [published online September 18, 2016]. J Am Coll Radiol. doi:10.1016/j.jacr.2016.07.010
Clinical Radiology
Federal Budget Must Initiate Immediate Action Not only is this extremely unfair to everyday Australians, who expect Medicare to be “free”, we are seeing radiology practices close. Many others are cutting services and introducing higher out of pocket costs. Even more are reducing their staffing ratios as they constantly battle against rising costs.
Dr Wriedt As the next Federal Budget is being prepared, the Australian Diagnostic Imaging Association (ADIA) is arguing strongly that action to increase radiology funding must be taken now! ADIA has presented the Government with a detailed 32-page Budget Submission, which clearly states the dire issues facing the radiology sector and millions of patients Australia-wide. It also provides a number of policy options which need to be progressed to help reverse almost two decades of policy neglect. First and foremost, indexation needs to be reinstated as soon as possible. It is simply unrealistic to think that 1998 rebates can be part of a Medicare system suitable for 2017. The funding shortfall is too significant. The numbers ADIA has presented speak for themselves. This year, more than nine million Australians will access 24 million individual radiology services on the recommendation of their GP or specialist. More than 5.5 million of those services will attract an average gap of around $100, which will see some 300,000 patients simply walk away because they are unable to afford these kinds of costs, creating significant barriers to early diagnosis.
In its Budget Submission, ADIA is also calling for closer collaboration between the government and the broader radiology sector to properly address the complex and inter-connected issues facing the sector and to make all spending as efficient as possible so as patient rebates can be increased. To make such a collaboration worthwhile, ADIA is urging that the Department of Health collects and examines data and sector-specific radiology information to ensure the Government’s decisionmaking process is based on accurate information and not misconceptions. A good example is the belief that radiology is a budget impost, when it is far more accurate to see it as a powerful way to reduce costs by delivering earlier diagnosis and superior treatment. An MRI that diagnoses conditions early is a very cost effective option when compared to major surgery. This collaboration between the sector and Government is certainly something which needs to be put in place above and beyond the current MBS Review which is primarily focussed on budget savings and not on repairing patient access and practice viability due to 18 years without indexation.
ADIA stands ready to work with the Government across all of this, to provide effective real-world solutions that would see tax dollars spent more efficiently. Of course, the Government has foreshadowed its willingness to move policy in the right direction. In its pre-election agreement with ADIA, the Government recognised that fees for some radiology services are below cost, that radiology remains a labour-intensive service despite advances in technology, and that structural policy reform is necessary for comprehensive practices to remain viable and provide patients with access to radiology. That was certainly an encouraging step, and ADIA and the Government are indeed making good progress on the implementation of those commitments, including an independent evaluation of the commercial environment in which comprehensive radiology practices operate. But the upcoming Budget provides the Government with an immediate opportunity for action – to take significant steps to correct the prolonged systemic underfunding and long-term policy failure that is damaging the sector’s ability to provide affordable, accessible care and financially punishing patients. Medicare needs to be fairer and more efficient, and it needs to change now. Dr Christian Wriedt ADIA President
Good policy requires hard data on what is working and what is not, so we can have a system which promotes quality and early diagnosis, not churn. 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).
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Clinical Radiology
Clinical Radiology Trainees Committee The Clinical Radiology Trainee Committee’s (CRTC) aim is to represent and advocate for the interests of trainees in the various College committees. As trainees, these committees are relevant to us as they shape the structure and assessments within our training program, and ensure the standard of education we receive is consistently high quality across the various training sites. Perhaps just as important, however, the CRTC represents an opportunity to foster ties between clinical radiology trainees from Australia and New Zealand. I’d like to thank the outgoing CRTC members for 2016, and welcome the new committee for 2017: Dr Will Ormiston (Secretary, NZ) Dr Jennifer Shoobridge (SA) Dr Anthony Cardin (VIC) Dr Dean Topham (NZ) Dr Hao Xiang (NSW) Dr Jeremy Ong (WA) Dr Arshad Sheriff (NZ)
Australian delegates (L-R): Drs Cara Odenthal (QLD), Meredith Thomas (SA), Dinesh Varma (VIC), Jules Catt (NSW)
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L-R: Drs Anthony Cardin, Dean Topham, Cara Odenthal, Ben Addison, Will Ormiston, Amy Stringer, Jules Catt, Felix Patterson (2017 CRTC members not present: Jennifer Shoobridge, Hao Xiang, Jeremy Ong, Arshad Sheriff)
In 2016, the College introduced Chris Bartley as Trainee Liaison Project Officer. Chris’ role is to facilitate improved communication between trainees and the College, specifically relating to the training curriculum. It has been great having Chris visiting training sites throughout metropolitan and regional locations in Australia and NZ. We look forward to working closely with Chris this year. In November 2016 I was fortunate to represent the CRTC (along with Jules Catt, outgoing Chair) at the Asian Oceanian School of Radiology Youth Club, held in Chiang Mai, Thailand. The Youth Club was conducted by the Asian Oceanian Society of Radiology (AOSR), which is an International Radiology organisation consisting of 24 national society members, including the College. 15 trainees and 10 tutors attended the Youth Club from our global region, including Japan, Thailand, China, Myanmar, South Korea, Taiwan, Malaysia and India. The two-
day program comprised of sessions on social leadership, society management, financial understanding, inter-human relationships, risk management and scientific research. There was also some free time to experience the Thai culture. This meeting was an incredible opportunity to interact with young radiologists from both developed and developing countries, to learn from one another about the way in which we practice radiology. If you are having any concerns regarding your training, or simply need support, I encourage you to reach out to your local CRTC representative. I can be contacted at caraodenthal@yahoo.com.au Dr Cara Odenthal Chair, Clinical Radiology Trainees Committee
Clinical Radiology
ANZSNR Update As we enter 2017 we reflect on a busy previous year. The 2016 ASM held in the Hunter Valley was hosted by Dr Geoffrey Parker, Dr Jason Wenderoth and A/Prof Andy Whyte. The meeting was well supported, and the change in format to include concurrent sessions allowed for an expanded head and neck focus in parallel with neurovascular and neurointervention. The scientific presentations included results from the first statewide Endovascular Clot Retrieval Service in Victoria, which commenced in the same year the major randomized controlled trials into acute stroke treatment were published. This system wide response so soon after level 1 evidence was available reflects well on Australia, Government and our Health Services.
