Issuu

Volume 15 No 2 / March 2019

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

DIAGNOSTIC IMAGING REFORM Is it time for a new Memorandum of Understanding?

Also Featured in this edition

Is your insurance really protecting you?

MBS Review:

The Good, The Bad, The Sometimes Ugly

MRI advocacy

– running the marathon

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www.i-med.com.au

Editor’s Pick 5 6 7

Advocating during electoral uncertainty Accreditation of the College News in Brief

11 15

Diagnostic Imaging Reform. Is it time for a new Memorandum of Understanding?

Getting the facts on AI - Intelligence 18

20 22

MRI Advocacyrunning the marathon

MBS Review: The good, the bad, the sometimes ugly

The patients voice – the human side of advocacy

What are your thoughts?

23 25 28

Liver MRIs – How one man’s passion made a difference. Targeting Cancer InsideRadiology

Workshops, Courses and Events

32 33

New draft training programs taking shape Part II exam tips from a HR Sear medal winner

Is your insurance really protecting you?

From the Faculty of Clinical Radiology

From the Faculty of Radiation Oncology

News from the professions

RANZCR releases its draft Ethical Principles for AI in Medicine for consultation

56 58

If you have thoughts or comments about one of the stories you have read in this issue, we want to hear from you. The submission of letters to the editor, articles and news items are encouraged. Please email any submissions to editor@ranzcr.edu.au

Trainee feedback – is it time for an overhaul?

Suggestions on surviving a nuclear blast; From the archives

Have you moved recently? Log into the MyRANZCR Portal and ensure your contact details are up to date at www.myranzcr.com

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Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editor Mark Grzic

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

S RG RADIOLOGY

Introduction

Advocating during electoral uncertainty A Message from the President

Dr Lance Lawler

At the commencement of my presidency in January last year, I committed on behalf of the College to devote resources to promote the role of our two specialties, lobby government to improve access and affordability in healthcare, and address the impact of artificial intelligence (AI) on our professions. Now, at roughly the halfway mark in my term, I'm happy to report that progress on these fronts is significant and heartening, with positive outcomes, large and small, achieved to date. The highlights of the year have included our gains in advocating for improved MRI access and, in November, the hosting of our first AI in Healthcare Summit. In recent years the College has turned away from what some had described as an 'inward focus and culture’, and lifted its game in stakeholder engagement, seeking out key decision-makers, participating in parliamentary committee processes and responding vigorously when opportunities for consultation arise. These included, in 2018, multiple meetings in Australia with the Health Minister and senior staff, Shadow Health Minister and Minister for Rural Health, and in New Zealand, with the Health Minister and other politicians. Our fundamental messages to government and stakeholders generally are firstly that radiology forms a linchpin in any modern healthcare system, and its practitioners possess insights into the system which, if heeded, would lead to more effective health policies. Secondly, radiation oncology is crucial in cancer care, incredibly cost effective and we

need the Government’s help to increase utilisation. We have also had more to say in the wider public domain about the issues facing radiology and radiation oncology through media releases and participation in various health awareness campaigns.

“As a consequence of a more pro-active and strategic approach, we have some runs on the board.” As a consequence of a more pro-active and strategic approach, we have some runs on the board. Among the recent achievements were increased funding in 2018–19 for specialist training program (STP) posts, additional MRI licences, and new Medicare items covering 3D breast tomosynthesis and a range of MRI scans, including certain obstetric, cardiac and liver cases, and the diagnosis of prostate cancer. Further, we have received messages of support from the major political parties to help reduce out-ofpocket costs for essential healthcare, work towards full indexation of radiology and retain bulk-billing incentives.

To this end, for the first time, the College has prepared an 'election survey' to be sent to the major political parties ahead of the national vote, with an intention to publish their responses prior to polling day for our membership and consumers to review. The initiative aims to inform the parties about the issues which matter to us and, where possible, obtain firm commitments from them. On our agenda for the federal election are our continuing efforts to lift restrictions on MRI access that cannot be justified on medical grounds, implementation of the Quality Framework, and a new Medicare schedule for radiation therapy. The College’s strong and proactive advocacy strategy has laid the foundations for the achievement of major goals in the coming year, and we are working hard to ensure we grasp every opportunity to be heard in the meetings that matter most.

However, the need for advocacy is unending, and with an Australian federal election looming, we must act to seize this opportunity to improve patient outcomes in our specialities.

Volume 15 No 2 I March 2019

Introduction

Accreditation of the College From the Chief Executive Officer

Ms Natalia Vukolova All members know that the College is accountable to the Australian Medical Council (AMC). In 2019 the College will be re-accredited by the AMC. Why this is important, who the AMC are and what this means are the questions I will address in this article.

Why is the College doing the AMC accreditation? The College must be accredited if it wants to provide specialist training and assessment programs and Continuing Professional Development (CPD) programs that allow our members to be registered as Specialists. • The Health Practitioner Regulation National Law Act 2009 makes the accreditation of specialist training programs a part of approval of programs for the purposes of specialist registration • The Medical Board of Australia's (MBA) registration standards indicate that AMC accreditation is a requirement for continuing professional development (CPD) programs • The Medical Council of New Zealand (which combines the functions of the AMC and the MBA) uses AMC accreditation reports to make decisions about recognising medical training programs in New Zealand.

Who is the AMC? AMC is the standards and assessments body for Medicine. It is a company limited by guarantee and managed by a Board of Directors. The AMC puts together an Assessment Team made up of experts in medical specialist education to review the accreditation

Inside News

of each College. RANZCR’s Assessment Team in 2019 will be Chaired by Dr Andrew Connolly, BHB, MBChB, FRACS, Head of Department, Department of General Surgery, Middlemore Hospital. Dr Connolly is an experienced AMC assessor and the immediate past Chair of the Medical Council of New Zealand.

What does the AMC expect? • Specialist medical programs and education providers that produce medical specialists who can practice unsupervised in the relevant medical specialty • Medical specialists who are providing comprehensive, safe and high-quality medical care that meets the needs of the Australian and New Zealand health care systems • Medical specialists who are prepared to assess and maintain their competence and performance through continuing professional education, the maintenance of skills and the development of new skills Practically, the AMC expects that its 10 standards are met or substantially met.

What is new in the AMC Standards for Colleges? Significant changes to the standards include: • Enhanced focus on trainee wellbeing • Enhanced focus on patient safety • New standards concerning indigenous health • Standards concerning continuing professional development have been revised in line with the Medical Board of Australia and Medical Council of New Zealand guidelines.

What are the consequences of non-compliance? The most likely consequences are a range of onerous reporting obligations and compliance activities, plus reputational damage, as assessment findings are public. • It is theoretically possible for the College to be disaccredited by the AMC; if that happens, then another provider will need to be found to deliver training and CPD programs (such as another College or a new organisation) • A bad outcome from the review may include additional full-scale reviews or shorter accreditation timeframes (such as a second AMC visit within 12 months), increasing costs and time investment from the College • Every review expects to get a number of conditions and recommendations as the process is meant to help continuous improvement.

What is the process? • Written report by the College – submitted by early May 2019 • AMC attends College examinations – April and May 2019 • Site visits by the AMC team to training sites; survey of trainees May-June 2019; 16th September to 20 September • Visit by AMC team for 1 week to Sydney office and interviews with key office bearers, committees and staff – September 2019 • AMC preliminary statement of findings to the College – end of September 2019 • Accreditation report to the College – early December 2019 • Final report and assessment outcome made public – by 31 March 2020

News from the Professions

News in Brief

The First Australian MR in Radiotherapy Meeting December 2018 saw the first official Australian Medical Research in Radiotherapy Meeting. The Meeting was the first of many milestones, including attendance by several international guests and local contributors. Topics included SABR for paediatric patients, Patient Rotation Systems for RT, and in-depth discussions of experiences with two different MRI-Linac systems that are currently available on the market.

Australia Day Honours for College Members including Order of Australia RANZCR congratulates Professor David Ball on receiving the Officer of the Order of Australia for distinguished service to medicine in the field of radiation oncology, to medical education and to professional bodies. A fantastic and well-deserved achievement. Dr Bronwyn King, from the Faculty of Radiation Oncology was recognised for distinguished service to community health, particularly through advocacy for institutional investment strategies.

Funding Round 4 now open for Rural Specialists Grants worth up to $10,000 are on offer to eligible rural specialists living and working in rural and remote Australia. Continuing Professional Development (CPD) activities can be undertaken with grant funding, which is being offered as part of the Support for Rural Specialists in Australia (SRSA) program. Rural specialists who receive grants can take part in CPD activities between 1 June 2019 and 30 June 2020. For detailed information visit the SRSA website. Applications close on 31 March 2019.

Targeting Cancer Ambassador Honoured Targeting Cancer ambassador, broadcaster, comedian and journalist Julie McCrossin was honoured at this year’s Australia Day honours. She was recognised for ‘significant service to the community, particularly through LGBTIQ advocacy roles, and to the broadcast media’.

STOP THE PRESS

longer cover the costs of providing these vital services through Medicare.

As March’s Inside News was going to press, the Federal Government announced indexation of ultrasound and X-Ray under Medicare from mid-2020.

Analysis by RANZCR and the Australian Diagnostic Imaging Association (ADIA) found that patients were increasingly out of pocket when they needed an ultrasound. This has resulted in the average gap for ultrasound reaching $106 per service, with patients paying around half the cost of ultrasound from their pockets.

“Indexation will allow more Australian patients the opportunity to afford ultrasound and X-ray services, which are essential and the first diagnostic test for many common health conditions and injuries,” RANZCR President Dr Lance Lawler said. Dr Lawler said successive Australian governments have failed to introduce indexation of radiology for more than two decades, meaning rebates no

“Many Australians are therefore being forced to choose between risking their health by not doing a scan or paying the gap payment themselves,” Dr Lawler said. “This also puts immense pressure on clinical radiologists to manage their workload while providing safe, high-quality services.”

The burden of out of pocket costs is even greater for women because much of their diagnostic imaging is ultrasound based which has been chronically underfunded by Medicare. “Ultrasound, for instance, is often used for gynaecology conditions and during pregnancy, so this is a big win for women across the country,” Dr Lawler said. In the lead up to the election, RANZCR will continue to advocate to improve access to MRI and for implementation of the Quality Framework. For more information, visit www.ranzcr.com

Volume 15 No 2 I March 2019

News from the Professions

New Zealand Branch News

Dr Gabes Lau

Happy New Year All – I hope you all enjoyed your summer breaks and the festive season.

Labour dispute – RMOs striking In New Zealand, the year has started off with the Resident Medical Officer (RMO) strikes. It seems we can expect the District Health Board (DHB) and RMOs to continue with their disagreement for a while. I think most of us would support a collaborative approach, which includes the views of Senior Medical Officers (SMO), to resolve the issues of workloads and safe working conditions.

Health Workforce New Zealand (HWNZ) In December, Dr Ashely Bloomfield (Director General Ministry of Health (MoH)) announced leadership changes at HWNZ. The Terms of Reference for the HWNZ Board have been updated towards a stronger strategic governance role. The Ministry will take the lead on delivery of health workforce strategy, planning, analysis and forecasting, and commissioning. As part of these changes, Professor Des Gorman has resigned with thanks for his service since 2009. The new Chair, Board members and revised Terms of Reference for HWNZ will be announced in April. Dr Bloomfield has also updated stakeholders on HWNZ progress on the processing of the 149 submissions for the Health Workforce Development fund

Inside News

that was initiated by Professor Gorman last year. The College submitted an Expression of Interest asking HWNZ to fund a fellowship programme for radiation oncology. Dr Bloomfield has indicated that we can expect to hear whether RANZCR will be invited to submit a complete application sometime early this year.

Workforce issues, the Ministry and the Health and Disability Review We met with Dr Andrew Simpson (Chief Medical Officer, MoH). I’m pleased to confirm that, following meetings with The College and other stakeholders, the Ministry will be prioritising recruitment and retention of radiologists in the public system. The Health and Disability System Review that was announced last year is now expected to get properly underway. The Phase 1 online tool for sharing ideas and feedback should be available as you read this. I encourage all members to participate independently, or as part of the College’s response – please check eNews for more information on how to contribute to the College’s response. You can also email nzbranch@ranzcr.org. nz if you want to be involved. I am aware that the Health and Disability Health Sector Review has been asked to consider future health workforce options as part of its work programme. The College’s role will be to build on the Ministry’s commitment and ensure the Review treats workforce issues related

to radiology and radiation oncology seriously and integrates solutions into the final recommendations.

Ethical Referrals for ACC Patients An issue arose last year in relation to cross shareholdings between referrers and radiology practices. The College opposes any financial arrangements that might motivate or influence referral patterns or impinge on a patient’s right to choose where to attend for the radiology services they need. The College worked closely with ACC to review the High Tech Imaging contract to clarify that financially motivated referrals would constitute a breach. We are continuing to raise this at the highest levels in ACC and with other key stakeholders.

Getting involved at the College The College is currently seeking people to fill some key roles in the Branch, including Training Network Director (Radiation Oncology) and Branch Education Officer (Radiology). This is a great opportunity for some new perspectives to come on board from Fellows and Educational Affiliates in the Branch. Please contact Jenna Howell at nzbranch@ranzcr.org. nz, telephone (04) 472 6475 or visit the College website for more information.

Features

WA Branch News

Professor David Ball Farewelled as JMIRO Editor-In-Chief

2019 will be an exciting year for Academic Radiology in Western Australia with the appointment of two internationally renowned Radiologists as UWA Chairs in Radiology. Professor Paul Parizel joins us from Antwerp, Belgium as the inaugural UWA David Hartley Professor of Radiology. Prof Parizel has a distinguished academic and clinical career as a Neuroradiologist. He is a recent past president of the European Society of Radiologists and European Society of Neuroradiology. Professor Derek Roebuck joins us from Great Ormond Street Hospital in London as the inaugural UWA Professor of Paediatric Radiology. Prof Roebuck has a distinguished career as an internationally recognised leader in the field of Paediatric Interventional Radiology and is a founding member and past President of the Society of Paediatric Interventional Radiologists.

Prof David Ball After 12 years, Professor David Ball has stepped down as Editor-In-Chief of the Journal of Medical Imaging and Radiation Oncology (JMIRO). Prof Ball had been a strong guiding hand for the Journal since he first took on the role in 2007. We spoke to Prof Ball regarding his experience and successes in this pivotal role. "I was very fortunate to be appointed as Editor-in-chief of Australasian Radiology at the beginning of 2007, and I regard it as one of the most satisfying and interesting activities of my professional career. The position had traditionally been occupied by a radiologist, so it never occurred to me, as a radiation oncologist to consider applying. It was a former Dean of the Faculty, my good friend Lester Peters who suggested I apply. I had had editorial board experience with the Journal of Thoracic Oncology, now the leading journal in its area, so knew how a quality international journal worked, and I had found the role interesting and quite different to my day to day clinical work, so felt well equipped to take on the challenge. Looking back at my 12-year tenure, the achievements that I am most proud of are: • Changing the name to The Journal of Medical Imaging and Radiation Oncology to better reflect its content and to move away from a

parochial image that would be of limited interest to a modern online international readership • Increasing the proportion of female Associate Editors on the Editorial Board to 35% • Appointment of Associate Editors in Physics, Nuclear Medicine and Statistics • Development of a close relationship with ASMIRT and their journal, The Journal of Medical Radiation Sciences • Introduction of a Medical ImagingRadiation Oncology subsection • Readership of the online journal has increased from 62,000 downloads to well over 100,000 per year • Introduction of full colour reproduction at no cost to authors • Academic rigour reflected in an article acceptance rate of 17% in 2017 • Most significantly, JMIRO has gone from not having any Impact Factor at all in 2007 to a new high in 2017 of 1.478 None of this could have been achieved without the ever-increasing quality of submissions from local and international authors, the enormous amount of voluntary work, reading and critiquing, by our section editors, associate editors, and reviewers. I would especially like to acknowledge the support I have received from the Editors of Diagnostic and Interventional Imaging, Alex Pitman and Gabes Lau, and the Editor of Radiation Oncology, David Christie. With their assistance I hope we have provided the Fellows of the College with a journal that is interesting, entertaining, and one they can feel proud of." Prof David Ball is succeeded by Professor Michael Barton who commenced his tenure at the start of this year.

Volume 15 No 2 I March 2019

What’s in Issue 2? Medical Imaging Review Article: Review and audit of the post‐surgical MRI breast: Pictorial essay Corresponding author: Dr Tracey Muir, Department of Radiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia. Audit of contrast‐enhanced breast MRI performed over a 3‐year period in a single institution to describe and summarise the changes seen after surgery and radiation therapy for primary breast cancer, breast augmentation and oncoplastic surgery. Seventy women were identified and reviewed (100 breast MRIs in total). The most common change seen was haemosiderin deposition. The early changes of skin thickening, oedema, seroma and background parenchymal enhancement decreased with time leaving residual breast shrinkage, haemosiderin/calcification and architectural distortion due to fibro-sis and scarring.