ARGANZ 2017 Workshops, Multi-Disciplinary Meeting, Concurrent sessions, School of ARGANZ and a diverse program meant there was something of interest for everyone. ARGANZ, the Special Interest Abdominal Imaging group of the College, held its annual meeting in Sydney at the Hyatt Regency Hotel on the weekend of 11-12 February. On the Friday before the conference ARGANZ also conducted a one day interactive workshop at the Crown Plaza Hotel on rectal MR, prostate MR, liver and pancreas pathology. Interest for this year’s meeting was unprecedented and our registration number had to be capped based on the size of the conference venue’s main auditorium, which given our previous registration history would have been more than adequate. This year’s guest speaker was Professor Richard Baron from the University of Chicago. Professor Baron is the
2017 ASM This years’ annual scientific meeting will be held at the Darwin Convention Centre in the Northern Territory from 6-9 July, and promises to be an excellent meeting with international speakers Dr Anne Osborne speaking on diagnostic neuroradiology and Dr Christine Glastonbury covering head and neck radiology, with a strong local faculty. There will be a dedicated neurointervention component as in previous years, and we encourage your attendance.
2018 Plans are already well underway for next years meeting, to be held in Hobart where Prof Jens Froelich will be the lead scientific coordinator.
Membership Membership remains strong and we encourage current radiology trainees with an interest in neuroradiology, head and neck radiology and neurointervention
immediate past president of RSNA and is one of the world’s leading educators. He gave a series of thoroughly engaging lectures on various liver topics. He also participated in the interactive liver workshop on Friday and a stimulating multi-disciplinary liver session on Sunday with a panel comprised of liver specialist radiologists, interventional radiologists, a hepatic surgeon and a hepatologist. The annual Research prize was contested with four high quality presentations being selected from the 16 submitted. This year, the prize was formally named in honor of Professor Richard Mendelson from Perth. Richard has been an important mentor to many of us and was the driving force behind the creation of ARGANZ. The winner of the Mendelson Research Prize was Dr. Rajeev Deva from Princess Alexandra Hospital for his presentation on Radiogenomics. Dr Deva won an all-expenses paid trip to the ESGAR conference. The school of ARGANZ was held on the Sunday morning for fellows in training. It consisted of current abdominal examiners taking the 4th year pre-exam candidates through a mock viva for the benefit of the younger trainees.
to apply to join the society. Nominated student members in a training position are entitled to free subscription to ANZSNR. Please contact Hilary Baldwin for information on how to apply.
CCINR The Conjoint Committee for Recognition of Training in Interventional Neuroradiology “went live” in 2016, with ANZSNR on behalf of the RANZCR being a founding member alongside representatives from ANZAN and NSA. The committee maintains a list of practitioners who have had their training recognised as meeting the accepted standards. The website can be viewed for more information www.ccinr.org.au Prof Peter Mitchell President, ANZSNR If you have any questions about the meeting or about the society, please contact Hilary Baldwin at the College on 02 9268 9777 or hilary.baldwin@ranzcr.edu.au
The meeting also benefited from a diverse program delivered by a highly experienced and well regarded national faculty. Concurrent sessions were held on Saturday on CT colonography, prostate MR and pelvic/gynaecological conditions. My thanks to the ARGANZ executive and ARINEX for their hard work and enthusiasm in putting together such a successful conference. Next year’s meeting will be held in Melbourne from 23-25 March 2018. Andrew Little ARGANZ Chairman
From left to right: Dr Rajeev Deva, Prof Richard Mendelson, A/Prof Andrew Little Volume 13 No 2 I March 2017
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Radiation Oncology
A Message
from the Dean
A/Prof Dion Forstner
The Faculty has had a challenging start to 2017. Ms Sally Crossing AM, the consumer member on Council, lost her battle with metastatic disease at the end of last year. Sally was a passionate consumer advocate who did much for radiation oncology; despite her declining health, she made a significant contribution to the recent College ASM. The Faculty and the cancer community more broadly will miss her dearly. As many of our members know, the Department of Health in Australia conducted a review of the Radiation Oncology Health Program Grants (ROHPG) Scheme in 2016, and produced quite a positive report, although it was disappointing that it did not recommend linking the ROHPG Scheme to compliance with the Radiation Oncology Practice Standards. Before the review report was made publicly available, and without any further stakeholder consultation, several changes to the ROHPG Scheme were included in the Mid-Year Economic and Fiscal Outlook (MYEFO), which was very disappointing. In particular, brachytherapy equipment, CT, planning systems and network infrastructure will no longer be eligible for ROHPG funding. The funding for external beam radiation therapy will also be reduced, which will have more significant impacts on smaller centres. We also have concerns about transition arrangements, and the paucity of information we have received. It is a significant backward step with major implications for our profession. The Faculty has submitted a letter to
the Minister for Health, and requested a meeting to discuss the impacts of these changes. We have also written a detailed response to the Department to outline our concerns, and will continue to engage with them on this issue. This year will also see a national election in New Zealand. The Faculty, under the guidance of the New Zealand Radiation Oncology Executive Committee, will be submitting our key policy positions to the major parties, to help ensure that the radiation oncology workforce and service provision in New Zealand will be sustainable into the future. All Faculty Standing Committees have developed their work plans for 2017, which will be focused on achieving the strategic priorities of the Faculty. The work plans informed the Faculty Council’s planning day on 23 February, prior to the first Council meeting for the year on 24 February. I encourage all members to get involved in the Faculty’s activities, send us suggestions, comments and feedback, and to advocate for radiation oncology whenever the opportunity arises.
Profile and Presence of Radiation Oncology
a challenging time for the campaign, as we focus our efforts on advocacy for prostate cancer. I encourage all our members to get involved in the campaign in some way, and to contribute to raising the profile of our profession and radiation therapy as a treatment option.
Funding for Radiation Oncology Advocacy for appropriate funding for radiation oncology in Australia will continue to be a priority for the Faculty, in particular the Medicare Benefits Schedule (MBS) review and the proposed changes to the ROHPG Scheme. We are yet to see the final report from the Oncology Clinical Committee (OCC) of the MBS Taskforce and whether the proposed changes to the radiation oncology schedule have been accepted. There is also uncertainty about the implementation of any proposed MBS changes and its impact on the sector, which would need to be carefully modelled and monitored.
continued over...
Under the leadership of the Media and Profile Committee, the Targeting Cancer campaign will continue to reach out to the cancer community and health professionals to increase their awareness of radiation therapy as an effective, safe and sophisticated treatment for cancer. The next 12-18 months will be
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Radiation Oncology
Congratulations to Prof Liz Kenny AO
Quality Assurance for Radiation Therapy Services
The Faculty owes a huge debt of gratitude to our MBS Review Working Group, chaired by Prof Liz Kenny. Her leadership of the group and efforts to modernise the MBS is only a small component of Liz’s achievements and distinguished contributions to the radiation oncology and radiology sectors, as well as to cancer care more broadly, which were well recognised through her being awarded an Officer of the Order of Australia in the Australia Day Honours this year.