Medical Imaging Original Article: Does dual-energy computed tomography pulmonary angiography (CTPA) have improved image quality over routine single-energy CTPA? Corresponding author: Dr Hao Xiao, Department of Radiology, Western Health, 160 Gordon St., Vic., Australia. Introduction: The aim of this study is to compare the diagnostic sensitivity between dual-energy computed tomography pulmonary angiography (CTPA) studies and routine single-energy CTPA studies. Methods: A total of 117 patients with clinically suspected pulmonary embolism were examined with dual-energy CTPA (DECT) and reformatted single-energy multidetector CTPA (MDCT) studies. Two independent radiologists assessed the image quality of the CTPAs with objective and subjective parameters, including by assigning an image quality score out of 10 for each study. Dose length product and effective dose were also calculated and compared. Results: The subjective image quality score for DECT and MDCT studies was 9.19 and 7.88, respectively; however, the increased level of detail in DECT may not be clinically applicable. Pulmonary artery ﬁlling defects were found in 12 patients, with no subjective diagnostic differences between dual-energy or singleenergy studies with either radiologist. The effective dose for DECT ranged from 1.8 to 7.8 mSv. The effective dose for MDCT ranged from 1.2 to 6.4 mSv. Conclusions: Radiologists are trained to look at routine MDCTs with high speciﬁcity and sensitivity. DECTs do not appear to offer trained radiologists improved detection of clinically relevant pulmonary emboli.

Medical Imaging- Radiation Oncology Original Article: Generation of Virtual Lung SPECT/CT Fusion Images for Functional Avoidance Radiotherapy Planning Using Machine Learning Algorithms Corresponding author: Dr. Ji Hyun Chang, Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Dongjak-gu, Seoul, South Korea Introduction: Functional image-guided radiotherapy (RT) planning for normal lung avoidance has recently been introduced. Single-photon emission computed tomography (SPECT)/CT can help identify the functional areas of lungs, but it is associated with delayed treatment time, additional costs, and unexpected radiation exposure. In this study, we propose a machine learning algorithm that can generate functional chest CT images based on conditional generative adversarial networks (cGANs). Methods: We collected a total of 54 lung perfusion SPECT/CT image sets from lung cancer patients who had been treated at a single institution. Each SPECT and CT set consists of 161 images. CT-to-SPECT image pairs that contained no lung voxels, were outside the lung parenchymal ﬁeld, or did not match anatomically (on account of the patient’s breathing) were removed at the physician’s discretion. After we excluded the inappropriate images, we selected 3,054 CT-to-SPECT image pairs of the training set (49 patients) and the 400 testing sets (5 patients). The model was trained using the cGAN algorithm. Results: We ran the model based on multiscale SSIM (MS-SSIM). With the 400 image pairs of the testing set, we obtained a lung SPECT/CT fusion image for which the MS-SSIM was 0.87 (0.60–0.99) compared with the original image. We estimated a gamma index between the generated and the ground truth images, resulting in a mean passing rate of 97.7±1.2% with a 2%/2mm threshold. This demonstrated the potential to generate functional areas of the lung parenchyma directly from chest CT images using the machine learning algorithm. Conclusion: The results indicate that the cGAN model used here can generate functional areas from RT planning chest CT images. This could be used for functional image-guided RT planning, for sparing patients’ lung function without additional imaging modalities and costs. Additional studies are needed with many more training and test sets.

Radiation Oncology Original Article: Dedicated MRI simulation for cervical cancer radiation treatment planning: Assessing the impact on clinical target volume delineation Corresponding author: Dr Jacqueline Veera, Peter MacCallum Cancer Centre, Bendigo Health, PO Box 126, Bendigo, Vic 3552, Australia Introduction: Magnetic Resonance Imaging (MRI) provides excellent soft tissue definition of pelvic tumours and organs. The aim of this study was to quantify differences in delineated clinical target volumes (CTVs) between computed tomography (CT) and MRI. Methods: Twenty patients with locally advanced gynaecological malignancies were recruited. Patients underwent dedicated MRI simulation following CT simulation. Four clinicians independently contoured each CT and MRI. CTV structures were contoured using the Radiation Therapy Oncology Group (RTOG) guidelines and lymph node CTV (LN-CTV) according to published guidelines. Interobserver variability was analysed using the dice similarity coefficient (DSC) and mean absolute surface distance (MASD). Results: Gross tumour volume delineation was more consistent on MRI compared to CT, the DSC improved from 0.77 on CT to 0.81 on MRI, P < 0.01. GTV volumes were significantly smaller on MRI compared to CT (MRI 92 cc vs. CT 117 cc, P < 0.01). The LN-CTV and combined CTV volumes were both significantly smaller on MRI compared to CT (LN-CTV: MRI 324 cc vs CT 354 cc, P < 0.01 and combined CTV: MRI 560 cc vs CT 600 cc, P < 0.01). The LN-CTV DSC was 0.75 for both MRI and CT, and the combined CTV DSC was 0.81 for MRI and 0.80 for CT, P = 0.27. Vagina and parametria volumes exhibited more variability compared to other structures. Conclusions: Magnetic Resonance Imaging contouring resulted in smaller and more consistently delineated volumes when compared to CT for most CTV structures. An MRI contouring atlas is provided to complement the existing RTOG contouring guidelines.

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

Features

Diagnostic Imaging reform. Is it time for a new Memorandum of Understanding? Other DI reforms… More than seven years on there has been no follow through by the Government on implementation of the remainder of the 2011 reform package, despite pre-election commitments made in 2016. Inadequate consideration has been given to identifying the reforms needed and their interconnectedness or to development of a plan or any implementation strategies.

What has happened to the DI Reform Agenda? In May 2011, as part of the 2011-12 Budget and in response to a Detailed Review of the Funding of Diagnostic Imaging Services, the Government announced that it would implement, in close cooperation with the diagnostic imaging sector, a Diagnostic Imaging (DI) reform package to improve the quality and sustainability of medical imaging. The Review established that there are complex, interrelated issues beyond the funding arrangements that need to be addressed in order to maintain ongoing access to appropriate, quality services for patients and to support longterm sustainability of the diagnostic imaging sector. The reform package was intended to address the issues identified and was to be underpinned by a Quality Framework – a series of reforms aimed at ensuring that Medicare funding is better directed to efficient, appropriate and quality imaging services for patients. The reform package was to be implemented in a phased manner over 3-5 years from 1 July 2011.

MRI reforms… One of the key elements of the reform package included expanding patient access to MRI and a suite of changes to MRI access and licensing arrangements were implemented over the ensuing three years. In 2018 systemic issues relating to the availability and accessibility of MRI in Australia remain with a Senate Inquiry1 finding that the MRI licensing system needs reform and urging the Minister to urgently consider its reform, has resulted in the MRI schedule not keeping up to date with today’s patient needs and outcomes. MRI policy settings and the lengthy MSAC process for assessment and funding approval for new MR applications continue to hinder appropriate use of MRI. Development of an equitable and sustainable framework for MRI is long overdue, yet recent promises by the two main political parties to fund a further 20-30 licenses only serve to highlight the lack of any political will to address the systemic issues.

In the time that has elapsed the pace of technological advance has escalated, and the disruptive impacts of these advances are starting to be recognised. Machine learning is expected to become a powerful force in radiology and imaging as we currently know it will not exist in ten years. In the face of new and potentially highly disruptive technology, radiologists need to ensure they participate in what will be a significant transformation of their work and a new era of patient-centred, collaborative and team-based care. Integrating radiological advances with the power of digital and information technology can deliver greater efficiency, quality and value in health care.

Broader health care system reform… Radiology is a pivotal component of 21st Century healthcare and must be factored into the development of broader health reform policies and it is concerning that there is no apparent overarching strategic direction for health care in Australia, nor is there any effective process for engaging in ongoing development and implementation of policies and strategies for the future provision of Radiology services within the broader healthcare delivery system. continued over... Volume 15 No 2 I March 2019

Features

Over the past ten years, despite successive governments having commissioned at least ten reviews and consultations directed at reforming and modernizing parts of the health system, there has been no significant reform undertaken. The Medicare Benefits Schedule (MBS) is a change management tool, yet the MBS Review was not charged with addressing the systemic issues affecting Radiology today and the need for its alignment with the broader health care system.

areas impacting the sector, including health policy reform, the take up of new technology, quality use of diagnostic imaging, workforce, training, service delivery and the viability of radiological services.

Technological innovation will impact patient management, outcomes and satisfaction as well as the cost of healthcare. If they are to future proof their specialty, there is an imperative for radiologists to be proactive in setting the direction for the future of their profession and to determine a reform agenda that has regard to the need for adaptation to disruptive change – one that is underpinned by a framework of quality and sustainability. With the migration towards a requirement for more disease/organ specific multimodality imaging expertise (eg cardiac imaging) this will not be achieved by quarantining the speciality through the regulatory framework but through training and standards.

“When the MOUs ceased on 30 June 2008, the Government decided that it would not continue to use such agreements to manage DI expenditure.”

How can DI Reform be achieved? Between 1998 and 2008, expenditure for Diagnostic Imaging Services in the Medicare Benefits Schedule was managed through a series of capped funding agreements or Memorandum of Understanding (MOUs) between the Commonwealth Government and various DI representative groups, including RANZCR. In principle, these MOUs were aimed both at managing MBS outlays for DI services and at providing a forum for the government and DI representative groups to work co-operatively across a range of key

Inside News

Collectively the four MOUs in force between 2003 and 2008 (Radiology, Nuclear Medicine, Cardiac Ultrasound and O & G Ultrasound) were broadly intended, through collaborative and co-operative strategies between the

parties, to promote: • Access to quality, affordable Diagnostic Imaging services for patients; • Effective management of outlays by the Australian Government for the diagnostic imaging services described in the Diagnostic Imaging Services Table (the DIST) of the Medicare Benefits Schedule (MBS) within agreed parameters; • Improvement in the quality and delivery of Diagnostic Imaging services through the development of quality frameworks. While the College and ADIA were a powerful force for effecting changes within the budgetary framework under the Radiology MOU which accounted

for more than 75% of total MOU funding over the five year period, the management of outlays dominated the business of all the MOU management committees at the expense of addressing the appropriateness of referrals and other key drivers of growth including new technology, unnecessary testing, self-referral and cost shifting. The focus on point of service cost and not the overall cost in the broader spectrum of disease and its management was a major shortcoming. Fiscal sustainability of the Radiology sector needs to be considered in the wider context of government outlays for health care - appropriate use of Radiology has the potential to achieve major savings in other areas of health care. At the same time, the sector needs a stable and predictable fiscal environment to maintain investment and deliver high quality imaging services. When the MOUs ceased on 30 June 2008, the Government decided that it would not continue to use such agreements to manage DI expenditure.

Is another MOU needed to progress DI reform? The Government wants to hear proposals on how to limit growth, how to deal with new technology, how to ensure imaging is necessary and appropriate, how to save money and how to achieve optimum patient outcomes. The Department of Health currently engages formally with the major stakeholders in the DI sector through the Diagnostic Imaging Advisory Committee (DIAC). This provides a forum for the Department to consult with the sector on DI issues, but in the absence of any shared vision for the future, agreed plan for reform or obligation on the part of the various parties to support proposals

Features

and work collaboratively towards their implementation, this forum has proved ineffective as a platform for progressing reform of the sector. This leaves the Government to adopt the obvious strategy of liming access and controlling pricing to manage DI outlays. In response to strong advocacy by ADIA and RANZCR in 2016 the Government announced a broad package of measures aimed at improving access to affordable diagnostic imaging for all Australians2 that a re-elected coalition would introduce. The Government has again failed to follow through on these commitments. Achieving change needs leadership, commitment and a plan - the interconnectedness of the key challenges facing radiology make it imperative for the profession, the industry and the government to work together to determine how radiology will be integrated into the future health care system. The parties need to develop arrangements with equal responsibilities for outcomes and a vision for radiology. Is it time for another formal partnership (or MOU) between the government and representatives of the Radiology sector to provide a platform for collaboration on the development of a plan to progress and implement reform in DI which allows for adaptation to disruptive change? It is inevitable that real policy and structural change will face opposition from some vocal stakeholders - this needs to be recognized and addressed, with leadership from the Government to progress meaningful reforms that benefit patients. There must be commitment to a process for change and the phasing out of obsolete techniques and technologies.

Vision for Radiology

Industry imperatives

Political imperatives

Professional imperatives

Investment; Standards; Infrastructure

SERVICE DELIVERY MODEL

College Standards

Integration of new technologies

Optimal re-structure

SUSTAINABILITY

Appropriate services and funding

It is essential to look beyond the level of Radiology funding at the current policy settings to determine what measures need to be in place to ensure that the sector is able to meet the challenges that lie ahead, including continuing rapid advances in imaging technology and associated capital and professional costs, the increasing demand for imaging, the appropriateness of imaging referrals and the maintenance of an adequate workforce. While access to, and availability of, imaging are both change management tools, reform measures must be founded on principles of both quality and efficiency if they are to be effective and sustainable. Radiologists must continue to take a leadership role in setting the reform agenda. To not do so risks the future of Radiology being determined by further fragmentation and disruption. Fundamental to any separate Radiology MOU would be a clear definition of what needs to be changed for quality purposes, what is an evolutionary stage and what the impact of disruptive change might be. This would provide an opportunity for Radiologists to

engage proactively in the development of a more futuristic plan for Radiology reform. Rather than capped funding for Radiology, a new MOU should also require the parties to work collaboratively to address funding sustainability issues for both the Government and the industry. Sandra Keogh

References 1. https://www.aph.gov.au/Parliamentary_Business/ Committees/Senate/Community_Affairs/ Diagnosticimaging/Report/c03 2. https://www.liberal.org.au/latest-news/2016/06/05/ coalition-plan-access-affordable-diagnosticimaging-all-australians

Volume 15 No 2 I March 2019

Features

Professional Development

CHANGES TO YOUR MEDICAL REGISTRATION REQUIREMENTS

Remediation

ARE YOU PREPARED? As you may know, the Medical Board of Australia (MBA) are changing their registration requirements for doctors. Whilst exact details of the implementation are yet to be announced, the College is mindful that 2022 is not as far away as it seems, and we are actively preparing to assist members transition to the new requirements which include the need to review performance and measure outcomes.

Professional Development

It’s never too early to prepare

Communication is key

The Faculty of Radiation Oncology have begun the process of a gradual transition commencing with the new triennium 2019-2021 Continuing Professional Development (CPD) Program by progressively introducing characteristics of the new requirements to familiarise members with the reform before they become compulsory.

Going forward the College will provide regular communication with members including a dedicated page on the RANZCR website with FAQs, each edition of InsideNews will build on the information previously provided to ensure a smooth and successful transition for College members.

2. 25% Measuring Outcomes e.g. Clinical audit, Reviews patient records 3. 25% Education activities e.g. conferences, lectures 25% Combination of any or all the above

Inside News

We encourage members to find out more by visiting: www.ranzcr.com

The Radiation Oncology CPD Handbook 2019-2021 includes a mapping of the 2019-2021 Triennium categories to the future MBA categories to assist members in meeting the new requirements for reviewing performance and measuring outcomes activities.

If you have any questions or concerns about the upcoming changes to your Australian medical registration requirements, please send them to cpd@ranzcr.com

Wellbeing

Remediation

Supplementary support will be provided for doctors:

Shift from attending conferences, workshops and courses to a mix of 3 categories; 1. 25% Reviewing Performance e.g. Peer review, multisource feedback

Wellbeing

• Aged 70 years Medical Board of Australia will: • Maintain contemporary professional standards e.g. update Code of Conduct

• Live in remote or isolated locations or working in professional isolation •

3 substantiated complaints that impact on patient safety against

• Foster a culture of respect across all medical professions

Doctors will need to undertake:

• Steward development and integration of wellbeing initiatives

• Health assessments, every three-years (for 70 years only)

• Regular peer reviews

Features

MRI advocacy – running the marathon Improving access to and affordability of MRI has been a major focus of RANZCR’s work over recent years. What are the achievements, how have they come about and why is this a key focus of RANZCR’s advocacy activities? Here is a guide to RANZCR’s recent work in this area:

Background RANZCR has increased its all-round advocacy efforts over the last five years. From a relatively low base, RANZCR has successfully established positive working relationships across the Federal Government and with key stakeholders such as the Australian Diagnostic Imaging Association, the AMA and our partner medical colleges. Improving access to and affordability of MRI services has been a prominent part of College and member advocacy.

Building relationships with binational governments to achieve results RANZCR’s relationships with the Australian and New Zealand governments have been one of our highest priorities. National governments are the most influential decision makers for our sectors, particularly in Australia where decisions about funding and regulation typically come from our federal government.

Policy Work RANZCR’s belief is that all tests that are clinically indicated should be funded on MRI. Although the major Australian political parties made welcome commitments to improve MRI access over the last year, announcing multimillion dollar expansions to licences and new MRI listings on Medicare, RANZCR will continue to press that MRI tests

available under Medicare keeps up with best practice and are accessible to most communities. In December 2017 RANZCR representatives were invited to Brisbane to present at the public hearings of the Senate Standing Committee into the Availability and Accessibility of Diagnostic Equipment in Australia. Several other members of RANZCR also made the case for improved MRI access on behalf of their hospital or practice group. The committee had been established to investigate issues including the difficulty of patients accessing radiology services and the uneven allocation of MRI licences. The committee’s subsequent recommendations in early 2018 echoed several of RANZCR’s proposals that access be improved and the Commonwealth Government implement a clear and transparent decision-making for awarding of MRI licences, rather than solely basing this on political factors.

Importance of Member Contribution Advocacy wins have also been achieved as a result of tireless work by individual clinicians. RANZCR members have been instrumental in the MBS Review, calling to remove clinically unsound restrictions such as for pelvic MRI, which the College is following up with the Department of Health. Other members have led on applications to the Medicare Services Advisory Committee (MSAC). That work has resulted in Medicare rebates for MRI for prostate cancer and some cardiac conditions listed. In late 2018, liver and obstetric MRI were listed by MSAC, allowing patients access to these vital MRI services and saving out-of-pocket fees.

New Zealand Work RANZCR has advocated for improvements to clinical indications, the referral pathway and training for GPs in appropriate use when referring patients for MRI. The New Zealand office continue to work with the with Accident and Compensation Commission (ACC) to advance this. Over the coming year, ACC will progressively roll out GP referrals to MRI across the country. RANZCR has also recommended that the ACC, GPs and consumer groups utilise its award-winning Inside Radiology tool to promote better understanding of MRI.

Going forward RANZCR is continuing to argue for quality improvements, better access for patients to MRI and indexation of all imaging modalities. With a federal election looming, more pledges to improving MRI access for patients are possible. The Federal Government is continuing to award new MRI licences from a pool of about 400 applicants, while Labor has also pledged further MRI licences if they are elected. The continuing effort to improve MRI awareness and accessibility will remain central to RANZCR’s advocacy work - one of the pillars of RANZCR’s core strategy over the next three years.

continued over...

Volume 15 No 2 I March 2019

Features

HOW MRI ADVOCACY IS PAYING OFF – KEY MOMENTS OF THE LAST 15 MONTHS: December 2017: RANZCR presents to the Senate Standing Committee into the Availability and Accessibility of Diagnostic Equipment in Australia’s public hearing in Brisbane. Then-President Dr Greg Slater tells the committee that the current Commonwealth Government’s approach to new MRI machines under Medicare lacks transparency and that access to for MRI services in Australia must increase significantly to support patient management. March 2018: Australian Greens pledge $550m for X-rays and funding on Medicare and an end to the Medicare rebate freeze for radiology services. March 2018: Senate Standing Committee publishes its recommendations, including that the Commonwealth Government immediately implement an application process with clear, objective and transparent assessment criteria to permit hospitals and radiology practices to apply for licences for MRI machines.

Mark Nevin, RANZCR Senior Executive Officer and RANZCR Manager Leila Stennett discussed key issues with political advisers during their recent visit to Parliament House. April 2018: A $400 Medicare rebate allowing patients to access MRI to help diagnose, detect and monitor prostate cancer is announced by the Federal Government. May 2018: Labor promises $80 million to deliver 20 MRI licences in locations of pressing need if elected in the 2019 election in its Budget response.

September 2018: Federal Government announces $175m investment in MRI, with 30 sites to receive Medicare eligible MRIs. December 2018: Liver and obstetric MRI will shortly be listed as Medicare items, as confirmed in the Mid-Year Economic and Fiscal Outlook. March 2019: Federal Government announces additional funding for a total of 50 Medicare funded MRI licences.

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Education

Getting the facts on AI – Intelligence 18

of performance has been somewhat levelling off over the last couple of years with few major advancements anticipated in the immediate future. Data privacy in the modern age was also a hot button topic with discussion around strategies to release usable information whilst at the same time protecting the security of the data itself. At a recent event, IBM’s CEO Ginni Rometty said, "Data will be the world's most valuable natural resource". If this is indeed the case, then security and ownership of data will continue to be a source of much discussion. Prof Hugh Bradlow unpacks the reality of machine learning. Over the last few years there has been much discussion in the healthcare sector about Artificial Intelligence (AI) and its potential impact. Recognising the need to be at the forefront of informed and factual discussion on both this and other emerging technologies, the College decided to bring together a collection of experts from across the globe to Intelligence 18 to separate fact from hype. Hosting a diverse group of speakers, there were a great many take-aways from the day. One of the biggest misconceptions that was clarified early on, was the idea of what most people envision when talking about AI. Known by some as Artificial General Intelligence (AGI), AGI is a machine capable of understanding the world as well as any human, and with the same capacity to learn how to carry out a huge range of tasks. This, we were reliably informed, is in fact a long way off. Though true AGI continues to elude us, one of the more consistent opinions from the day was that the current iteration of AI is very effective when

it comes to pattern recognition. That is, the ability to recognise patterns across large sets of data is bordering on superhuman both in terms of speed and accuracy. The failings though start to appear when you start to introduce unknowns and variations into the process.

“There needs to be something which says if you are negligent and lose data you will go to jail. That will get people’s attention.” To date, there are around 14 published peer-reviewed trials of AI apps in medical imaging with 12 FDA-approved apps for AI in medicine and though this may sound impressive, the rate

During his talk, Professor Hugh Bradlow, President of the Australian Academy of Technology and Engineering, spoke about data privacy. “I think the solution is that we need an Australian equivalent of GDPR and laws that treat security properly - like occupational health and safety,” The European Union’s General Data Protection Regulation (GDPR), is a set of rules designed to give citizens more control over their personal data and simplify the regulatory environment. The reforms are needed to reflect the world we're living in now and brings laws and obligations - including those around personal data, privacy and consent - up to speed for the internet-connected age. “There needs to be something which says if you are negligent and lose data you will go to jail. That will get people’s attention.” Fellow speaker Yves-Alexandre De Montjoye, Assistant Professor from the Lecturer Academy of London, also agreed that Australia’s current data protection laws were inadequate.

continued over... Volume 15 No 2 I March 2019

Education

“There’s been examples where the digitisation process has been shown to be flawed, raising various ethical and privacy questions.” He also spoke at length about utilizing data once it had been collected and the dangers associated with it. “Organisations and individuals also need a change of mentality to realise that traditional anonymization mechanisms are not working anymore and that we need to change our approach.” A/Prof De Montjoye said medical imaging was one area where data security must be taken seriously and that a “clean data basis” must be built to ensure patient records and information always remained securely protected. Closer to home, the Chief Medical Officer of the Australia Digital Health Agency, Prof Meredith Makeham spoke at length about MyHR, its successes and challenges. She highlighted the progress regarding the commencement of the uploading of radiology reports and where they hope to go over the next few years. Other speakers addressed the lack of investment locally in many of these areas of emerging technology. With billions being invested by many nations, including the USA, UK and China, Australia’s lack of investment places it in danger of being left behind. At a glance some of the main areas which Australia needed to look at addressing included, the building of capacity in regards to creating a safety framework, engaging in workforce training, informatics infrastructure, ethics and policy frameworks. The conference also gave attendees the opportunity to engage directly with speakers with forum sessions providing expert knowledge to real world issues facing health practitioners and those outside the sector.

Inside News

Dr Jordan Nguyen opens the day exploring the human side of technology

Members wishing to view some of the talks from Intelligence 18 can view them at the following address: https://webcast.ranzcr.com/ Mediasite/Showcase/default/ Channel/artificalintelligence

Prof Meredith Makeham updates on Australia’s National Digital Health Strategy

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Features

MBS REVIEW: The good, the bad, the sometimes ugly Medicare is revered by Australians. It also generates passionate debate amongst clinicians about what is funded and how. In 2015, the Government embarked on a journey not unlike Hannibal through the Alps, to review over 5,000 Medicare items against contemporary practice and evidence. RANZCR was there every step of the way. The review of the Medicare Benefits Schedule (MBS) demonstrates the multitude of complexities and hard slog that is our advocacy work. It also neatly demonstrates the central and influential role RANZCR, clinical radiologists and radiation oncologists have played in the major component of the Coalition Government’s health strategy over the past three years.

The purpose of the MBS review The MBS Review commenced mid-2015 and was an initiative of former Health Minister, the Hon Sussan Ley. Once announced, RANZCR reached out to the Minister’s Office and the incoming Chair of the Taskforce to ensure the needs of our sectors were prioritised and highlight the central roles of radiology and radiation oncology in the health system. We informed the Taskforce of RANZCR’s willingness to be a proactive contributor and the importance of close collaboration. Off the bat we had a huge win with the appointment of former College President Dr Matthew Andrews to the Taskforce. RANZCR acknowledged the need for the MBS Review Taskforce, including optimising the interface between MBS funded services, ensuring the rules framework was consistent without increasing red tape and ultimately improving patient care, had merit. Both RANZCR’s Faculties, however, were immediately aware of the potential impacts the review could

Inside News

have on diagnostic imaging and radiation therapy. We also had broader concerns over allegations of 20% of imaging being wasteful and the lack of overarching strategic direction for health care in Australia.

Our advocacy work begins From day one, RANZCR emphasised the importance and the vital contributions of diagnostic imaging and radiation therapy to patient outcomes and health care more broadly. RANZCR was also keen to stress that there needed to be a clear focus on the implications for front line care to ensure there are no detrimental impacts on sustainability, accessibility and affordability.

“RANZCR saw merit in the MBS Review but had concerns about allegations of 20% of imaging being wasteful.” Having set clear policy priorities, RANZCR sought to engage constructively in the process but enact firm resistance where any recommendations made by the Taskforce were not evidence-based and impacted on patient access to key tests or procedures. A constant theme of RANZCR’s modus operandi has been vigilant scrutiny over the entire decision-making process. RANZCR challenged the Taskforce on several governance matters including quorum for radiologist attendance at Diagnostic Imaging Clinical Committee (DICC) meetings, the primacy of DICC on imaging matters when other clinical

groups tried to divert attention (and propose cuts) towards radiology, dealing with overlap between clinical committees and a fair workload for clinician volunteers. Radiation oncology was reviewed through the Oncology Clinical Committee (OCC). RANZCR’s Faculty of Radiation Oncology set a strategic goal of redesigning all items in that part of the MBS and worked tirelessly to develop a proposal of how the schedule could be redesigned based on the complexity of planning and treatment delivery. Our proposal was well received by the OCC and accepted with minor modifications. There have been examples of RANZCR publicly advocating against MBS Review Taskforce recommendations. For example, the argument against the restriction of knee MRIs to over 50s saw RANZCR unite in opposition with several stakeholders. These included the Australian Diagnostic Imaging Association (ADIA), the Consumers Health Forum and Council of the Ageing (COTA). While the lobbying was ultimately unsuccessful, it illustrated RANZCR’s ability to build coalitions with other important stakeholders. However, in the majority of cases our advocacy work safeguarded or improved patient care. For example, RANZCR secured patient access to digital breast tomosynthesis, which has been listed on an interim basis while the MSAC undertakes its review. A range of changes to item descriptors have also been proposed that improve access to crucial tests. RANZCR continues to press for those to be implemented.

Features

The importance of clinical imput None of these advocacy efforts could have been achieved without clinicians driving and engaging with the process. This involved participating on clinical committees and working groups within the MBS Review. RANZCR members also helped draft submissions and responses through our internal committees and led applications to the Medicare Services Advisory Committee (MSAC).

The significance of our work Patient care remains at the heart of everything RANZCR does. Any advocacy efforts are only implemented with that critical element in mind, such

that clinical radiologist and radiation oncologist volunteers have made a significant contribution to the quality and accessibility of Medicare services. By taking a pro-active approach to advocacy, RANZCR has also achieved a more trusted, respected and ultimately more visible presence in the eyes of the Department of Health (DoH), other medical colleges and key stakeholders. RANZCR has not, however, taken any advocacy steps on a whim. RANZCR continues to maintain constructive relationships with key decision-makers such as the DoH, the Chair of the MBS Review Taskforce and with the Minister for Health the Hon. Greg Hunt and his advisors.

What lies ahead? One of the key pillars of RANZCR’s College Strategy for the next three years is advocacy. RANZCR will continue to take action and have its voice heard on a range of issues including MRI access, artificial intelligence, digital health, utilisation of radiation therapy and particle therapy. While the College was no doubt considered a vocal presence, RANZCR was described as an ‘outstanding contributor’ to the MBS Review by a senior department official.

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Volume 15 No 2 I March 2019

Features

The Patient's voice – the human side of advocacy Providing patient-centred care is at the heart of RANZCR’s advocacy efforts which is what makes Lee Hunt’s role such a vital one. Lee is the consumer representative on the Faculty of Radiation Oncology (FRO) Council, overseeing all bodies within the FRO. A former cancer patient and current Executive Member of Cancer Voices NSW, Lee is in a strong position to provide valuable ‘human’ input to the Council’s decision-making processes. “When you are a cancer patient you just want to get rid of the cancer and get through it,” she said. “You are not thinking of advocacy. “I feel that for patients, quality of life after treatment is just as important as the treatment they receive. That’s where my work in advocacy comes in.” After working in education for 40 years, Lee joined Cancer Voices NSW, which runs advocacy and research training for cancer consumers and supports consumer representation on various committees and cancer research projects. Lee has first-hand experience of cancer treatment, having been diagnosed with aggressive grade three breast cancer about 15 years ago and a recurrence last year. She underwent chemotherapy, radiation therapy and drug treatment and continues to receive medical support to manage side effects of her cancer treatments. Working initially with the Media and Profile Committee of Targeting Cancer, the College’s campaign promoting the importance of radiation therapy as a curative cancer treatment, Lee was later asked to join the FRO Council.

Inside News

“I’m very passionate about promoting the achievement of high standards,” she said. “I suppose because of my background in teaching, I’m keen that trainees have every opportunity to learn and develop. “I feel that, with my particular experience, I can tell people about how radiation therapy may work for them. “It’s still an under-utilised form of treatment, so I’m happy to help play a role in educating people about it.” Lee said she felt “respected” by the Council and always able to play a key role in its decision-making processes. “Everyone has been welcoming and I’ve never been made to feel that my opinions are not considered,” she said. “I have never felt the College is trying to hide something; we have always had frank and open discussions (on the Council). “It was hard at first grasping some of the technical detail we would cover in the meetings, but people like A/Prof Sandra Turner and A/Prof Dion Forstner have always given their time to help me understand things better. “Because of my background in education, I’m not backward in having my say and I feel I am respected by other members. “There’s also a variety of backgrounds of members of the Council which is great because you are bringing diverse experience together.” Lee said that, while there is more work to do, she is happy with the College’s advocacy efforts in the area of radiation oncology. “I believe the College is in advance of other cancer care groups in terms of patient care,” she said. “The College

Lee Hunt has been a valued patient representative on RANZCR’s Faculty of Radiation Oncology Council. emphasises the maintenance of high standards and the improvement of the patient's journey. “I’m delighted that the College has increased advocacy work with the government in recent years. That’s obviously important. “I have really enjoyed working with researchers, since my passion is research. I find that working with people such as Professor Paul Keall, who is trying to improve the treatment and minimise the side effects for people undergoing radiation therapy, is very rewarding. “I enjoy looking at how we can better use what we presently have in a more beneficial way for patients. “In being a member of the Council, I hope I provide a reminder to clinicians what they are working for and why they do what they do.”

Features

Liver MRIs – How one man’s passion made a difference Late in December 2018, the rebate for Liver MRI -saving patients $800 - was listed on Medicare. The result was part of a campaign that had started back in 2012 shortly after the ARGANZ ASM. The effort was led primarily through the efforts of A/Prof Tom Sutherland, an abdominal and forensic radiologist based at Melbourne’s St Vincent’s Hospital. Results like this are often heartening at a time when Governments are working to balance budgets, so we sat down with A/Prof Sutherland to find out how he ‘survived’ the application process – and why individual advocacy is important: “I wanted to drive this because I’m passionate that everyone should have access to the best possible healthcare, plus the idea of people having to pay $800 for this MRI is based on an American-style approach to healthcare I don’t agree with. “It’s definitely been a long and occasionally frustrating process. There was one time I got a 360-page document to review with a one-week deadline, and while on call, so it led to a few nights without sleep. I think I have A/Prof Tom Sutherland

the personality though that once I start something, I want to finish it – so giving up wasn’t an option.

should be entirely responsible for advocacy and it’s too big a demand on individuals.