In late 2016, the Faculty completed the Position Paper on Image Guided Brachytherapy (IGBT) for Cervical Cancer. Thanks to the Gynaecology Oncology Radiation Oncology Collaborative (GOROC) executive members who led the development of this paper.
Congratulations Prof Liz Kenny AO!
Faculty of Radiation Oncology Lung Interest Cooperative Workshop – save the date!
The Position Paper on Establishing and Sustaining Regional, Rural and Remote Radiation Therapy Centres has also been completed in collaboration with the Radiation Oncology Tripartite Committee. The paper will be used
Proudly supported by Varian, the Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) will hold a one day workshop on Friday 1 September at the Radisson on Flagstaff Gardens, Melbourne, with the theme to cover targeting radiotherapy treatment for advanced lung cancer. Please save the date – more details to follow in the June edition of Inside News.
There are a very limited number of places available for all College courses and workshops. Interested members are urged to register at www.ranzcr.edu.au/news-a-events/ courses to secure their place.
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Inside News
to guide the establishment and sustainment of regional radiation therapy centres. These documents will soon be available on the College website.
If you have any feedback or comments on any of the above, please email Sonja Cronjé at faculty@ranzcr.edu.au
Radiation Oncology
Chief Censor in Radiation Oncology
A/Prof Margot Lehman
In keeping with the theme of this edition of Inside News, e-health and digital transformations, I would like to outline how technology is currently employed and can be employed in the future of radiation oncology education, training and assessment. The aim of digital health is to use dedicated technology to deliver safer, more efficient and better quality healthcare.1 Over recent years, most clinicians have been involved with the application of digital technology to daily practice. However, one of the known determinants of improved patient care and health outcomes is the quality of the training of their treating doctors.2 Engaging with new technology offers those involved with medical education access to tools which can both support and advance education and training. In the Faculty of Radiation Oncology (FRO), TIMS (the trainee information management system) supports the training program by functioning as a repository for assessment submission, and tracking trainee progression against the requirements of the program. Online contouring modules and workshops, such as those offered by ESTRO through the FALCON (Fellowship in Anatomic delineation and CONtouring) platform allow participants to improve their contouring and delineation skills. The concept familiar to many of us, of “see one, do one, teach one” can, with the application of technology, become “see one, simulate many, do one competently and teach everyone”. A Learning Management System (LMS), a software application that allows for
the administration, documentation, and delivery of learning materials and activities (such as readings, tutorials/ lectures, simulation cases, videos), has long been on the agenda for the College. It is fair to say that the initial attempt to provide a LMS was not without problems. However, the importance and usefulness of a “fit for purpose” LMS is seen as a priority and a project team has been employed to lead this activity. In addition, the FRO Specialty Training Unit is keen to explore how technology can be employed to transform the way assessments (including examinations) are undertaken. The European Diploma in Radiology, for example, uses an online platform to test knowledge, skills and competence through the administration of computer-based short cases, and practical oriented cases. In theory, the assessment of anatomical knowledge and contouring and planning competence would be ideally suited to the application of such technology. However it must be remembered that technology only provides the tools by which educational activities and assessments can be delivered. The content of the educational activities, clearly defined educational objectives and cost-effective remains paramount. To this end, work continues on the implementation of the recommendations of the ACER / Prideaux review. The steering group has identified three medical expert and three non-medical expert program areas. The medical expert streams include: Oncology Sciences, Tumour Site Specific
Knowledge (incorporating clinical assessment and decision making and anatomy, contouring and plan evaluation), and Clinical Oncology. The non-medical expert streams include: Leader (including health advocate/professional), Communicator/ Collaborator and Scholar. The steering group met with Fellows in December 2016, who expressed an interest in becoming involved in small groups to start progressing this work. On behalf of the steering group I would like to thank Drs Angela Allan, Apsara Windsor, Daisy Mak, Mark Pinkham, Andrew Potter, Alex Tan, Rahul Mukherjee and Tanya Holt for their commitment to date. In conclusion, and as always at the beginning of a new year, I would like to welcome all the new trainees entering into the training program and embarking on a career in radiation oncology. On behalf of all involved in the educational activities of the College, I wish you the very best.
If you would like further information on any of the above, please contact Pamela Spoors, Head of Specialty Training on ronctaa@ranzcr.edu.au
References 1. Australian Government Department of Health. Digital Health available at www.health.gov.au/ehealth. 2. JAMA 2009; 302:1277
Volume 13 No 2 I March 2017
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Radiation Oncology Advertorial
Intelligent Treatment Delivery: Multi-Arc, Non-Coplanar High-Definition Radiotherapy High-definition radiotherapy (HDRT), is the ability to deliver more compact radiation doses to the targeted tumor and “fall off” sharply outside the target zone, minimising and, where necessary, even eliminating dose to Organs at risk. HDRT involves the use of multi-arc and/ or non-coplanar treatment beams, capitalises on the unique capabilities of Varian’s TrueBeam® platform and its powerful control system that dynamically synchronises imaging, patient positioning, motion management, and treatment delivery. “We believe that HDRT will be the next big advance in radiation oncology, rivaling the development of IMRT in the 1990s, IGRT and volumetric modulated arc therapy (VMAT) in the 2000s, and linac-based radiosurgery in more recent years, in terms of importance to the field and potential impact on patients,” said Kolleen Kennedy, president of Varian Oncology Systems. “It has the potential to vastly simplify the planning and delivery of advanced treatments like stereotactic radiosurgery, and make it possible for more facilities to offer these highly precise treatments. We anticipate that a high-definition approach could make image-guided radiosurgery a mainstream offering, for clinical and also for economic reasons.” Researchers at the University of Alabama at Birmingham (UAB), University of California, Los Angeles (UCLA), the UK National Health Service (NHS) Greater Glasgow, Washington University, and others have been testing new capabilities from Varian for planning non-coplanar radiosurgery treatments. These treatments utilise the synchronised motion of the linear accelerator and the collimator to increase the number of beam angles available for a treatment while reducing
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Inside News
normal tissue dose, making it possible to focus more radiation on the tumor.
the potential to improve outcomes for patients.”
Garry Currie, Head of Radiotherapy Physics at Beatson West of Scotland Cancer Centre, has been comparing conventional stereotactic radiosurgery (SRS) treatment plans to potential HDRT plans. The software automates isocenter optimisation, as well as collimator angle optimisation and trajectory arc selection. “From the planning that we have undertaken so far, we have found that the non-coplanar arc plans offer a significant improvement in both the dose coverage to the planned tumor volume (PTV) and an associated reduction in the dose to the organs at risk, due to far superior and sharper dose fall-off around the tumor volume,” he said. “
Varian continues to work with clinical research partners around the world to further define and deliver the toolkit that will make it possible to plan and deliver these very sophisticated treatments safely, efficiently and accurately.
The UCLA research team has published work evaluating non-coplanar treatment plans for lung tumors, demonstrating that, compared with conventional IMRT plans, this approach could significantly reduce the amount of dose going to the heart, esophagus, trachea/ bronchus tree, spinal cord, and healthy lung tissues.1 Another published study compared non-coplanar plans with VMAT plans for liver cancer, finding that the former could offer significant improvements in dose conformality and normal organ sparing.2 “This approach can simplify and reduce the time required for complex treatment planning, particularly for radiosurgery for multiple metastases,” said Evan Thomas, MD, PhD, postdoctoral research fellow at UAB, and first author on a journal article comparing linacbased non-coplanar multi-arc treatments with Gamma Knife® radiosurgery for multiple cranial metastases.3 “Less time and planner effort will be required to develop better plans. Better plans have
Varian Medical Systems Australaisa
References 1. Dong P et al. 4π Noncoplanar Stereotactic Body Radiation Therapy for Centrally Located or Larger Lung Tumors. Int J Radiation Oncol Biol Phys, Vol. 86, No. 3, pp. 407-413, 2013. 2. Dong P et al. 4π Non-Coplanar Liver SBRT: A Novel Delivery Technique. Int J Radiation Oncol Biol Phys, Vol. 85, No. 5, pp. 1360-1366, 2013. 3. Thomas EM et al. Comparison of plan quality and delivery time between volumetric arc therapy (RapidArc) and Gamma Knife radiosurgery for multiple cranial metastases. Neurosurgery. 2014 Oct;75(4):409-17; discussion 417-8. doi: 10.1227/ NEU.0000000000000448.
Radiation Oncology
Radiation Oncology Trainees Committee Welcome to the New Year and, for those that had holidays over Christmas and New Year, I hope it was enjoyable and restful. I would like to take this opportunity to thank and congratulate the 2016 Radiation Oncology Trainees Committee (ROTC) for doing a wonderful job and building an incredible foundation for initiatives such as the Mentorship Program and RO Trainee E-newsletter. I also wish to introduce the incoming Radiation Oncology Trainee Committee for 2017. This year our committee comprises of enthusiastic fresh faces with bright new ideas and we have committee representation from each training network in Australia, New Zealand and Singapore to ensure our trainees have a wider and more comprehensive access to our ROTC. I look forward to working with such an enthusiastic and committed group of trainees and anticipate it will be a fruitful and exciting year ahead!
ROTC 2017 The ROTC’s primary purpose is to advocate on behalf of all trainees. We welcome any contributions or suggestions and perhaps most importantly, we would like to hear if you have any concerns regarding your training or well-being in general rotc@ranzcr.edu.au The names of the 2017 ROTC are listed below. Dr Kimberley Nguyen (Chair, NSW South) Dr Hui Sze Wong (Secretary, SA) Dr Nick Bucknell (VIC/TAS) Dr Luke Nicholls (QLD) Dr Hendrick Tan (WA) Dr Sena Han (NZ) Dr Stephen Chin (NSW North) Dr Teng Hwee Tan (Singapore) For direct contact details of the committee, please email rotc@ranzcr.edu.au
Key Projects for 2017 Mentorship Program
will keep you updated with further developments. Training Assessment of Training Site (TATS) The ROTC wish to engage with the Education and Training Committee to provide ongoing feedback to improve the format in which trainees currently give feedback and optimise its utility. Raising the Profile of Radiation Oncology We hope to improve trainee awareness of issues related to the profile of radiation oncology and aim to develop PowerPoint templates which can be used by trainees to present at their respective hospital’s grand rounds, medical student or junior medical officer teachings. We hope this will in turn improve trainee engagement in the Targeting Cancer campaign. Dr Kimberley Nguyen Chair, Radiation Oncology Trainees Committee
A recent survey completed by the College demonstrated significant stress and burnout amongst radiation oncology trainees. The College is exploring strategies to address this issue.
ROTC 2017 Back row L-R: Drs Stephen Chin, Luke Nicholls, Hendrick Tan, Teng Hwee Tan, Nick Bucknell Front row L-R: Sena Han, Hui Sze Wong, Kimberley Nguyen
The 2016 ROTC proposed that one potential tool to combat stress and burnout could be a Mentorship Program and sent out a survey to trainees to explore this. The majority of trainees who participated responded positively to mentoring as an effective way of developing a doctor’s potential as well as helping to manage stress and burnout. Thus, the 2017 ROTC wishes to workshop this further and develop a Mentorship Program for trainees. We
For examination dates in 2017, visit www.ranzcr.edu.au/training/exams/ radiation-oncology-examinations/ examination-fees/examination-date For courses and workshops visit www.ranzcr.edu.au/news-a-events/ courses
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Radiation Oncology
Establishing and Sustaining Regional, Rural and Remote Radiation Therapy Centres During 2015-16, under the auspices of the College’s Quality Improvement Committee (QIC) and the Radiation Oncology Tripartite Committee, the Faculty of Radiation Oncology (FRO), Australasian Society of Medical Imaging and Radiation Therapy (ASMIRT), Australian College of Physical Scientists and Engineers in Medicine (ACPSEM) sought members passionate and experienced about regional radiation therapy health care to provide a commentary on the establishment and sustainment of regional radiation therapy centres. The paper underwent a reiterative cycle of feedback from the College, ASMIRT and ACPSEM members before approval through the Faculty of Radiation Oncology Council and Radiation Oncology Tripartite Committee. The paper discusses issues that need to be considered when establishing a new centre; from planning stages to operational readiness, as well as the ongoing management of a radiation therapy facility in regional and remote areas. The target audience is the management team, which usually involves a combination of established hospital staff with variable experience in the establishment of radiation therapy centres and their integration into existing services; as well as experienced radiation oncology managerial staff employed to assist and collaborate in establishing such centres. This paper provides commentary on aspects of establishing and the running of radiation therapy centres in regional and remote Australia. Irrespective of the geographical location of the radiation therapy centre, the core operational, legislative and practice standard elements for safe and quality service delivery are the same. These are dictated by standards within the industry, and federal and state
requirements. It is acknowledged that there are specific challenges faced in remote and rural Australia that need to be highlighted. It is fair to say this mostly applies to two linear accelerator centres, with or without other oncology services (e.g. chemotherapy), which are the most common infrastructure set up in regional Australia currently. Centres established with single linac units can derive insights from this document as well and larger centres can of course learn from the single linac experience. The membership consulted for this document included the leadership team of the Radiation Oncology Tripartite Committee and membership of the three constituent bodies previously mentioned. This paper represents the collective wisdom and experience of staff who have been through the challenges of establishing and sustaining regional and remote radiation therapy centres. The future of this issue? With the decentralisation of radiation therapy services, the decentralisation of Australia’s population along urban sprawl and regional development corridors, and now the potential decentralisation of subspecialities within radiation therapy (e.g. stereotactic technologies and access), this document was felt to be a first iteration. Thank you to members who have taken the time to provide feedback on the document and share their experiences and challenges faced in regional radiation therapy centres, and to ASMIRT and ACPSEM for their leadership and voice. Dr Sid Baxi Chair, Tripartite Committee Regional Interests Working Group (TRIG)