“Sometimes the paperwork involved could be overwhelming, but the Medical Services Advisory Committee (MSAC) people were supportive with the logistics. It’s also became something of an educational journey for me in terms of reviewing evidence and making sure I am up-to-date with the latest literature.

“I guess before this whole process, I had this idea of the College as this mysterious entity, but it’s helped me discover more about how the College works and how it can help you achieve things. I’ve discovered that people there are happy to help you if you just ask.

“If you are interested in reaching your advocacy goals, I would say contact the College, let them know what your passion is and find out how they can help you achieve change.”

“If you are interested in reaching your advocacy goals, I would say contact the College, let them know what your passion is and find out how they can help you achieve change. “The whole process can seem overwhelming, but I think persistence and having a clear goal about what you want to achieve is key. Ultimately, it’s your choice to get involved - but it’s more interesting than being a passenger.”

“When the rebate was finally announced I had a sense of relief, but also satisfaction. There’s only a finite number of people I will see in a day as a radiologist, no matter how busy I am, whereas this is something benefiting lots of people. “It’s also spurred me to go further with advocacy aims. I want the rebate for CT Colonography to be expanded and I’ve already started filling out the paperwork for this process and contacting the people at MSAC. “Everyone I encounter in radiology is very patient-centred, but I think there is a big reluctance among our profession to get involved (in advocacy). I don’t think it’s selfishness – I just think as a radiologist it’s easy to say that RANZCR

Volume 15 No 2 I March 2019

For GPs

Advocacy

To Canberra and beyond

Targeting Cancer continues strong advocacy efforts Targeting Cancer Clinical Lead A/Prof Sandra Turner and RANZCR representatives recently visited Canberra to discuss the campaign’s progress and future objectives with Federal MPs The Hon Warren Entsch (LNP, Leichhardt) and The Hon Jason Clare (ALP, Blaxland). Targeting Cancer and RANZCR representatives recently attended Canberra to discuss promoting radiation therapy as a treatment option. From left: Warren Entsch MP, Targeting Cancer Clinical Lead Sandra Turner, Jason Clare MP and RANZCR Senior Executive Officer, Faculties, Strategy and Advocacy Mark Nevin.

Mr Entsch and Mr Clare are co-chairs of the Parliamentary Friends of Prostate Cancer Awareness Group, which aims to support prostate cancer patients, service providers and practitioners. Topics covered in the discussion at Parliamentary House included the importance of improving cancer patients’ access to radiation oncology and ensuring prostate cancer patients receive full information on treatment options for their condition, including the potential benefits of radiation oncology. “One of the key aims of Targeting Cancer is to help ensure that men with prostate cancer know all about potential treatment options,” A/Prof Turner said. “This is vital to ensuring they choose the most appropriate treatment option for them. “Ultimately, it is about treating patients with their respect they deserve and allowing them to make the right treatment choice for their circumstances. “This was an excellent opportunity to help drive better patient outcomes. We thank both Mr Entsch and Mr Clare for their time.

statement calling for prostate cancer patients to be made aware of all available treatment options, including radiation therapy. The statement can be viewed at www.ranzcr.com

Targeting Cancer promoted in Sydney to Hobart yacht race Targeting Cancer was honoured to have been promoted by the competing crew of Midnight Rambler in the recent Sydney to Hobart yacht race.

“It also underlines RANZCR’s proactive efforts to advocate the work of radiation oncologists and the importance of radiation therapy as a curative cancer treatment.”

Skipper Ed Psaltis and his crew very kindly agreed to wear Targeting Cancer t-shirts and caps during the early stages of the world-famous race, with Ed also wearing his cap during pre-race interviews.

Last year the Faculty of Radiation Oncology released its position

Pre-race media pieces highlighting the link-up and including an interview with

Targeting Cancer Clinical Lead A/Prof Sandra Turner were featured on Channel 7 Sydney and Melbourne and reached an estimated audience of about 700,000 viewers. The link-up was established courtesy of Midnight Rambler crew member David Sharp, whose wife Wendy is a radiation therapist based at Western Sydney’s Westmead Hospital and a keen Targeting Cancer supporter. “There’s a lot of knowledge about things like chemotherapy, but people may not know too much about radiation therapy,” Psaltis said. “Targeting Cancer is a great campaign so we were happy to help (promote it).” continued over...

Volume 15 No 2 I March 2019

Advocacy

Other recent media activities Targeting Cancer representatives have undertaken other recent media activities to help promote the importance of radiation therapy as a curative cancer treatment. Dr Lucinda Morris appeared on multiple ABC local radio stations recently to discuss her work mapping out best future oncology care for older cancer patients.

Midnight Rambler skipper Ed Psaltis (far right) and his crew were happy to support the Targeting Cancer campaign in the recent Sydney-Hobart yacht race. “We were absolutely delighted that the crew of Midnight Rambler supported us in this way,” Targeting Cancer Working and Advisory Group Chair Dr Lucinda Morris said. “It was a fantastic gesture and a great way to raise awareness of radiation therapy to the public and promote the Targeting Cancer campaign and ‘brand’.”

Made by renowned film and TV director Henry Zalapa, ‘That’s Where We Come In’ aims to explain why the Targeting Cancer campaign was launched, who is involved and how it is working towards its goal of ensuring all cancer patients who may benefit from radiation therapy get it. Viewers are encouraged to join and support the campaign.

Midnight Rambler finished the iconic race in 42nd place overall, but third in its class, coming home in a time just over three days and 21 hours.

The video features Targeting Cancer Clinical Lead A/Prof Sandra Turner, Targeting Cancer Working and Advisory Group Chair Dr Lucinda Morris and campaign ambassador Julie McCrossin, together with radiation therapy staff from Blacktown Hospital in Sydney’s west.

Targeting Cancer continues to seek ways to promote the campaign and its objectives through the wider media. Any ideas are welcome and should be emailed to info@targetingcancer.com.au

Targeting Cancer’s information video now available Targeting Cancer is proud to announce it has produced a short video aimed at promoting further awareness of radiation therapy and the campaign across the globe.

Inside News

Two versions of the film are available – a full version of about three minutes long and an edited 90-second version. Targeting Cancer will promote the video over the coming months as part of its ongoing efforts to highlight the importance of radiation therapy as a curative cancer treatment.

The study, which Dr Morris presented at the 2018 RANZCR ASM and is the first of its kind, will help outline best practice radiation therapy treatment for older cancer patients across the globe. Targeting Cancer Clinical Lead A/Prof Sandra Turner also appeared on New Zealand’s Newstalk ZB Radio to discuss the study led by Queenslandbased radiation oncology registrar Dr Luke Nicholls highlighting the lack of radiation oncology education in New Zealand and Australian medical schools. This research, which also received coverage in other media outlets including the Daily Telegraph and Otago Daily Times and was presented at last year’s RANZCR ASM, revealed junior doctors feel they lack knowledge of best practice radiation therapy care. More information on Targeting Cancer’s work to promote radiation therapy as a cancer treatment is available via the campaign website: www.targetingcancer. com.au

Advocacy

How you can help Radiation oncologists, medical physicists and radiation therapists are welcome to help promote the Targeting Cancer campaign. Since its launch just over five years ago, the campaign has played a significant role promoting the importance of radiation therapy as a treatment option for cancer. People across the globe have accessed the campaign website, www. targetingcancer.com.au, while its social media and traditional media imprint continues to grow as well.

More participation from health professionals would be welcome to help further spread the word.

• Spread the word about the campaign among colleagues and encourage them to join

Some of the practical ways to assist the campaign are:

• Obtain promotional materials, including badges, stickers and caps, by emailing Philip Munro and the Targeting Cancer team at info@targetingcancer.com.au

• Sharing articles/tweets from the Targeting Cancer Facebook/Twitter accounts • Refer patients and other professionals to the Targeting Cancer website (www.targetingcancer.com.au or targetingcancer.co.nz) • Promote the campaign through an awareness or oncology education evening

Musculoskeletal MR

Made Simple

Join us for this fun and interesting Musculoskeletal MR Workshop with Dr. William Renner. “Renner’s Rules” breakdown complex topics into simple components make reading MSK MR exams easy to understand. Practical interpretation of scans is emphasized. Included is an up-to-date 130-page MSK MR Workbook and a MSK MR Cases Workbook. Two-Day Agenda

CPD Points RANZCR

2019 Meetings:

July 27-28 Auckland, NZ Aug 3-4 Sydney Aug 17-18 Melbourne Aug 24-25 Brisbane Aug 31-Sept 1 Adelaide

High Resolution Chest CT Made Simple Workshop

2019 Meetings:

July 29 Auckland, NZ Sept 7 Melbourne – “In Memory of Dr. Ben Felson”

One-Day Agenda

CPD Points RANZCR

Go to www.MSKMR.com for more information and to register.

Volume 15 No 2 I March 2019

Education

InsideRadiology is an Australasian resource on clinical radiology tests, procedures, and interventions, providing up-to-date information to health consumers and health professionals and improving doctor-patient communication. www.insideradiology.com.au

InsideRadiology is a conduit of communication between the College, health consumers, and health professionals; further promoting the role and value of clinical radiology and clinical radiologists in patient care.

Information in Plain English 60 per cent of Australians whose first language is English, have ‘very poor’ or ‘marginal’ health literacy. Most people’s literacy levels are like that of a Year 6-8 student (12-14 years), this is the level we should be writing at for consumers. If we are to cover 80 per cent of the population then we need to ensure our language is aimed at the 12-14 years.

Web Activities 2018 was a great year for the site, with 1,955,226 visits, which was a year on year increase of 13.2% and peaking at 184,218 sessions in May 2018. The Gadolinium Contrast Medium page attracted the highest volume of traffic with 158,049

Visitor Locations Trans-Tasman visitors account for 16% of the total activity on the site, with 45% of visitors accessing the website from the US and 10% from the UK. The majority of our target audience are accessing the site from large cities with eastern Australian capital cities responsible for over 65 per cent of Australian and New

Promote InsideRadiology to Patients and Colleagues

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Zealand visitors, however there is still a steady stream of visitors from regional and remote locations.

Supplementing your Online Resources InsideRadiology encourages its information partners, hospitals, and radiology practices to link directly to the InsideRadiology website so that staff, patients and referrers can access trusted information straight from their own website that can easily be printed into a fact sheet. InsideRadiology will continuously update the items as part of an ongoing review strategy so that radiology sites have up-to-date information for their patients without the extra administration. Referral to the website only accounts for two per cent of our total audience and 3.13 per cent of Australian visitors; however, it accounts for 26 per cent of total visitors from New Zealand. This demonstrates that direct linking currently is an extremely effective way to reach InsideRadiology target audience in New Zealand. Please help us promote InsideRadiology by following us on Twitter and Facebook (@InsideRadiology)

Inside News

1. Gadolinium Contrast Media 2. Coronary artery calcium scoring 3. Transvaginal Ultrasound 4. Nuclear Medicine Bone Scan 5. PET Scan 6. Iodine Containing Contrast Medium 7. VQ Scan 8. MRI 9. Bursal Injection 10. Nuclear Medicine Renal Scan

Most Popular Items for Health Professionals 1. Gadolinium Contrast Media 2. VQ Scan 3. Transvaginal Ultrasound 4. Image Guided Facet Joint Corticosteroid Injection 5. Nuclear Medicine Bone Scan 6. Bone Mineral Density Scan 7. Computed Tomography 8. MIBG Scan 9. CTCA 10. Contrast Medium, Iodine vs Gadolinium Contrast Mediums

If you need further information please contact insideradiology@ranzcr.edu.au

Promoting InsideRadiology in your professional networks.

any  Recommending topics that could be

considered for inclusion.

Most Popular Information Items

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Supplementing your hospital or practice resources using links to InsideRadiology.

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Education

RANZCR Workshops, Courses and Events A number of educational activities and events are on the calendar for 2019 across clinical radiology and radiation oncology.

Radiation Oncology Trainee Courses – register now! Registrations are now open for the Phase 1 Foundation Course and Phase 1 and 2 Exam Preparation Courses.

Phase 2 Exam Preparation Course 17 – 18 May 2019 The Phase 2 Exam Preparation course will be taking place from 17 – 18 May 2019 at Rydges World Square, Sydney. Designed for trainees as they approach exam readiness, the course provides an opportunity to:

Phase 1 Foundation Course and Exam Preparation Course 20 – 23 June 2019 The Phase 1 Foundation Course and Exam Preparation Course will be taking place from 20 – 23 June at Rydges World Square, Sydney. The course is designed for Phase 1 trainees, with the Foundation course specifically designed for those who are in the first 12 months of Phase 1 training. The course will: • Provide didactic lectures in the main topic areas to supplement trainee knowledge in the four basic sciences

RANZCR/ACR Education Center Courses RANZCR is pleased to be offering educational courses in partnership with the American College of Radiology (ACR) again this August. Each course will be delivered by leading specialists to provide intensive, interactive and targeted training to attendees. The courses will take place on various dates between Friday 9 August and Sunday 18 August at the Pullman on the Park, Melbourne. Course Topics:

• Provide an opportunity for trainees to ask specific questions of experts in a dedicated questions and answer session, as well as informally following individual sessions

• High Resolution CT of the Chest: 9-11 August

• Better understand the exam development process and how exams are marked

• Provide specific guidance on exam preparation and techniques including mock exam on the Sunday

• Body and Pelvic MR: 12-14 August

• Simulate sitting the Viva exam and receive feedback immediately afterwards

• Provide an opportunity for trainees to network professionally and socially

• Practice a written question from each paper, workshopping the answers with the Phase 2 examiners • Develop strategies to cope with exam stress and to ensure trainees perform to the best of their abilities. Registration fee $880.00 including GST per trainee Registration includes morning tea, lunch, afternoon tea and refreshments throughout the duration of the course. A cocktail reception will be held on the Friday evening of the course and is included in the registration fee.

Registration fees: Foundation Course: $880.00 including GST per trainee Exam Preparation Course: $1,100 including GST per trainee Registration includes morning tea, lunch, afternoon tea and refreshments throughout the duration of the course. A cocktail reception will be held on the Thursday evening of the course and is included in the registration fee.

• Prostate MR: 10-11 August and 17-18 August (same course content) • Neuroradiology – Head and Neck: 16-18 August The courses are filling up fast with over half sold! Register to secure your place today www.acrcourses.ranzcr.com

continued over...

For further information and to register for the Phase 1 Foundation and Exam Preparation Course, please visit www. rophase1course.ranzcr.com

For further information and to register for the 2 Exam Preparation Course, please visit www.rophase2course.ranzcr. com

Volume 15 No 2 I March 2019

Education

SAVE THE DATE! Foundations of Leadership in Radiation Oncology – hosted by RANZCR/ESTRO/CARO This new course introduces foundation principles of effective Leadership as they apply to senior trainees and junior practitioners in the radiation oncology professions. The course aims to equip participants with the knowledge, skills and attributes viewed as basic building blocks for becoming effective leaders in the context of improving care for cancer patients. The course will take place on Friday 30 and Saturday 31 August 2019 at the Parkroyal Hotel, Sydney, NSW. Further information will be available at www.ranzcr.com/ whats-on/events

Upcoming Workshops – Until June 2019 3rd Structural Heart Disease Asia Pacific Symposium, Auckland New Zealand, 04 - 06 April 2019 ILROG international Lymphoma Radiation Oncology Group, Tokyo Japan, 06 – 07 April 2019 2019 Australian Pain Society 39th ASM, Gold Coast Queensland, 07 – 10 April 2019 2nd Royal Hospital International Conference, Al Irfan Oman, 11 -13 April 2019 Foundations of Leadership In Radiation Oncology, Europe, 26 April ESTRO 38, Milan Italy, 26 – 30 April 2019 Stoller: A Comprehensive Tutorial In Musculoskeletal Imaging In NYC, New York USA, 01 - 03 May 2019 Head and Neck Made Easy 2019, Melbourne Victoria, 04 May 2019 2019 ARRS Annual Meeting, Honolulu Hawaii, 05 - 10 May 2019 RANZCR Phase 2 Exam Preparation Course 2019, Sydney New South Wales, 17 - 18 May 2019 The 9th IDKD (international Diagnostic Course Davos) Intensive Course, Hong Kong China, 24 – 26 May 2019 ABDORAD 2019, Melbourne Victoria, 01 – 03 June 2019 Imaging In Prague, Prague Czech Republic, 09 - 12 June 2019 RANZCR Phase 1 Foundation and Exam Preparation Course 2019, Sydney New South Wales, 20 -23 June 2019

Inside News

Education

New draft training programs taking shape The Training and Assessment Reform (TAR) project has made significant progress during 2018 towards a final draft of the training programs for clinical radiology and radiation oncology. Both Steering Committees and all the working groups should be commended for their hard work, dedication and enthusiasm. In December 2018, the TAR Taskforce reviewed the status of the program development by both Faculties, and considered all the dependencies of the program implementation, i.e. Learning Management System (LMS) development, stakeholder engagement, policies and guidelines review, and change management. It was decided by the Taskforce that the new training programs for both specialties will be officially launched in 2021, with a key milestone being completion of the draft training programs by August 2019. 2019 is shaping up to be both an exciting and challenging year, with both Steering Committees busy consolidating the learning outcomes, finalising the assessment framework and tools, identifying opportunities/activities to assist with trainee learning, and mapping out the progression pathway.

Clinical Radiology The Clinical Radiology Steering Committee has developed a 3-phase training framework, which clearly outlines the expected competencies, appropriate assessments and learning opportunities for each phase, as well as decision making points throughout the training journey. At this time most of the working groups have reviewed the syllabus relevant to their program areas. Whilst consolidating the learning outcomes, the Steering Committee felt that a more comprehensive review of the syllabus

was warranted to articulate the expected competencies more clearly. A Syllabus Review Team was therefore formed to undertake a holistic review of the clinical radiology syllabus. Their mandate was to ensure that the content is up to date, reflects current practice, is aligned to the programmatic assessment, and incorporates recommendations of the working groups.

“Prior to the launch of the new training programs, widespread stakeholder consultation and communication will be undertaken to ensure our members have the opportunity to provide input.” Radiation Oncology The Radiation Oncology Steering Committee is at the final stage of consolidating the learning outcomes. The Syllabus is still aligned with CanMEDs roles but has been restructured with a focus on patientcentred care. It is expected that the final draft will be released for stakeholder consultation in Quarter 2 of this year. The Steering Committee is currently working on finalising the training framework, aligning to the learning outcomes. Most of the assessment tools and learning activities have already been developed, and will continue to be refined. Pilots of Oncology Sciences Workshops will continue within NZ

and NSW networks, and will expand to other training networks throughout this year. Decision making points for trainee progression are also being considered by the Steering Committee.

Implementation Both Steering Committees are committed to establishing and implementing world-class training programs and accompanying redesigned curriculum framework for trainees in both specialities. The redesigned curriculum and assessment framework will train, assess and graduate competent clinical radiologists and radiation oncologists who will deliver optimal patient care. IT infrastructure is critical to the success of the delivery of the new training program, and this has been a priority for the College. A fit for purpose modern Learning Management System is under development to support the delivery of new training program, to measure identified outcomes and allow tracking of trainee progression. Prior to the launch of the new training programs, widespread stakeholder consultation and communication will be undertaken to ensure our members have the opportunity to provide input. We will continue to run pilots of newly developed assessment tools and learning activities when they become available. It is important to ensure the assessments are not onerous, are easy to use, and will facilitate the provision of feedback between supervisor and trainees. We will be visiting training networks in due course to present the training programs, answer questions and take suggestions on improvement. We will also ensure proper training and support are in place for our members when the new training programs are implemented. continued over... Volume 15 No 2 I March 2019

Education

All members and training sites are encouraged to get involved by either participating in the pilots, providing feedback during stakeholder consultation, or speaking to us during our roadshows. Only through your collaboration are we able to produce practical, viable training programs that will train clinical radiologists and radiation oncologists with expected competencies across each of the CanMEDS roles.

We would like to thank all members who have contributed their time and expertise to this important project. If you would like more information or have any questions regarding the project, please contact Legend Lee, Educational Developer at the College at legend.lee@ranzcr.edu.au.

2019 RANZCR / ACR EDUCATION CENTER COURSES SECURE YOUR PLACE TODAY

9 – 11 AUGUST 10 – 11 AUGUST 12 – 14 AUGUST 16 – 18 AUGUST 17 – 18 AUGUST

HRCT Prostate MR Body and Pelvic MR Head and Neck Prostate MR

SPACES PER COURSE ARE LIMITED! Register now at acrcourses.ranzcr.com For further information contact the RANZCR Conferences and Events Team events@ranzcr.edu.au or +61 2 9268 9777

Inside News

50 OVE % R SO LD The Royal Australian and New Zealand College of Radiologists®

Pullman Melbourne on the Park, Victoria, Australia

AUD

5,71700

incl. GST

per delegate per course

Education

Part II exam tips from a HR Sear medal winner The RANZCR Part II exam and its preparation was the most challenging experience I have faced in medicine, requiring more time and dedication than I expected. I was thrilled when I passed, and subsequently stunned and humbled to learn that I had received the HR Sear Medal for the 2017 exam series. Since passing the exams, I had become more involved in teaching in my home hospital as well as working with some other groups of candidates around Sydney. I was happy that my experience and insights could be of use to someone else. I was delighted to be invited to spend some time in Gosford with the candidates. The Central Coast put on some of its beautiful weather for my day with the department. Dr Rattan greeted me with a smile and a tour of their growing department. The new Nuclear Medicine Department was particularly exciting as a budding Nuclear Medicine Advanced Trainee myself. I wish I could say that there was some magic formula to viva success, but I can’t. It became increasingly apparent as I reflected that my success was in large part due to others, the mentors and heroes who I had found within my training and the support structure provided by my wonderful family, friends and study partners. A very warm thank you to the Gosford Department for allowing me to join you for the day. I was treated to lunch with the Staff Specialists and finished the day with a night at Terrigal Beach with my husband. We had a relaxing dinner with a cocktail by the water, and woke up to views of the ocean. It truly is a very special part of the world.

My 7 Best Tips For Part II Exams

6. Simulate the exam setting as best you can

1. Report as much and as widely as you can, starting from first year.

For eFilm writing, type out your answers under time pressure in the format and sentence structure you would use on the day. For vivas, embrace stressful learning opportunities (e.g. in front of big groups or formal practice vivas). If you can, organize some sessions with unfamiliar examiners with different styles and case sets.

This piece of advice came from my own Director of Training. Candidates who are more involved with their departments reporting tend to do better come exam day. You are more comfortable with normal findings, incidental findings and the language of the chosen modality. It will show through.

2. Build a strong support network. This includes your colleagues (consultants and registrars in your department), study partners and groups, and your friends and family. Don’t be afraid to ask for help when you need it.

3. Learn from those who have come before you. Who do you know that has been successful in the past? Take note of whether there was something unique about their preparation, and any hardlearned wisdom that they may have passed on. One of my most admired consultants had a few attempts at a particular viva. The knowledge and experience they now offer the sitting candidates is worth its weight in gold.

5. Don’t forget the clinical history. The biggest mistake I see viva candidates making when I show cases is that they don’t consider the clinical history when working through the case. It will allow you to create a more relevant discussion and differential diagnosis list.

7. Take care of yourself. At times, I did a terrible job of this. Exams are a hard time in the life of a radiology trainee. Try and eat as best you can, allow time for sleep, rest and downtime and ask for help if you need. This might be from someone in your support team or a professional. Overall, be kind to yourself. Sally Ayesa

4. Learn from those around you. When you attend tutorials, seeing the cases is only part of the learning on offer. What were the candidate’s strengths and weaknesses? Why did the examiner show this particular case? Were any pearls of wisdom thrown into the discussion? If you are lucky enough to attend a tutorial from an examiner keep an ear out for common stumbling blocks that you can address in your own learning.

Dr Sally Ayesa

Volume 15 No 2 I March 2019

Avant Doctor in Training Research Scholarship Program 2019 Applications now open

Dr Jeremy Tan Ophthalmology Trainee 2018 grant recipient

Offering up to $450,000 in funding across a total of 19 scholarships and grants. At Avant, we understand the pressures you face as a doctor in training. Making a contribution to medicine through research can be rewarding. It can also be one of the best ways to enhance your career. That’s why we are once again offering the Avant Doctor in Training Research Scholarship Program.

Supporting you in making a difference Find out more and apply today: 1800 128 268

avant.org.au/scholarships The full terms and conditions for the scholarship program are available at avant.org.au/scholarships. Applications close at 5.00pm on Friday 31 May 2019. IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at avant.org.au or by contacting us on 1800 128 268. 3010 02/19 (1080)

Education

Is your insurance really protecting you? Insurance. Whether working in public or private health it’s a necessity of modern medicine. Premiums can vary according to billings, your practice history, region that you practice in and level of market competition. For many professionals, they have the same Medical Defense Organisation (MDO) from University because it was the one that offered the best freebies and it’s too much trouble to change, but do you know what you are paying for? Have you recently read your policy terms and conditions? Most of the time the answer is no, and why wouldn’t it be? Most professionals are time poor and insurance is just one more part of a modern practice. If that’s the case, it’s worth taking a few minutes to familiarise yourself with the details of your policy. After all you pay money each year to an organisation based on the idea that they will protect you in the event of a problem, but protection comes with conditions and you need to understand the conditions. For those who work exclusively in public practice, you will often find that as part of your contract you are indemnified for the work that you do so you may feel having your own insurance isn’t necessary but have you considered what would happen if there is a dispute between you and your employer? Will they take your side in a dispute when push comes to shove? Many practitioners will elect to maintain their own private indemnity insurance to cover for this potential issue, but even for just this coverage, not all policies cover you the same.

How about when you travel for work? Most policies will cover you for your usual work but when it comes to locums or volunteer work outside of the country that you are registered to practice in, your work may not be covered. Though many policies allow practice in a different country for a specified duration, some policies exclude specific countries. The United States is often the main exclusion. Hopefully you will never need to call on your MDO for help, but it is certainly worth taking some time to familiarise yourself with your policy exclusions. Exclusions are conditions in which your MDO may refuse coverage. It is important to understand these because they can make the difference between a successful claim and coverage being denied. Most exclusions are quite clear however there are some that can be fiddly. If you are unclear about what an exclusion means, call your MDO and ask them to clarify it in writing so that there is no ambiguity. However you choose to manage your practice, insurance is one aspect that will be with you, even into retirement. Understanding what you have and what you are covered for can give you piece of mind and should never be neglected.

A few helpful Insurance tips •

The marketplace is more cutthroat than you may think. Even if you like your MDO, simply calling them when you receive your renewal notice and asking for a discount can net you a reduction in your annual premium.

•

Know your billings. If you work in private practice what you estimate at the start of the year with and what you end up billing might vary. Always ensure, either up or down, that your billings are accurate. Many MDO’s will give you up to 12 months to adjust your billings to ensure your coverage is correct. If less, some even refund the difference.

•

Protect yourself. Make certain your policy covers you for the work you do. If you do a procedure that falls outside of the norm for your specialty, confirm that your policy is covering you.

•

Taking an extended break from practice? Many policies offer the option to switch your policy to a Doctor-On-Leave status, (usually you need to be away for at least three months). This change will still cover you for your past practice whilst not charging you for work you are not currently doing.

•

Report Incidents. If you feel that something small may grow into a potential problem, it can be worth a few minutes to report the incident.

Mark Grzic

Volume 15 No 2 I March 2019

Key Dates Call for Abstracts Open:

Janurary 2019

Call for Abstracts Close:

April 2019

Registrations Open:

April 2019

ranzcr2019.com

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.

Education

Destination Auckland: Our Top 5 Must See and Dos as part of RANZCR 2019 Auckland, New Zealand will host the RANZCR 70th Annual Scientific Meeting: Back to the Future. The program includes an exciting international faculty of leading experts available to view on the 2019 ASM web site www.ranzcr2019.com. That being said, not only is the Local Organising Committee assembling a thought provoking program, they want you to enjoy your time in Auckland and experience what the city and beyond has to offer. To help plan your time in this transforming and vibrant city, here are 5 suggested experiences for you to consider whilst visiting Auckland.

1. Day trip to an isle of wine This is a hidden jewel just a 35-minute ferry ride and you’re in Waiheke Island, Auckland’s island of wine. Waiheke Island features several vineyards and olive groves, multiple white sand beaches and a variety of shops and restaurants. Join a wine tasting tour and linger over a vineyard lunch, with gorgeous views to match. Visitors agree that Waiheke Island is one of the best wine areas in the region and a must visit on your trip to Auckland.

2. Kayak to a volcanic island Hire a kayak and paddle out to Rangitoto Island, a dormant volcano not far from downtown Auckland (you can also get there by ferry). On arrival at Rangitoto Island, which is the largest and youngest

of Auckland’s volcanoes, you will start the 1hr trek to the summit, viewing the spectacular sites and learning all about the history of the region. Upon reaching the top you will be treated to the finest 360 degree views that the Auckland region has to offer.

3. See the world’s largest collection of Māori taonga Discover more than 1000 taonga (treasures) at the Auckland Museum – the largest collection in New Zealand (and the world). From small precious artefacts to an original full-size marae (meeting house) and waka (canoe), this is a fascinating glimpse into early Māori culture.

4. Visit the world’s only island Dark Sky Sanctuary Ok so it may be a little beyond the city boundaries (a car and ferry trip) but not only is Great Barrier Island a place of incredible beauty, it’s also the first island in the world to be designated as an International Dark Sky Sanctuary – joining only two other locations. Take a one-hour walk for a dip in the natural hot pools at Kaitoke Hot Springs. Soak up the scenery too and feel the stress melt away.

5. Hobbiton Movie Set and Waitomo Glowworm Caves Located roughly 200km southeast of Auckland on a working sheep farm, the Hobbiton Movie Set is a must for fans of "The Lord of the Rings" and "The Hobbit" movies. It's the country's only set left from the films and features the movies' famous hobbit homes and The Green Dragon Inn. On your return from Hobbiton stop in at the Waitomo Glowworm Caves. This world-famous natural wonder, which is situated about 180km south of Auckland, features a boat ride through Glowworm Grotto, where thousands of glowworms illuminate the cave ceiling. These bright, tiny creatures can only be found in New Zealand.

Reference: 10 Things you can only do in Auckland, published by Auckland Tourism, Events and Economic Development. Images provided courtesy of Auckland Tourism, Events and Economic Development.

Volume 15 No 2 I March 2019

Education

Australia and New Zealand Present at the Radiological Society of North America ASM to recommending that radiologists embrace AI and form partnerships with other specialities, she suggested that radiologists should eventually be responsible for the direct imaging care of her their patients. “In 2043, radiologists will have realized that if they truly want to be recognized as physicians who are providing patientcentered care, they have to come out of their reading rooms and interact with patients directly,” Rao said.

Embracing more direct patient care and interaction was one of the key messages for radiologists at Novembers Radiological Society of North America’s (RSNA) Scientific Assembly and Annual Meeting. With the theme of ‘Tomorrow’s Radiology Today’, the ASM looked at the challenges facing specialists and how they might adapt. RANZCR representatives were in attendance for the five-day event, both as part of the audience as well as to present a range of talks to the assembled body. With opening remarks from Prof John Slavotinek, 2018’s Dean of Faculty of Clinical Radiology, the Australian and New Zealand contingent addressed a range of topics that were very well received. A/Prof Dinesh Varma spoke of Education, Training assessment and Reform Initiatives in Australia and New Zealand in Radiology. This was of particular interest to many with RANZCR being in the position of having commissioned a full review of its assessment and examination processes for Fellowship training, across both its Faculties in 2014.