To access a copy of the paper, visit the College website http://www. ranzcr.edu.au/advocacy/statements
For more information, or to provide feedback and suggestions for future revisions please contact Philip Munro, Manager, Quality and Standards at the College on quality@ranzcr.edu.au or +61 2 9268 9763
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cts a tr s Ab pen r fo w O l l Ca No
RANZCR PERTH 2017
68th Annual Scientific Meeting
explore the
extraordinary extraordinary explore the
19 – 22 October 2017 Crown Perth Convention Centre Western Australia www.ranzcr2017.com Platinum Partner
Sponsorship and Exhibition Opportunities Now Available Contact Encanta for further details or to tailor a package to suit your marketing objectives (08) 9389 1488, ranzcr@encanta.com.au
Keynote Speakers Radiology Prof Jeff Geschwind, Yale University School of Medicine, USA Prof Suresh K. Mukherji, Michigan State University, USA Prof Michael P. Federle, Stanford University Medical Center, USA Prof Mark J. Kransdorf, Mayo Clinic College of Medicine, USA Radiation Oncology Prof Brian O’Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto Prof Lena Specht, Rigshospitalet, Copenhagen University Hospital, Denmark
Radiation Oncology
Vale Ms Sally Crossing AM (1946-2016)
Ms Sally Crossing
The College was saddened by the passing of Ms Sally Crossing AM on 28 December 2016, after a long and brave battle with cancer. Sally was an inspiring and well respected advocate for people affected by cancer over many years following her own diagnosis with breast cancer in 1995. She founded the Breast Cancer Action Group New South Wales in 1997. This group compiled the Directory of Breast Cancer Treatment and Services NSW, which earned Sally the inaugural NSW Consumer Advocate Award. In 2000, Sally led the establishment of the Cancer Voices movement in Australia, and became the chair of Cancer Voices NSW. Sally’s considerable advocacy efforts were recognised through her appointment as a Member of the Order of Australia in 2005.
Australian Commission on Safety and Quality in Health Care, and the Faculty of Radiation Oncology at the Royal Australian and New Zealand College of Radiologists. Through Cancer Voices, Sally facilitated the formation of the Australian Cancer Consumer Network in 2014, a group of 30 consumer related cancer organisations. In the same year she also accepted an Honorary Doctorate of Health Sciences from the University of Sydney for “extraordinary leadership and contributions to supporting those with cancer from diagnosis, though treatment, care support and survivorship, in both advocacy and research”. Sally was the consumer member of the Faculty Council in 2015 and 2016. During this time, she demonstrated her wide knowledge of the radiation oncology sector, and her commitment to supporting the Faculty’s work – including advocating for the continuation of the Australian Clinical Dosimetry Service, the implementation of the Radiation Oncology Practice Standards, and appropriate patient access to affordable radiation therapy services. Despite her declining health, Sally attended the College’s Annual Scientific Meeting in 2016, and made very valuable contributions to the Faculty Forum and some of the scientific sessions. The College is indebted to Sally for her tireless efforts and dedication. She taught us so much and will be sadly missed. However, her legacy will live on and will continue to influence consumer engagement for many years to come.
FROGG News The Faculty of Radiation Oncology Genito-Urinary Group executive is busy putting the finishing touches to the upcoming workshop on the management of relapse following local treatment for prostate cancer. Our international speaker and local faculty will cover the issues surrounding PSMA PET scanning, technique and timing of post-operative radiation therapy, management of pelvic nodal relapse, oligometastases and local recurrence, the use of hormone therapy and promising systemic therapies. The workshop is targeted at radiation oncologists and we devote significant time to discussing our “art” (doses/ techniques/volumes). We plan to develop guidelines on the subject of relapse and we look forward to your participation. See you in Noosa on 30 March to 1 April!
Please contact Tan Nguyen at faculty@ranzcr.edu.au with any questions about FROGG.
A memorial service was held at the University of Sydney to celebrate Sally’s life, on Saturday 4 February 2017, which also marked international World Cancer Day.
Sally was instrumental in many consumer advocacy activities, and contributed to numerous cancer organisations, including Cancer Council NSW, Consumers’ Health Forum of Australia, the Board of the
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Radiation Oncology
TROG Cancer Research update Sub Studies Committee TROG owns the datasets generated by the many TROG-sponsored (Category A Trials) trials in its portfolio. The size and maturity of this portfolio is constantly increasing, therefore there is a need to facilitate access for secondary analysis of data generated by these trials. Secondary analysis of the data can be used to address questions which were not posed in the original protocol or which have arisen as a result of new evidence becoming available. Access to data is available for TROG members and non-members. Applications are made through the TROG Secondary Analysis Policy application form available on the TROG website. All applications must be supported by a full TROG member. A sub studies committee is being established to proactively identify
priorities and develop standardised procedures for inclusion in the research portfolio and access. This committee will report to the TROG Scientific Committee. More detail will be provided as the committee progresses. We invite interested TROG members to be involved in the committee. Further information can be requested by contacting joan.torony@trog.com.au
TROG 2017 ASM The 29th Annual Scientific Meeting (ASM) was held from 6-9 March 2017 at the ANZ Viaduct Events Centre in Auckland, New Zealand. The event provided a unique opportunity for all health professionals with an interest in radiation oncology, to collectively discuss and influence the direction of current and future cancer clinical trials.
The theme for our 2017 meeting was ‘Radiation Oncology: Precise Treatment, Quality Research’. Drs Giuseppe Sasso and Laura Ciurlionis were the coconvenors and international speakers included Professor Andre Dekker, medical physicist at MAASTRO Clinic in the Netherlands and Dr Nancy Lee, radiation oncologist at the Memorial Sloan Kettering Cancer Centre in New York. The 2018 TROG ASM will be held in Hobart, Tasmania on 19-22 March 2018. Visit www.TROG2017.com for more information throughout the year. We look forward to seeing you in Hobart next March. Joan Torony CEO TROG Cancer Research
IMAGING UPDATE IN SYDNEY
September 11-15, 2017 / Four Seasons Hotel
STARTX State of the Art Radiation Therapy Conference 2017 Darling Harbour, Sydney 4-6 August STARTX is back with the best of cutting edge content in radiation therapy, radiation oncology medical physics and clinical radiation oncology.