Inside News

Prof Liz Kenny took listeners on a journey through Radiation Oncology and Interventional Oncology, and how it’s a marriage made in heaven. With a growing number of practitioners performing an ever increasing range of procedures this talk was very timely. A Journey in Vascular Interventional Research - Lessons Learned and Future Prospects was the talk presented by A/Prof Andrew Holden. Delving into how technological advances will facilitate more refined and new procedures in Interventional oncology, is an area of huge growth potential. Though her full research results won’t be presented for another few years, Prof Patricia Desmond’s talk on the Role of Iron in Neurodegeneration has potential global significance and held the audience’s attention as she discussed the implications of her work. Beyond the talks there were discussions around artificial intelligence, particularly looking at how algorithms can be used to improve image quality. This theme of seemed to dominate much of the year’s event. RSNA President Vijay Rao laid out her vision for how radiologists may be operating 25 years from now. In addition

Radiologists from across the globe attended the event, which also featured discussions on how AI can improve workload pressures and allow radiologists to spend more time on patient care, among others. The 2019 will once again be held in the Windy City, from December 1-6, Chicago USA. You can find more information on how to attend at www. rsna2019.org

Clinical Radiology

A new year brings new opportunity A Message from the Dean

Clin A/Prof Sanjay Jeganathan I hope you all enjoyed some welcome rest over the summer after what was no doubt a busy 2018. It’s always a pity how quickly holiday memories fade, but I trust you are all back into the swing of things now. For myself, it’s been a busy but exciting couple of months settling into my role as FCR Dean – a role I feel humble yet privileged to accept. Little did I know when I qualified as a radiologist in South Africa that 20 years later, I would be elected to this position. Working in Townsville, Lower Hutt, Auckland and Perth, I have been fortunate to meet many wonderful patients and fine fellow clinicians and experience the many ups – and sadly occasional downs – of our great profession. These experiences have not only helped me grow personally but have given me an insight into the complex issues facing radiology. As Dean, I intend to make a positive contribution to finding solutions to these issues. It was excellent to end 2018 with the listing of Medicare-funded Obstetric and Liver MRI confirmed in the MidYear Economic and Fiscal Outlook. These successes were a result of hours of tireless lobbying by the respective clinicians, Stacy Goergen and Tom Sutherland. I congratulate them both for their work. As Tom notes elsewhere in this issue, ‘It’s more interesting getting involved than being a passenger’. I couldn’t put it better myself Tom. I have certainly arrived at a challenging time for both the College and the Profession. Some of the current ‘big ticket’ items include ongoing funding restrictions and lack of commitment from the Government to full indexation which will need high level engagement

by the College. The long delay in implementing the Quality Framework is a major concern and needs our continued attention. We have the MBS Review, the New Zealand the Health and Disability System Review and Australian Medical Council accreditation assessment of our College, to name a few of the challenges ahead this year. The Australian federal election will take place before the end of May, with all the potential impacts on relationships with key political stakeholders this will bring. On top of this, we have our continued business as usual activities, including preparing for the Annual Scientific Meeting later this year. There is also the continuing influence of artificial intelligence (AI) on our profession, which RANZCR is addressing by the formation of a dedicated working group and the establishment of principles governing the ethical use of AI in healthcare. Whether we like it or not, AI will significantly alter the way we practice as Radiologists. This is why RANZCR is taking a pro-active approach to shape that change. We have two newly appointed Office Bearers within the Faculty. Dr Meredith Thomas is our new Chief Censor. Meredith brings with her a wealth of experience working in various roles within the College and I look forward to working with Meredith as we go through and Training and Assessment Reform. Associate Professor Dinesh Varma is the Chief of Professional Practice and Dinesh is no stranger to the College. As Past President and Chief Censor he brings with him the necessary vigour and enthusiasm that is needed for this newly created position. This new position will significantly help foster post-fellowship

learning and Professional development of our members. It is only through the collaboration of volunteer members that we can effect change and ensure a positive future for our profession. Now, perhaps more than ever, your participation in various College committees and activities is needed to further strengthen the role of the clinical radiologist. As radiologists we devote our personal resources to making ourselves the best radiologists we can be, but engagement in our advocacy efforts – even if only in a small way, helps the effort. As Adjunct Professor Stacy Goergen notes elsewhere in this issue, engaging in advocacy efforts makes you a better radiologist. Get involved in Hospital Committees, District Health Boards, get to know your local politicians and Health Consumers. This is the best way we could advocate for our profession. I intend to make a difference as Dean and I hope you also make 2019 the year when you will make a difference too. I would like to once again thank my predecessor, Professor John Slavotinek, for the wonderful support he has given to ensure the smooth transition of the role. I would also like to thank the College staff for their great support so far. I have received all the assistance I needed to settle into my role and they have given me insight into how the College intends to meet the challenges of the year ahead. I am keen to engage with members and I can be reached through the College website at fcr@ranzcr.com Sanjay Jeganathan Volume 15 No 2 I March 2019

Clinical Radiology

Reforms and accreditation set to dominate the year Chief Censor in Clinical Radiology Dr Meredith Thomas

As the incoming Chief Censor in Clinical Radiology (CR), I would like to express my gratitude for the work of the outgoing Chief Censor, A/Prof Dinesh Varma, and wish him every success in his new role as the inaugural Chief of Professional Practice. A/Prof Varma was instrumental in the ensuring that the governance recommendations of the 2015 ACER/Prideaux review were implemented, appointing myself and Dr Barry Soanes, the respective Chairs of the Clinical Radiology Curriculum Assessment Committee and the Clinical Radiology Examination Review Panel, as Deputy Chief Censors. This enabled the formation of a strong leadership team within the Specialty Training Unit (STU), and I look forward to working closely with the Deputy Chief Censors during my term as Chief Censor. I come into the role at an extremely busy time for the CR STU, with the Training and Assessment Reforms progressing, and the usual business of STU continuing, including examination processes, training site accreditation visits and IMG assessments, as well as continual review of processes and policies. In addition, 2019 brings the Australian Medical Council’s accreditation of RANZCR‘s specialist medical education and training and professional development programs.

Inside News

AMC Accreditation of RANZCR Many of you would have previously been involved with accreditation processes, as trainers or as trainees, at a training site or at a College level. The accreditation process includes a detailed written submission from the College addressing the Accreditation Standards (as outlined in the Standards for Assessment and accreditation of Specialist Medical programs and Professional Development Programs 2015), as well as assessment visits to the College, its committees and representatives, observation of examination processes, and visits to a number of training sites. The College Staff and involved Fellows are to be commended for the preparatory work they have already done for this accreditation process.

RANZCR Accreditation of Training Sites A very busy component of our usual business is accreditation of training sites. We have 138 training sites (44 Full accredited sites, 85 Linked sites, 9 Speciality sites) and 10 training networks across Australia and New Zealand, with a 5-year accreditation cycle. Just as it is requirement that RANZCR comply with AMC accreditation standards, it is a requirement of radiology training sites and networks comply with all RANZCR accreditation standards, as outlined in the RANZCR Accreditation Standards for Education, Training and Supervision of Clinical Radiology Trainees. Accreditation is now primarily done at a Network level, recognising that there are also frequent requirements to accredit new individual training sites. The accreditation team is very ably led by Dr Mark Philips, Chief Accreditation Officer, who will be supported in 2019 by the newly formed Clinical Radiology Training Accreditation Working Group, with oversight from CRETC. A priority for this committee will be finalisation of Clinical Radiology Network Training Accreditation Standards.

Clinical Radiology

Capacity to Train Standard 3 of the RANZCR Accreditation Standards for Education, Training and Supervision of Clinical Radiology Trainees states “The Training Site provides a wide range of educational and training opportunities for trainees that are aligned with the requirements of the Radiodiagnosis Training Program Curriculum” This includes standards around the Key Conditions of Training, the Body System Syllabus, and the Experiential Training Requirements. Trainee numbers are increasing in many networks; to address increasing workload needs training sites, to address increase workforce needs, and as increasing numbers of rural and private sites are incorporated into networks to broaden the training experience, some federally funded by the Specialist Training Program and the Integrated Rural Training Pipeline. We need to ensure that Networks have the capacity to train these increased numbers of trainees, particularly in areas such as paediatrics, obstetrics and gynaecology and breast imaging, and the Specialty Training Unit has recently formed a Paediatric Working group to look at new and innovative ways to deliver training in paediatrics. It is important that training Networks are able to demonstrate capacity to train when applying for accreditation of additional training positions.

Training and Assessment Reforms (TAR)

Clinical Radiology Examination Review Panel (CRERP)

Work continues on progressing the TAR project, and I would like to express my thanks for the many Fellows who have contributed, particularly those who have been members of our working groups. You can find out more about this in the article on page 31.

CRERP is the Committee involved with the setting, marking and monitoring of the Part 2 Clinical Radiology Examinations. It comprises 2 Lead Examiners from each of the body systems, as well as 2 Pathology Lead Examiners. We have recently farewelled 2 of our Lead Examiners, Dr Jim Koukounaras (pathology) and A/Prof Andrew Little (abdomen) and are soon to be seeking Expressions of Interest for these positions. If you are an experienced examiner who is interested in having a greater role in the examination process and is excited by the opportunities offered by the TAR to better incorporate modern educational principles in our assessment processes, I would encourage you to apply. I thank Dr Koukounaras and A/Prof Little for the contributions they have made to the committee and to the examination process.

Clinical Radiology Curriculum Assessment Committee (CRCAC) CRCAC is comprised of members of the Clinical Radiology Fellowship with an interest in curriculum and assessment. 2019 will be a very exciting year for the committee, as the Training and Assessment Reforms progress toward piloting and implementation. CRCAC will have responsibility for continuing oversight of the proposed curriculum reforms and work-based assessments, including competencies of early training, patient safety, assessment of procedural competencies, non-medical expert roles, and research. In 2019 Prof Ken Lau, Dr Chee-Yan Hiew and Dr David Brunacci were farewelled from the committee, after many years of combined service, and I would like to thank them for their tremendous input. We are seeking new members for the committee and would encourage those with an interest or expertise in medical education to submit an expression of interest. Please refer to the Current Opportunities Page on the RANZCR Website.

Volume 15 No 2 I March 2019

Clinical Radiology

Clinical Radiology Trainee Matters

Happy new year to you all. I’m Doctor Ben Addison, 5th year radiology trainee, Aucklander, ice hockey aficionado, Norwegian Forrest Cat wrangler, and the incoming Chairperson of the Clinical Radiology Trainee Committee for 2019. With a new year comes a variety of new committee members, but first I’d like to thank those who have not returned to the committee in 2019 - Drs Jeremy Ong, Bonnie Leung, Ushan De Silva, Evyn Arnfield, Bernadette Wong and of course our retiring Chair Anthony Cardin. Your contributions have been very much appreciated and I enjoyed working with you all in 2018. Best of luck for 2019 and the rest of your careers as radiologists! Our new Committee for 2019 includes returning stalwarts myself and Dr Matthew Lukies (Vic), and brighteyed new-comers Dr Acrane Li (NZ), Dr Merribel Kyaw (NSW), Dr Morgan Schulze (SA), Dr Jeff Hocking (QLD), Dr Shoba Ratnagobal (WA), and Dr Sophie Thoo (SA). I’d like to extend a warm welcome to the whole committee on behalf of the trainees of Australasia, I’m sure they’ll all do an amazing job. Advocacy can be defined as the act or process of supporting a cause or proposal. It is the central purpose of the Clinical Radiology Trainee Committee, to look after the needs and interests of our constituents, the radiology trainees of Australasia. Our role is to provide support and trainee perspectives on the running of the college particularly in matters directly regarding trainees, including examinations, training structure and college sponsored events such as the ASM. As advocates for trainees it is essential that we know what trainees want. In order to facilitate this we need to hear from you, so please don’t hesitate to contact your local committee representative to discuss anything you

Inside News

like regarding the training programme. We can then bring matters to the college and advocate for trainee’s opinions and desires. We welcome new ideas, things such as Matt’s very sensible idea to build a wall between the emergency department (ED) and Radiology, assuming we can get ED to pay for it, or building a literal bridge between New Zealand and Australia – the “GC Highway” or “ANZAC biscuit flyover” (name TBC). Another important advocate for trainees is Chris Bartley the RANZCR Trainee Liaison Officer, whose role in the college is to take on trainee concerns or questions and act as a conduit between trainees and the college. He’s a valuable resource and I suggest everyone should take advantage. Changes will be occurring over the next couple of years, with a lot of work being done currently around the examinations and course structure. With these changes we will need feedback from you all to get a truly representative trainees’ perspective, in order to ensure college processes remain fair and transparent for trainees. Hopefully everyone has some great plans for 2019, which should obviously include coming to Auckland for the RANZCR ASM this year; it will be an awesome conference and as always, a great way to meet new colleagues and get back in touch with old ones. We look forward to seeing you all there! Good luck to all the candidates sitting exams this year and welcome to all our new trainees. Bring on 2019! Warmest Regards, Dr Ben Addison

Dr Ben Addison

Clinical Radiology

Chief of Professional Practice

Expressions of interest for the Professional Practice Committee were finalised in late 2018 and I now have the pleasure of announcing the following appointments, who join me as members of the Committee; • Andrew Ko-Wai Cheung

New South Wales

• Mitchell Raeside

South Australia

• Catherine Jones

Queensland

• Christoph Schick

New Zealand

• John Slavotinek

South Australia

• Sanjay Jeganathan

Western Australia

• Dinesh Varma (CPP)

Victoria

A/Prof Dinesh Varma

It is my privilege to commence as the inaugural Chief of Professional Practice for the Faculty of Clinical Radiology (FCR). Having worked as Chief Censor for the past three years, I am eager to ‘symbolically and virtually’ retrace my own steps as a trainee, by moving from the RANZCR training program, to the College’s Post Fellow program. My role will be supported by a new committee, known as the Professional Practice Committee. This Committee, together with the responsibilities assigned to me as Chief of Professional Practice will work to steward post fellowship learning and maintenance of competency in a way that streamlines the individual’s journey throughout their professional life assuring clinical excellence and providing the highest standard of care to our community. The committee will do this by providing guidance for the development, implementation and review of postfellowship learning, including CPD, credentialing and certification of subspecialty programs within the Faculty.

The Committee has a breadth of representation from various aspects of our profession as well as from New Zealand. My first step as Chief of Professional Practice will be to seek the views and opinions of FCR members regarding post-fellowship learning at the College. I plan to reach out to all corners of the Faculty for input regarding how you see the role of general and subspecialty radiology, both now and in the future. I hope to use the outcomes from this consultation to inform the trajectory for the Committee which is scheduled to have its first meeting in March 2019. A crucial role for the Professional Practice Committee will be informing and advising the FCR Council on matters relating to CPD reforms. Over the next two to three years, the Medical Board of Australia and Medical Council of New Zealand will be reforming the way doctors maintain their medical registration. Please see the article in

this edition of InsideNews, that outlines the proactive approach the Faculty of Radiation Oncology have taken to ensure a smooth transitioning of their members to the new requirements. You can find the article on page 14. I will look forward to providing updates regarding the progress of the Professional Practice Committee in each edition of InsideNews. Yours sincerely, Dinesh Associate Professor Dinesh Varma Chief of Professional Practice Faculty of Clinical Radiology

Volume 15 No 2 I March 2019

Clinical Radiology

Great strides made in the recognition of the importance of IR and INR in healthcare Recognition of the growing importance of Interventional Radiology (IR) and Interventional Neuroradiology (INR) across the broader healthcare system has been a part of the College’s ongoing advocacy work and 2018 saw some exciting results as part of this ongoing effort.

including Professor Andy Adam, Dr Glen Schlaphoff and Dr Gerard Goh, and was well attended by members. Our plan is to hold this forum each year to provide an ongoing opportunity for members to engage with the College and provide input into the advocacy and development of interventional radiology interests.

Representing IR and INR Internally, a broad range of interventionalists have been involved in developing the strategic direction for IR and INR and ensuring that interventional considerations are integrated into all areas of College work. In addition to the Interventional Radiology Committee and Faculty Council, College members from all aspects of interventional practice have been, and continue to be, closely involved in key College roles and projects, including: • defining a scope of practice for the full breadth of radiology; • examining and redesigning the procedural component of the Radiology training program; • exploring synergies and opportunities for partnerships between IR and Radiation Oncology • providing advice to internal committees on matters relating to interventional practice and service delivery

The College also successfully nominated representatives for a range of external bodies, including: • Multiple committees under the MBS Review Taskforce, including vascular, cardiology, principles & rules, pain management • Prosthesis List Advisory Committee – Panel of Clinical Experts • RACS Audit of Surgical Mortality Committee • NSW Health Scope of Practice Working Group - Radiology • ANZCA Safe Sedation Working Group • ACSQHC Peripheral Venous Access Clinical Care Standard Working Group

Inaugural IR Forum at the 2018 RANZCR ASM

• scoping models for training in interventional radiology and interventional neuroradiology

A vital part of any good advocacy strategy is understanding and keeping up-to-date with issues impacting on those delivering services on the ground. The IR Forum, held for the first time at the 2018 ASM, was designed to provide such insight and give members an opportunity to hear about, and provide feedback on the College’s plans for IR and INR.

• reviewing the College’s credentialing programs and developing a postFellowship training and credentialing framework.

Presented by Dr Nick Brown, Chair of the Interventional Radiology Committee (IRC), the session included several internationally renowned guest speakers

• updating the RANZCR Standards of Practice for Diagnostic and Interventional Radiology

Looking to the Future - White Paper on Interventional Radiology A major theme from the IR Forum was a clear and agreed need to define and develop the interventional subspecialty. More scoping work, and guidance from the College membership, is needed to determine what that formalisation might look like and this is a key priority for 2019. To support this work, the College has released a White paper: Interventional Radiology, which outlines the breadth of such as undertaking. All members are encouraged to read the paper and provide feedback through the ‘Consultations’ page on the College website. We anticipate more advocacy opportunities for our interventional members during 2019 and beyond. If you have an interest in representing the College, please contact us via email interventional@ranzcr.edu.au, including your areas of interest and expertise.

Volume 15 No 2 I March 2019

ECLIPSE: DESIGNED FOR

ECLIPSE 15.5 | Treatment planning is all about finding the optimal balance between target coverage and organs-at-risk sparing, so ultimately your patients get MORE advanced care. The Eclipse™ treatment planning system’s multi-criteria optimization (MCO) feature allows real-time exploration of what happens when different clinical criteria are varied. MCO leverages both RapidPlan™ knowledge-based planning and the existing optimization workflows—helping you find the optimal plan for a given patient, MORE quickly and with MORE certainty. For more, visit us at Varian.com/Eclipse.

Radiation may cause side effects and may not be appropriate for all cancers. © 2017, 2018 Varian Medical Systems, Inc. Varian and Varian Medical Systems are registered trademarks, and Eclipse and RapidPlan are trademarks of Varian Medical Systems, Inc.

Radiation Oncology

2019 – Raising the Stakes A Message from the Dean

Dr Madhavi Chilkuri I trust that members have had a restful break and I extend my wishes to you all, and your families, for the new year. This is my first report as Dean, a position that I am honoured to hold. Having completed my medical and specialist training in India, I have had experience working briefly in India and then in Jamaica before taking some time off to pursue a Master’s degree in Public Health in Boston. My journey in advocacy and policy started then and has culminated in Australia with my involvement with the College and now as Dean. Over the last 10 years, I have had the opportunity to work within diverse service delivery models and geographical areas in Australia. After working much of my professional career as a generalist radiation oncologist, I am now working at The Townsville Hospital as a staff specialist sub-specialising in head and neck, lung and upper gastrointestinal cancers. I am grateful to all my departmental colleagues who support me through my dual responsibilities.

Faculty Council meeting At the time of writing, we are preparing to hold the Faculty Planning Day, where we prioritise work plans for Working Groups, Standing Committees, and Faculty Council for 2019. This will be followed by the first meeting of 2019. Our committees and working groups continue to have ambitious work plans and I thank all members in advance for the huge amount of time and dedication they give to the Faculty and the profession.

MBS Review We are awaiting the final outcomes of the recommendations of the Oncology and Urology Clinical Committees of the MBS Review Taskforce. Whatever the final outcomes are, there will still be large amounts of work for the Faculty to do; whether working towards modelling/ piloting of a new radiation oncology schedule or continuing to advocate for radiation therapy in the care of prostate cancer.

New Zealand Horizon Summit In May, the New Zealand Minister of Health, Dr David Clark, is hosting a radiation oncology horizon summit at parliament house. The summit will bring together some of the key players in cancer care in New Zealand, including politicians, bureaucrats, and senior District Health Board staff, and will address planning for service demands and appropriate resourcing of the sector.

Results of the 2018 Workforce Census have been written up and submitted to JMIRO for publication. I would like to extend my thanks to A/Prof. John Leung for all his work in the workforce space.

Order of Australia Congratulations to two radiation oncologists who became Officers in the Order of Australia (OA) at the Australia Day Honours. Prof. David Ball, immediate-past Editor-in-Chief of the Journal of Medical Imaging and Radiation Oncology (JMIRO), and Dr Bronwyn King, advocate for tobaccofree investment strategies.

Data collection The biennial Faculty Facilities Survey will be conducted this year. The Secretariat is in the process of ensuring we have up-to-date details for all the centres across Australia and New Zealand, including contact people to send the survey to. Data collected through the Facilities Survey is critical for much of our advocacy work. As always, we acknowledge the sensitivity of data and ensure that no centre can be identified.

Volume 15 No 2 I March 2019

Radiation Oncology

A year of goals Chief Censor in Radiation Oncology

A/Prof Margot Lehman

The beginning of a New Year is a good time to outline the goals for the Specialty Training Unit (STU) over the next twelve months.

raining and Assessment Review T (TAR) A decision has been made by the TAR Task Force to delay the implementation of the programmatic approach to training by twelve months to 2021. Throughout 2019, the aims of the TAR working groups and steering committee are to: a. Finalise the curriculum and send this out for stakeholder review. At present clearly articulated and updated learning outcomes for both Medical Expert and Non- Medical Expert roles have been identified and are in the process of being collated into one document. The aim is to have the curriculum available for review by the June Director of Training (DOT) meeting b. Finalise the Work Based Assessment tools and continue to pilot them, complete the program of assessments with regard to number and type of assessments required and clearly articulate how trainee progression will be tracked and evaluated. The latter will dovetail with the new Trainee Performance and Progression Policy. c. Continue to pilot the Oncology Sciences workshops and expand the number of Training Networks participating in the pilots. d. Development of a plan for implementation of the program in 2021 including the development of educational and training tools for both clinical supervisors and DOTS. It is anticipated that 2020 will see widespread engagement and training

Inside News

of all clinical supervisors, DOTS and TNDs with respect to the new program roll-out. Updates on the above will be provided at both Director of Training and Training Network Directors Meetings.

ustralian Medical Council (AMC) A Re-Accreditation The College will undertake its AMC Re-Accreditation this year. The ReAccreditation process involves a number of activities across the College including site visits, face to face meetings and attendance at examination preparation workshops and examination series.

ROET priorities for 2019 a. AMC Accreditation Standard: Trainee Selection Guidelines. The College is aware that the future of the specialty is dependent on selection of trainees and that selection should be based on academic, clinical and non-clinical/ non-academic requirements. In order to assist Networks in selecting appropriate candidates, the College commissioned an external review on how selection processes can be improved. The Work Psychology Group undertook this work and have developed a competency framework to be used as the basis for a review of the Trainee Selection Guidelines. I am very grateful to Dr Bronwyn Matheson and Ms d'Avigdor for commencing the work on redrafting these guidelines. b. AMC Accreditation Standards: Indigenous Health and Cultural Safety orking towards “closing the W gap” in terms of the poorer health

outcomes experienced by Indigenous populations and in an effort to increase the representation of indigenous peoples in our Specialty, the ROETC has identified measures to improve cultural competency and cultural safety as a priority in our training program. The AMC has a number of standards outlining requirements. A working group will be established to assess how these standards can be addressed.

Phase 1 and Phase 2 Examinations The development and conduct of examinations for both Phase 1 and Phase 2 is core business for the STU. The TAR recommendations regarding the introduction of marking criteria and standard setting have largely been adopted as standard practice but ongoing processes of refinement will occur. Throughout 2019, Dr Sean Brennan (Chief of Examinations) along with the Phase 1 examination leads (Dr Carminia Lapuz and Dr Claire Hardie) and the Phase 2 examination group and Pathology lead (Dr Najmun Nahar) will review and provide advice regarding modifications to the examinations to ensure they remain fit for purpose.

Courses As in previous years the Phase 1 Foundation and pre-examination course and the Phase 2 pre-examination workshop will be held in 2019. In closing I would like to welcome all the new trainees who are taking the first steps towards becoming a radiation oncologist. Radiation oncology is an exciting and rewarding field of practice and the radiation oncology community welcoming and supportive.

Radiation Oncology

Radiation Oncology Trainee Matters Happy New Year and a warm welcome to all the first-year trainees who have joined the program in 2019. I would firstly likely to acknowledge the excellent work of the 2018 Radiation Oncology Trainee Committee (ROTC) on their representation and advocacy efforts. The Inside News theme for this issue is advocacy. Upon discussion with colleagues and mentors, this term often reflects varying meanings to different people. On a professional level, we must consider advocacy as a tool that brings about positive change that benefits our patients and ourselves. On an individual level, this is not a mission which requires a position of leadership or power. As trainees, we must be advocates for our own teaching and engage in the ongoing development of our clinical knowledge. We advocate for our patients by embracing a notion of safe and evidence based clinical practice through research and self-education. We advocate for the wellbeing of ourselves and our colleagues and as future radiation oncologists we become advocates for the profession of radiation oncology. The ROTC’s primary goal is to represent and advocate for the interests of all radiation oncology trainees. We do this primarily through our own committee and by having representation on each of the relevant College standing committees. Navigating through the challenging arena of specialty training requires a combination of time management, dedication and a resolute commitment to the long journey. Our responsibilities as clinicians, partners, parents, mentors, students and advocates for our patients encompass the challenges that will test and inspire us throughout training. The ROTC serves as a point of engagement and support for trainees throughout this endeavour and I encourage any trainee requiring

support or guidance on any training related matter to contact myself or any committee representative. Name

Network

Position

Mihir Shanker

QLD

Chair

Jessica Dortmans

Secretary

Gabrielle Metz

NSW Northern

Education and Training Committee

Lucinda Burke

NSW Northern

Media and Profile Committee

Anna Gubbins

Annual Scientific Meeting Committee + NZ rep

Wee Loon Ong

VIC

Quality Improvement Committee

Nicholas McNeil

SA/NT

Economics and Workforce Committee

Annie McKean

NSW Southern

Radiation Oncology Research Committee

Key goals for 2019 1. Increased engagement between members and ROTC: I encourage all trainees to contact myself or the members of the ROTC from their network with any concerns, feedback, ideas on improving the training experience or any training related matters. This year the ROTC will aim to proactively improve our engagement with trainees with regards to garnering feedback on courses and examinations and to inform of opportunities in training, research, coursework, conferences and grants throughout the year. 2. Targeting Cancer: The Targeting Cancer campaign plays a tremendously important role in community engagement with our specialty and ensures patients are empowered to access radiation oncology services. The campaign continues in 2019 led by Dr Lucinda Burke with plans for further GP education sessions, leadership campaigns in conjunction with ESTRO and trainee engagement

for coordinating local projects. We encourage any trainee wishing to be involved to contact the ROTC and for those active on social media to remember to use the Twitter handle @targetingcancer. 3. Mentorship project: This project commenced in 2017 in response to a College survey that demonstrated significant stress and burnout amongst radiation oncology trainee colleagues. The Faculty of Radiation Oncology Mentorship Working Group (FROMWG) is in the final stages of setting up a mentorship pilot program for trainees and early Fellows aimed at providing guidance and support throughout training. I look forward to an excellent year ahead and introduce and welcome the new members of the ROTC in 2019. Best wishes Dr Mihir Shanker Chair Radiation Oncology Trainee Committee

Volume 15 No 2 I March 2019

Advertorial

Multi-Criteria Optimization: Creating HighQuality Treatment Plans in a Fraction of the Time Multi-criteria Optimization (MCO) is a clinical decision support tool that was added to Varian’s Eclipse™ treatment planning system in version 15.5. MCO enables clinicians to quickly improve plan quality by balancing clinical tradeoffs. Using this tool, clinicians can explore what happens when they vary different clinical criteria, such as the degree to which particular organs are spared versus coverage of the targeted tumor, without a time-consuming trial and error process.

if the clinician would like to explore possible compromises between doses to organs-at-risk and how these affect the target coverage, this is possible to achieve 'on the fly' without the need to re-optimize or re-calculate dose. This real-time exploration of trade-offs helps to eliminate the back-and-forth between dosimetrist and clinician, allowing for efficiency gains in the planning timeframe. We also see MCO as a tool to further improve and optimize RapidPlan™ models.”

“MCO is a very powerful and clinically beneficial tool that will take many of the inefficiencies out of treatment planning and provide the required information to dosimetrists and clinicians at the time they need it most,” stated Trent Aland, national director of Physics at Icon Group, Australia’s largest dedicated cancer care provider. Aland was among those who led preclinical testing of the MCO tool in Eclipse v15.5.

The Beatson Cancer Centre in Glasgow UK are seeing significant improvements in their complicated cases, particularly with pediatrics and plans involving the central nervous system. “The most significant reductions in dose to OARs have been for our younger patients, for example, where we are trying to treat the whole lung while reducing the dose to the heart,” noted Suzanne Currie MSc, medical physicist and clinical scientific lead at the Beatson. “Using MCO, we are seeing a dramatic reduction in cardiac toxicity for pediatric patients, because we are often able to decrease the dose to OARs by up to 25%.”

“MCO works by creating several optimized treatment plans that the user can visually review and evaluate using slider bars,” said Aland. “For example,

A screenshot from the MCO Workspace. By using the slider bars on the left, clinicians are able to investigate trade-offs between target coverage and organ sparing during treatment planning. Here they will see the impact of these tradeoffs on the dose volume histograms, the 3D dataset and on their clinical goals.

Inside News

Beatson practitioners are also fine-tuning their treatment planning by capitalizing on the unique, complementary combination of RapidPlan knowledge-based treatment planning software and MCO. “While RapidPlan helps us know what should be achievable for a patient based on previously planned patients, MCO can help us tailor that plan based on the individual patient’s unique clinical circumstances,” remarked Dr. Currie. “We use RapidPlan to get the DVH estimates and then MCO to further optimize the plan. Using both together enables the rapid creation of superior plans.” The Beatson team is using RapidPlan followed by MCO optimization for many sites, including prostate, head & neck, lung, gynecological, and spine. This combination is also enabling the Beatson team to treat recurring patients who may not have been eligible for a second treatment due to the need to substantially minimize the cumulative dose going to OARs. “Using these two tools—RapidPlan and MCO—we are able to sculpt the dose and optimize our plans in ways we were not able to before. As a result, we are able to retreat a much larger group of patients than in the past,” explained Dr. Currie. Dr. Karl-Heinz Kuefer, Division Director Optimization at the Fraunhofer Institute for Industrial Mathematics in Germany and co-inventor of the MCO tool, has plans to collaborate with Varian researchers on extending the use of MCO to other types of radiotherapy and to explore how this tool can be used to enable adaptation of Eclipse treatment plans while the patient is on the couch. In addition, Dr. Kuefer hopes to fully achieve his original goal: to give clinicians the power to guide the compromises necessary for optimal treatment planning and to discuss these trade-offs with patients: “We want practitioners to be able to empower patients and their families by using MCO to show them that they are getting the best possible treatment plan.”

General Interest

Can your voice make a difference? Individual clinicians have helped drive change through their own personal advocacy achievements. How have they gone about it, what have they learned, how has it benefited them as radiologists and what advice do they have for others thinking of following in their footsteps? Inside News spoke to two radiologists for their views. Collaboration is the key to achieving change through advocacy, says Stacy Goergen. Based at Victoria’s Monash Health, Adjunct Clinical Professor Goergen has helped drive change across various advocacy areas over her 25-year career in radiology. “What I’ve learned is that no one person can change things,” said Prof. Goergen, whose work has covered areas including Quality and Standards, guidelines for appropriate use of medical imaging, consumer information and obstetric MRI funding. “Change is something that’s achieved by people working together and most importantly persisting in the face of hurdles and setbacks. “It’s been wonderful to meet and work with so many people in my work with the College, not only in the radiology community. It has led to many friendships, connections and unexpected collaborations. “I think (advocacy) also improves your knowledge and capacity as a clinical radiologist by being exposed to so many perspectives and experiences.” Prof. Goergen said participating in advocacy has benefits for radiologists, no matter what stage their careers are at. “I think when you’re younger you actually have time to get involved in advocacy issues, before other

commitments shift your focus. However, many newly qualified radiologists are heavily focussed on building only their technical proficiency which, in the longer term, may be a mistake,” she said. “It’s understandable – there is always so much to learn and there is a lot of anxiety and uncertainty when you are newly qualified and pushed out of the nest to fly as a fledgling consultant. We need to make a bigger effort to mentor young radiologists in the not necessarily obvious benefits of activism. “Like any other line of work, you can become jaded and a bit disengaged after working in clinical medicine for 10 or 15 years and getting involved in advocacy work can help rejuvenate your enthusiasm and interest in what you do.” Prof. Goergen’s latest achievement included providing clinical leadership for the successful application to the Medicare Services Advisory Committee for Medicare funding of obstetric MRI, funding which was confirmed in the recent Mid-Year Economic and Fiscal Outlook (MYEFO). This will enable women with a suspected fetal central nervous system abnormality to access rebate-eligible MRI services from mid2019.

explanation and persuasion, not to get frustrated by impasses.” Prof. Goergen said advocacy wins had also helped her achieve job satisfaction aside from her day-to-day achievements. “It is rewarding,” she said. “When you have effected change for the better in the life of someone who isn’t the patient right in front of you, through policy change, advocacy, guidelines, education or funding, it makes all the hard work worthwhile.” Stacy Goergen is a radiologist and Director of Research at Monash Imaging in Melbourne, and a Clinical Adjunct Professor, Monash University, School of Clinical Sciences at Monash Health. Other achievements include being principal or co-investor on grants totalling $8m in the areas of CT dose optimisation, Chair of RANZCR’s Safety, Quality and Standards Committee and being project lead on the development of referral guidelines for the new GP referred MRI items introduced into the Medicare Schedule in 2013. She is a former editor of the award-winning Inside Radiology website.