REGISTER NOW
www.startxconference.com
For international and national keynote speakers, application forms for STARTX Six of the Best abstracts in radiation therapy, physics and radiation oncology and more go to the website for updates.
General Session: 22 credits / 7:00 am-1:00 pm Sep 11-12: Neuro, Thoracic / Sep 14-15: Breast, MSK Virtual Colonoscopy Workshop / 12 credits Sep 12: 2:00-5:00 pm / Sep 13: 7:30 am-6:00 pm HRCT of the Lung Workshop / 3 credits Sep 14: 2:00-5:00 pm https://radiology.ucsf.edu/cme/ucsf-imaging-update-2017-sydney Attendees may claim RANZCR CPD Points.
Early bird and group discounts available, discounted registration for radiation oncology advanced trainees, undergraduate radiation therapists and physicists. ACPSEM, AIR and RANZCR CPD applied for. Key Dates Registrations Open 13th March 2017 Call for Abstracts Open 13th March 2017 Call for Abstracts Close 16th June 2017 Early Bird Registration Closes 30th June 2017
For further information and sponsor prospectus, contact the Conference Secretariat : Will Organise, asmith@willorganise.com.au +61 2 49 736 573
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Inside News
Faculty: Heather Greenwood, MD (breast); Travis Henry, MD (thoracic); Christopher Hess, MD, PhD (neuro); Priyanka Jha, MD (abdominal); Daria Motamedi, MD (musculoskeletal); Judy Yee, MD (abdominal) Department of Radiology and Biomedical Imaging University of California San Francisco
Radiation Oncology
Asia-Pacific Radiation Oncology Special Interest Group – Cambodia, Papua New Guinea and a New Executive Committee APROSIG-Cambodia Collaboration It has been a busy few months for the APROSIG team. In September 2016, an APROSIG team, consisting of Dr Iain Ward, Dr Mei Ling Yap, Dr Stephanie Corde-Tehei (Physicist) and Kate Rogl (Radiation Therapist) visited the National Cancer Centre (NCC) in Phnom Penh. The visit was generously funded by the College’s International Development Fund (IDF) grant. The aim was to understand the needs of the department and develop a short and long term plan for collaboration. The centre is currently being built, with plans for a CT simulator, HDR brachytherapy and a Varian Linear Accelerator to be operational by mid-2017. The centre is a long-awaited initiative in a country with a population of 15 million, which currently only has one radiotherapy machine, installed in 2016. It was a productive week, including visits to the oncology departments, NCC building site, the Australian embassy and a meeting with the Cambodian Ministry of Health representative. The APROSIG team also delivered talks on a variety topics including QA and incident reporting. The visit set up strong foundations for ongoing future collaborations. Through funding received from the Department of Foreign Affairs and Trade (DFAT) Australian Volunteers for International Development (AVID) program and the College’s IDF grant, APROSIG is currently in the process of organising a medical physicist and radiation therapist to work along-side Cambodian staff for 6-12 months when the NCC opens. Applications for a medical physicist are still welcome. Please spread the word to any medical physicists who may be interested in being involved in this exciting opportunity! Contact: mei.yap@sswahs.nsw.gov.au
APROSIG team with sole linac in Phnom Penh, at the Khmer-Soviet Friendship Hospital
Radiation Oncologist Needed in Papua New Guinea Dr Iain Ward visited Papua New Guinea (PNG) as part of an International Atomic Energy Agency (IAEA) - Programme of Action for Cancer Therapy (PACT) mission. Unfortunately, the National Radiotherapy Treatment Centre at ANGAU Memorial General Hospital in Lae has been without a radiation oncologist from the beginning of 2016. There will be no radiotherapy service for the country, unless a replacement can be found. Lae is the second-largest city in PNG, with a population of 100,000, and has better road access for patients from other parts of the country than Port Moresby. The local technical university offers a degree in radiation therapy, but physics is dependent on visits from an Australian Medical Physicist.
replacing. Nevertheless, good palliation is provided and curative intent treatment of cervix, breast and head and neck cancer is delivered. The PNG Government is currently advertising for a radiation oncologist, the package including accommodation, car and leave inclusive of flights to and from Australia. Locum positions are also being considered. Contact Dr Iain Ward for more information: Iain.Ward@cdhb.health.nz
continued over...
Patients are treated with 2D radiotherapy and treatment times are long, as the cobalt source needs
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Radiation Oncology
Meet the New Executive Committee! We have recently expanded our executive committee with the addition of three new members: Dr Jayasingham Jayamohan Jayasingham (JJ) is a radiation oncologist from Westmead Hospital who has years of experience teaching in South India and the National Cancer Centre in Sri Lanka. Dr Francis Ho Francis is a radiation oncologist at the National University Cancer Institute, Singapore. He helps coordinate the training of radiation oncology trainees from Low and Middle Income Countries (LMIC) in SE Asia and is actively involved in the South East Asian Radiation Oncology Group (SEAROG).
Dr Andrew Oar Andrew is a final year trainee at Liverpool/Campbelltown Hospitals and has previously completed a Masters of International Public Health as well as development work in Africa and Latin America.
International Development Activities Database There has been an enormous amount of work done by College members within LMIC in our region, including outside of the APROSIG banner. We hope to enhance collaboration between these initiatives – a first step to achieving this is through the formation of a web-accessible database on current international development activities by College members. If you are working with LMIC departments in the Asia Pacific region, please contact: Dr Andrew Oar at andrew.oar@sswahs.nsw.gov.au so we can add this information to the database.
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Inside News
General Interest
New Zealand Branch News
Dr Lance Lawler
It’s only March but already we have covered a fair bit of ground – I’m not sure if we should read anything into this just yet. We have completed a submission on “The Model of Care for Vascular Services”, a proposal to define the expected standard of care NZ District Health Board vascular units need to provide. Within this we made clear our views on the value of interventional/ vascular radiologists and the need to base any investigation and treatment decisions on sound clinical guidelines. Hopefully this focussed approach will be rewarded by an understanding of the tremendous benefits radiologists can bring to healthcare pathway and overall service design. Well, we can but dream. We have been asked to speak at a Hui on the Medical Imaging Workforce (by this they mean the MRTs), specifically the role of community providers in models of care, collaborative solutions, the role of technology and training. Our approach will be to emphasise the value of communication and teamwork between primary and secondary care, and the willingness of service providers to work together to provide better solutions. We are hoping for a receptive audience. We also have the official launch of ‘Choosing Wisely’ next month, NZs version of the international program to target appropriate investigations and treatments – and avoid those not indicated. The College has put together
an excellent set of six recommendations including the use of plain films in specific trauma settings, the use of CTPA and also CT Head imaging. There is a link on our College website that will take you to the full versions of these. The other medical colleges have produced recommendations related to their own practice, and yes, it has been a struggle getting them to focus on what they actually do rather than everyone saying we do too much radiology! Finally, ACC is set to investigate the possible role of GP referrals for MRI scans, and have initiated a trial of this in Auckland. The College has had only very limited input into this, we are to meet with them next month and hopefully we will have more information following this. Looking forward, each year the College has the opportunity to recognise members who have made significant contributions to the profession of radiology and radiation oncology. Us Kiwis are not as good at doing this as our Australian counterparts, but we can change that. Please consider your peers for these Honours or many others and make contact either with myself, or the Branch Office or visit www.ranzcr.edu. au/members/awards-a-prizes/collegehonours for information and forms. 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
Fellows in clinical radiology (more than five years post-Fellowship) who are based in New Zealand are eligible to apply for the Rouse Travelling Fellowship in 2017, as the opportunity falls with New Zealand this year. If successful, a clinical radiology Fellow from New Zealand will travel to Australia to attend and speak at the Annual Scientific Meeting in Perth from 19 – 22 October 2017. This Fellowship honours the memory of Mr Edgar Rouse and forms a continuing acknowledgment of his great contribution to the education activities of the College over many years. Applications close on 10 April. Contact gaps@ranzcr.edu.au for more information on this Fellowship.
For any New Zealand Branch enquiries, please contact Alexander Brunt at nzbranch@ranzcr.org.nz
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General Interest
Australian Branch Meeting Dates to June 2017 Annual Scientific Meeting Saturday 10 June
Location Sofitel Noosa 14-16 Hastings St, Noosa Heads QLD 4567
Academic Nights Tuesday 5 September
Hillstone St Lucia Carawa St, St Lucia QLD 4067
ACI Education Lectures Tuesday 4 April – trainee presentations Tuesday 25 July Tuesday 14 November
Kerry Packer Lecture Theatre Royal Prince Alfred Hospital Missenden Rd, Camperdown NSW 2050
Radiotherapy Club Meetings Wednesday 19 July Wednesday 22 November
Cockle Bay Room Park Royal Darling Harbour 150 Day Street Sydney NSW 2000
QLD
NSW
WA
Monthly Professional Meeting (MPM) Wednesday 15 February Wednesday 15 March Wednesday 19 April
Wednesday 17 May Wednesday 21 June Wednesday 19 July – trainee presentations Wednesday 16 August Wednesday 8 November
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 the College on +61 2 9268 9777 or branches@ranzcr.edu.au
Branch Contacts 2016 ACT Chair: A/Prof 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: contact branches@ranzcr.edu.au to nominate Honorary Secretary: Dr Chee-Chung Hiew E: chee-chung.hiew@sesiahs.health.nsw.gov.au Meeting Contact: Ms Anthea Temple E: anthea.temple@health.nsw.gov.au NSW Radiotherapy Club Ms Sarah Hall E: branches@ranzcr.edu.au
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Inside News
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 Mark Phillips E: ausphillips66@yahoo.com.au Honorary Secretary: Dr Peter Zheng 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: Vacant – contact branches@ranzcr.edu.au to nominate TAS Chair: Prof Stephen Stuckey E: slstuckey@mac.com Honorary Secretary: Dr Gerard Goh E: G.Goh@alfred.org.au
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
General Interest
From the Trainor/Owen Collection The Trainor Owen Collection enters the Virtual Age
The Trainor/Owen Collection is full of curiosity showcasing the development and medical contributions of radiology and radiation oncology throughout the 20th century. In our last edition of Inside News, the archive reported from our most recent intern who spent her time cataloguing and digitising the historic objects in the archive. Today we see this catalogue become a online museum by launching on the eHive website. It was Morris Owen who, upon his professional retirement, was inspired to collect and preserve the milestone developments of the specialism and the College. Thus creating one of the first collections of its kind. From these early beginnings, the collection has grown considerably. Today the collection houses over 450 objects dating back to the 1890s ranging from large x-ray tubes and equipment to teaching aids and films to contrast dyes and syringe kits. These objects have been donated by various specialists throughout the decades and have come together to create an extremely
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unique and all together fascinating collection of historic medical objects. As we launch our first online museum, we reflect on the past greats of the industry who, without their generous donations, none of this would be possible. Notably but not limited to; Dr Sear, founding member the College, Dr Ryan, founding chair of the College Education Committee and Dr Bennett, founding custodian and major contributor to the Trainor/Owen Collection. Being able to combine historic collections and bring them into the 21st century can only be possible with the advancements of technology. These advancements provide opportunities for collections like the Trainor/Owen Archives to become more accessible to anyone with an internet connection. Online museums allow for wider access to broaden audience engagement allowing both members and the greater pubic to interact and learn from the Trainor/Owens’ eccentric collection of medical instruments and teaching aids.
In the future, we would like to add to the virtual world by including sound bites from the recent activities in the oral history projects and showcasing specific objects in line with College activities to preserve the relics of the past for future generations.
Visit the RANZCR Trainor/ Owen Virtual Museum here: www.ehive.com/collections/5079/ trainor-owen-collection
How can you help? The Trainor/Owen Virtual Museum is still in its infancy. Should you come across a mislabelled object or can add to the objects description, please contact Eva Stokes-Blake on archives@ranzcr.edu.au or +61 2 9268 9725
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Volume 13 No 2 I March 2017
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General Interest
Congratulate your Colleagues We would like to congratulate the following Fellows for their Australia Day awards.
Adjunct Professor Lizbeth Kenny AO
Senior Radiation Oncologist, Royal Brisbane and Women’s Hospital; Medical Director Central Integrated Regional Cancer Service; Adjunct Professor University of Queensland Adj Prof Lizbeth Kenny was named an Officer of the Order of Australia in the 2017 Australia Day awards for distinguished service to medicine as a clinician and researcher in the field of radiation oncology, and to executive roles with professional organisations nationally and internationally.
Professor John Boyages AM
Discipline Head, Radiation Oncology and Professor of Breast Oncology Prof John Boyages was named a Member of the Order of Australia in the 2017 Australia Day awards for significant service to medicine in the specialty of radiation oncology as a clinician, to medical education, to professional organisations and to people with breast cancer.
Professor Makhan Khangure AM
Professor Albert Lam AM
Prof Makhan Khangure was named a Member of the Order of Australia in the 2017 Australia Day awards for significant service to medicine in the field of neuroradiology, to education, and to a range of professional medical associations.
Prof Albert Lam was named a Member of the Order of Australia in the 2017 Australia Day awards for significant service to medicine, particularly to paediatric radiology, as a clinician, and to child health education.
Senior Neuroradiologist and Emeritus Consultant Royal Perth Hospital
Head of Diagnostic Ultrasound, Department of Medical Imaging, Sydney Children’s Hospital
Volume 13 No 2 I March 2017
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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.
RANZCR Supporters
Revised Professional Documents
Bayer Australia Ltd www.bayer.com
Clinical Radiology Written Report Guidelines.
TNI Pty LTD www.tni-australia.com Everlight www.everlightradiology.com.au I-Med www.i-med.com.au
Sectra www.sectra.com/medical All College standards, policies and guidelines are available on the College website www.ranzcr.edu.au/resources/ professional-documents All College position statements and reports can be found here: www.ranzcr.edu.au/advocacy/statements If you have any enquiries about these documents, please contact the College on +61 2 9268 9777
Integral Diagnostics www.integraldiagnostics.com.au Deutsch Medial Pty LTD www.deutschmedical.com.au Lightbox Radiology Education www.lightboxradiology.com Varian Medical Systems Australasia www.varian.com Become a RANZCR Supporter The College is delighted to offer organisations the opportunity to become a RANZCR Supporter, which will provide you with many benefits as listed below. To become a RANZCR Supporter, please visit www.ranzcr.edu.au/ members/membership-categories/corporate and complete an application form and return to the College at editor@ranzcr.edu.au • Discounted advertising opportunities. • A RANZCR Supporter logo to display on your website • A RANZCR Supporter listing on the College website, in Inside News and in the Annual Report • The College’s quarterly newsletter - Inside News • The College’s bi-monthly scientific journal - Journal of Medical Imaging and Radiation Oncology • The College’s monthly electronic newsletters – Faculty of Clinical Radiology and Faculty of Radiation Oncology and other associated electronic newsletters • The College’s Annual Scientific Meeting brochure • An electronic version of the College’s Annual Report
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Inside News
General Interest
Australasian Meetings 2017
International Meetings 2017
April
April
ILROG 2017 Melbourne, VIC, 7-8 April 2017 www.ilrogmelbourne2017.org Australian Pain Society 37th ASM Adelaide, SA, 9-12 April 2017 www.dcconferences.com.au/aps2017
May AMSIG ASM Melbourne, VIC, 6-7 May 2017 www.amsig.org/amsig/amsigmelbourne-2017 Radiology Asia Singapore, 19-20 May 2017 www.radiologyasia.com
June IRSA and RANZCR Registrar Conference Liverpool Hospital, NSW, 3-4 June 2017 www.irsa.com.au/meetings/155-irsaregistrar-conference-2017
July ANZSNR ASM Darwin, NT, 6-9 July 2017 www.anzsnr.org.au IRSA Conference Port Douglas, QLD, 11-13 July 2017 www.irsaconference.aot.com.au
August Health Informatics Society of Australia Brisbane, QLD, 6-9 August 2017 www.hisa.org.au/hic
RANZCR Annual Scientific Meeting Dates NZ Branch ASM 2017 4-6 August 2017 Nelson, New Zealand www.ranzcr2017.co.nz ASM 2017 19-22 October 2017 Perth, WA www.ranzcr2017.com ASM 2018 25-28 October 2018 Canberra, ACT
College Meetings 2017 Board 12 May 13 June (telco) 18 August 9-10 November Annual General Meeting 20 October Faculty Council – Clinical Radiology 27 April (telco) 22-23 June 24 August (telco) 14-15 September 20 November 7 December (telco) Faculty Council – Radiation Oncology 28 April (telco) 21 July 25 August (telco) 13 October
ESER/BSER ASM London, UK, 25-26 April 2017 www.eser-society.org ARRS 2017 New Orleans, USA, 30 April – 5 May 2017 www.arrs.org/am17
May ESTRO 36 Vienna, Austria, 5-9 May 2017 www.estro.org/congresses-meetings/ items/estro-36 ESPR ASM Davos, Switzerland, 30 May – 3 June 2017 www.espr2017.org
June ESGAR 2017 Athens, Greece, 20-23 June 2017 www.esgar.org/annual-meeting/ esgar-2017 CARS 2017 Barcelona, Spain, 20-24 June 2017 www.cars-int.org
September ASTRO ASM San Diego, USA, 24-27 September 2017 www.astro.org/2017-ASTRO-AnnualMeeting.aspx
~ Death Notices ~ The College notes with regret the death of the following members: Dr Herbert Feltham, Fellow and Life Member, NZ Dr Choon Woo, Fellow, NSW Dr Veena Chari, Fellow, NSW
Volume 13 No 2 I March 2017
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Courses and Workshops Classifieds
RADIOLOGY CPD IN ISRAEL With Donald Resnick and László Tabár 21 CPD
points • 5-8 June, 2017
NEURORAD 2017 Case Review and Lecture Series Sat 20th May to Mon 22nd May
International Speakers & Expert Educators Prof. David Yousem (Johns Hopkins) Assoc Prof. Jenny Hoang (Duke Uni)
The Pullman Albert Park, Melbourne
Registration Open Now!
2017
www.globalradcme.com
Australia’s largest CT & MR conference
International Speakers James Smirniotopoulos One of the great neuro teachers of today
Niall Power
GI/GU expert & 7/7 London bombings experience
Featuring a full program of lectures and case-review workshops specifically for radiologists and radiology registrars.
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28-30 July 2017 Jupiters Gold Coast
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Musculoskeletal MR—Commonly Imaged Joints 11-13 August 2017
Neuroradiology—Brain, Head/Neck and Spine 11-13 August 2017 and 14-16 August 2017
14-16 August 2017
High Resolution CT of the Chest 18-20 August 2017
11TH SCIENTIFIC MEETING
Quandaries and Controversies for the Multidisciplinary Team 5th - 7th October 2017 Sheraton Grand Mirage Resort, Gold Coast International speakers: Christiane Kuhl, Radiologist Monica Morrow, Surgical Oncologist Charlotte Coles, Radiation Oncologist Sunil Badve, Pathologist Local keynote: Jemma Gilchrist, Clinical Psychologist Including: Radiology - MRI case study workshop with Christiane Kuhl Radiation Oncology - interactive sessions with Charlotte Coles Radiation Technology – case studies and positioning
Contact: Kerry Eyles kerrye@asbd.org.au 0477 330 054 www.asbd.org.au
Radiation Oncology Trainee Courses Rydges World Square, Sydney
REGISTRATION NOW OPEN
Body and Pelvic MR
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Limited places available. Register at www.ranzcr.edu.au/ news-a-events/courses events@ranzcr.edu.au
REGISTRATION NOW OPEN
Phase 2 Exam Preparation Course 12-13 May 2017 Phase 1 Foundation and Exam Preparation course Contact: 15-18 June 2017
events@ranzcr.edu.au
Limited places available. Register at www.ranzcr.edu.au/news-a-events/courses
Advertising submitted by third parties does not constitute endorsement by The Royal Australian and New Zealand College of Radiologists.
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