“The process took over two years, which is relatively quick for the listing of a new item in the Diagnostic Imaging Schedule,” she said. “I provided the clinical expertise on the application and had multiple exchanges throughout the application process with the Department of Health and other people involved. “My role centred on developing the questions for literature reviews, putting the outcome of the reviews into clinical context and bringing the focus back to what was needed by patients. “The mental challenge was to understand the importance of

continued over...

Volume 15 No 2 I March 2019

General Interest

For Ronny Low, advocacy was thrust upon him but despite his initial trepidation, he has become a driving force for change in radiology. Dr Low’s diverse and successful advocacy work includes serving as Chair of RANZCR’s CT Reference Group and the Iodinated Contrast Media Guideline Working Group. He begins his first term as a member of RANZCR’s Faculty of Clinical Radiology Council in 2019 and has special interests in prostate MRI and MR guided prostate biopsies, abdominal and pelvic imaging and musculoskeletal imaging. He said he initially viewed advocacy with suspicion as a trainee. “I was not one for advocacy – at university I thought the people in the student guild were oddballs,” he says with a laugh. “I was in my second year of training at Royal Perth Hospital when Professor Turab-Chakera, a real stalwart of the hospital, came round the corner, pointed at myself and another trainee and said, ‘RANZCR has started a committee for trainees – you two will nominate yourselves today’.

“We’ve also seen significant improvements in the training of registrars in WA. I’m hoping that this will continue and that eventually WA will have the best training program in Australia and New Zealand.” Dr Low said radiologists keen to get involved with advocacy needed to look at their own passions and motivations. “I think you need to look for an area that you are interested in and where you can add something of value,” he said. “I hope that every radiologist has something they feel particularly passionate about. “I was interested in the new contrast guidelines because I felt they were not best practice, so when an EOI came up I put my hand up.” Dr Low said the personal benefits open to radiologists also made participating in advocacy an important goal. “It’s intellectually stimulating, you learn a lot and I think it makes you a better radiologist,” he said. “You get to meet some interesting and smart people as well.

“We replied ‘Yes Prof!’.

“I think it broadens your horizons and gives you a better understanding of what the college does and what it can’t do.

“That’s how I started getting involved. It wasn’t my idea but I’m quite glad that ‘Prof’ made me do it.”

“You also learn how things are perhaps done differently in one part of the country to another.

Dr Low said he took great satisfaction from his achievements, which include formulating new contrast guidelines and working towards even higher standards for trainees.

“I think a lot of people whinge about something they want changed, but I figure it’s better to change them yourself than to whinge about them.”

“I think it was great that we didn’t just copy the Americans and Europeans for our guidelines and chose to develop our own, which I believe are now the most up-to-date and evidence-based, especially in light of the Royal College of Radiologists’ recent decision to start referring their own radiologists to use the RANZCR guidelines instead of their own.”

Inside News

Dr Ronny Low is Chair of RANZCR’s CT Reference Group, Iodinated Contrast Working Group and Applied Imaging Technology Working Group. He is also co-Director or Radiology Training at Perth’s Fiona Stanley Hospital, where he works as a Consultant Radiologist.

Dr Low also said there were also more straightforward ways radiologists could become advocates. “I think it’s important to note that advocacy comes in different shapes and sizes,” he said. “On an individual basis, radiologists can be advocates through every day things like attending MDTs, ensuring they add value to patient care and being the best radiologist they can be.”

STACY AND RONNY’S TIPS FOR ADVOCACY SUCCESS: Find an issue you are passionate about Look for the personal benefits of advocacy Remember that advocacy starts at a grassroots level Be tenacious! Always keep the big picture in mind Be prepared for setbacks and how to deal with them

General Interest

We hope everyone had some time off during the festive season and are back with full vigour to face the challenges in 2019. We welcome Dr Rajiv Rattan as our new Committee member and look forward to working together. That leaves one more vacancy for a member from New Zealand. Anyone with a special interest in Emergency Radiology is encouraged to put their hand up to join the committee. ANZERG is collaborating with Oman Radiology and Molecular Imaging

TROG Grants, a Trainee’s perspective I applied for the TROG Grant in 2018 because it is an opportunity to meet and learn from leading cancer researchers at the SMART workshop and TROG ASM. I particularly wanted to attend the SMART workshop to help build my skills in statistics and research design. I also wanted to attend the TROG ASM to learn more about TROG Cancer Research and to meet the individuals who drive these innovative research ideas. The application process was surprisingly straightforward, and my consultants were very supportive. A few months after submitting my application, I was delighted to hear that I had been awarded the Grant to attend the SMART workshop and the TROG ASM in the beautiful city of Hobart.

Society (ORMIS) this year for the first joint meeting in conjunction with The Royal Hospital, Muscat 2nd international conference. This will be held at the state of the art Oman Exhibition and Convention Center, Muscat from 11 to 13 April 2019. More than 2000 delegates are expected to attend the multidisciplinary conference with over 300 speakers including 50 international faculty from over 20 specialties making it the largest multi-disciplinary conference in the region. RANZR is awarding 14.5 CME points for this conference. ORMIS has heavily discounted the registration fee and we hope to attract radiologists from around the globe including Australia and New Zealand

The SMART workshop was a day of presentations and interactive sessions. I particularly enjoyed the robust discussions among the trainees, clinicians and statisticians when appraising pre-set articles. Through this workshop I learnt about the importance of proper study design and critical analysis of research articles.

to attend the conference. This will also be a great opportunity to travel around Muscat where the nations of the world meet and live in perfect harmony and peace. It is often referred to as the “Switzerland” of the Middle East where rugged mountains meet the sea on sun-kissed sandy beaches in perfect accord, where culture, history and the contemporary exist in unison. A detailed flyer is included in this edition of Inside News For registration and more information visit https://ricoman.org/. A/Prof Dinesh Varma Chair ANZERG

at the 1920s-style gala! I would like to thank RANZCR and TROG for this opportunity to attend such a fun and inspiring meeting! Dr Michelle Li Radiation Oncology Trainee Peter MacCallum Cancer Centre

TROG ASM was an opportunity to hear the results from the latest TROG trials and the new research ideas. It gave me a glimpse of the amount of work that is involved in setting up cancer trials and the importance of collaboration between institutions. Perhaps the most memorable moment was when Prof Lester Peters, during the Head and Neck Stream Breakout session, encouraged us to be bold in order to make a difference in cancer research. During the final night at TROG ASM, I fine-dined and danced the night away

Volume 15 No 2 I March 2019

General Interest

RANZCR releases its draft Ethical Principles for AI in Medicine for consultation RANZCR's position as a thoughtleader in the growing world of artificial intelligence (AI) has been further underlined by the publishing of its draft Ethical Principles for AI in Medicine for consultation. The eight principles outline the most appropriate use of AI and machine learning (ML), including how both can successfully help drive even better patient care. They are believed to be the first of their kind devised by a professional healthcare body and will also include detail on how AI and ML can be used to ensure the protection of patient data and balanced with the application of humanitarian values. “New technologies such as AI are having a huge impact on healthcare, with enormous implications for both health professionals and patients,” RANZCR President Dr Lance Lawler said. “They have the ability to help doctors work in a more time-efficient and effective manner and – ultimately – provide even greater treatment for patients. "There are millions of scans such as ultrasound and MRI performed in Australia each year, underlining the critical role imaging plays in healthcare. How radiology adapts to AI will have flow-on effects for patients and other healthcare professionals, which is why it was important for RANZCR to develop these principles. “The agreed principles will, when established, complement existing medicinal ethical frameworks, but will also provide doctors and healthcare organisations with guidelines regarding the research and deployment of ML systems and AI tools in medicine.” The principles have been developed by RANZCR’s AI Working Group, which was established to assess how best to

Inside News

harness the growing impact of AI and ML on medicine, with an emphasis on radiology and radiation oncology. "There's lots of hype and misinformation around AI,” Dr Lawler said. “It is important to look beyond that and concentrate on the important issue how we can best use it for the maximum benefit of patients. "RANZCR has been a thought-leader in the AI space. As well as forming our AI Working Group, we also hosted the inaugural Intelligence18 summit at Sydney's Doltone House last year which united national and international experts to discuss the impacts of AI on healthcare.

"The draft principles are available to view via the RANZCR website and we would welcome feedback from anyone interested in this area and how AI and ML can be used to their fullest potential.” The ethical principles will also help RANZCR develop a set of professional standards for the use of AI and ML in radiology and radiation oncology. These standards will be available in due course. Details can be found on the RANZCR website at www.ranzcr.com. The consultation closes on Friday, April 26.

ABDORAD 2019 Case Review and Lecture Series Sat-Mon 1st – 3rd June

International Speakers and Expert Educators Prof. Mukesh HARISINGHANI (Harvard) A/Prof. Kartik JHAVER (Uni Toronto) Dr Mark GOODWIN (Austin Health)

Crown Promenade Melbourne

www.conferencestogo.com.au

General Interest

The Faculty of Radiation Oncology Genito-urinary Group (FROGG) is pleased to invite you to the 2019 FROGG Workshop “The Art of Genitourinary Radiation in 2019 – Bladder, Prostate and Beyond” to be held from the 8th-10th of August 2019 at the Shangri-Lai Hotel in Cairns. The objective of FROGG workshops is to increase awareness of emerging evidence and promote best practice in the delivery of radiation treatment for genito-urinary malignancies. There have been significant developments in the management of bladder cancer where radiation is often under-utilised. With increasing improvements in

Effective advocacy vital for future of our sector In the lead up to this year’s federal Budget, ADIA has once again escalated its campaign to end the freeze on all Medicare rebates for radiology. The campaign is part of an ongoing push by ADIA, in collaboration with RANZCR, to ensure that radiology is given appropriate priority by the decision makers in Canberra. Advocacy is crucial in this equation and in delivering the best possible outcomes for our patients and profession. We are competing with other parts of the health sector for funding and the attention of policy makers, and so the strength of our advocacy determines whether or not our policy ideas are implemented.

the understanding of biomarkers & genomics, imaging, treatment delivery techniques and image verification, one of the aims of this year’s workshop is to discuss the evidence for optimising patient selection and treatment delivery for patients with bladder cancer. There have also been several recently reported prostate cancer trials in the oligometastatic and post-prostatectomy setting that have major implications on our practice. Thus, the theme for this year’s workshop is: “The Art of Genitourinary Radiation in 2019 – Bladder, Prostate and Beyond”. The meeting will feature keynote presentations from Prof Ananya

Together, ADIA and RANZCR are the only advocates for our profession and for radiology as an indispensable part of our health care system. We must stand together as a united sector because we are more effective when we do so. Importantly, we are also advocates for our patients. We understand how government funding and policy settings affect our patients, and as peak bodies we have a responsibility to share this knowledge with politicians and officials, and to advocate solutions. We have consistently demonstrated that working collaboratively delivers real outcomes for patients: in 2016 we prevented the Government’s cut to the bulk billing incentive from being implemented; and CT, mammography, fluoroscopy and interventional radiology rebates will be indexed from July 2020.

Choudhury, from The Christie Hospital (UK), who is an international expert in bladder & prostate cancer, prognostic/ predictive biomarkers and MR imaging in radiotherapy. The workshop is targeted towards radiation oncologists (including registrars), medical physicists and radiation therapists who are involved in treating genito-urinary malignancies. We encourage you all to escape the winter and we look forward to welcoming you to warm and sunny Cairns in August. The FROGG Executive Committee

ongoing campaign to end the freeze on all Medicare rebates has continued to escalate in response to Government inaction and is being heard at the highest levels. We have spoken out against Medicare cuts to services like MRI knee scans and myocardial perfusion imaging. These arose from the MBS review and are contrary to clinical evidence. And we have advocated for the Quality Framework, a joint ADIA-RANZCR proposal for strengthened professional supervision rules for CT and contrast administration, to ensure that patients have access to clinically-led radiology services. We must continue to work together as a sector to build and protect the future of radiology in Australia.

As readers will know, the Medicare freeze has now lasted for more than two decades, putting pressure on patients and practices alike. ADIA’s Volume 15 No 2 I March 2019

General Interest

Trainee Feedback – Is it time for an overhaul? Feedback is vital for any formative radiologist, but a new study has shown that improvements in current processes may be needed. The Feedback in Radiology Training: Perspectives of Australian Radiologists and Trainees study assessed the nature of feedback interactions between a supervisors and trainee radiologists. It revealed that the radiology workplace environment has unique characteristics that influence how feedback is undertaken which differ from other postgraduate training programs. “Most radiology literature in the past has looked at how to give feedback, rather than the process, the culture and characteristics around it,” study co-author and Melbourne-based Interventional Radiologist Dr Alex Rhodes said. “There’s more work to be done but this study has shown there is a need to improve the feedback literacy of the profession as a whole.” The study, which is believed to be the first of its kind undertaken in Australia, incorporated 15 interviews – six supervisors of training and nine radiology trainees of various ages and experience. ‘Thematic analysis’ of the responses suggested that a lack of time to facilitate feedback conversations and face-to-face discussion were barriers to effective feedback provision, While contemporary trainees were also appreciative of feedback in written forms, Dr Rhodes said the study has revealed a ‘one-way’ culture of feedback interaction.

Inside News

“We found the emphasis of feedback is black or white – ‘did you get this right or wrong’,” Dr Rhodes , who has a Master of Clinical Education and is a member of the RANZCR Curriculum Assessment Committee, said. “There were also themes of time constraints and limited understanding of the importance of having good feedback discussions. “We found there may still be difficulties in sitting down next to someone and discussing what has happened. The themes of ‘no news is good news’ and ‘I don’t want to disturb the boss,’ were highlighted as signature features of the feedback culture in radiology, both of which reduce trainees’ engagement with feedback. “The more that we can enhance feedback to trainees then their performance should ultimately be improved and this leads to safer and better outcomes for patients.” Dr Rhodes said he study highlighted how trainees and supervisors needed to work together to ensure feedback is provided effectively. “I don’t think one single guideline will solve the problem,” Dr Rhodes said. “There are things that could improve [feedback provision] though like organising dedicated time to providing feedback and orientating trainees and supervisors to the purpose of feedback.” Dr Rhodes said he hoped further research would lead to further discussion around radiology education, curriculum development and the successful implementation of workplacebased assessments

General Interest

Suggestions on surviving a nuclear blast From the Archives From time to time, the Archives uncovers something that captures an unusual aspect of the past. Through the course of our work, we came across a brief but informative guide titled, Survival From Nuclear Warfare. Delivered to the Australian population, the document appears to have come from those helpful people of the Commonwealth Directorate of Civil Defence. This department, as far as we have been able to determine, no longer exists, which, with Governments proclivities to disband entire departments well known, we can take this as perhaps a positive sign that the risk of nuclear attack has diminished significantly. Political commentary aside, whilst the title itself is indeed gripping, we can only imagine how, at a time of fear and paranoia, the arrival of this simple document in a person’s daily mail delivery would have generated a response far greater than idle curiosity.

The pamphlet includes helpful figures showing the chances of survival, depending on distance from the epicenter of the blast of a 20 Kiloton Device. Needless to say, for those unfortunate enough to be within the initial 2 miles (3.21 km) of the blast, your chances are less than ideal. It does however continue to provide other helpful suggestions such as “you need cover…” including for those inside, diving under a table or bed. Any barriers between your body and the explosion will reduce the dose of gamma rays you are likely to receive. The Directorate finishes the pamphlet reminding readers at the end that it is unlikely that you will need to put this information to use, however we are keeping it in the archives just in case…

For RANZCR members Though the Trainor Owen Archive is accessible to all, the College makes our archivists available to members who would like assistance in combing through the archives or for those unable to access them in person due to geographical constraints. In order to make an appointment or to request assistance from the College Archivist, email Eva Stokes-Blake at archives@ranzcr. edu.au Donations to the archive are assessed on a case by case bases

Volume 15 No 2 I March 2019

General Interest

Cardiac CT Training 2019 We go beyond simply meeting training requirements:

~ In Memoriam ~

Unrivalled venues: MAY: Zest, Point Piper, Sydney NOV: ICC Darling Harbour, Sydney

Dr Neville Myers, Fellow, SA AICC ULAR CT

AUSTRALIAN

TITU

2019 COURSE DATES: 5 Day Level A Course 2nd - 6th May 2019 7th - 11th November 2019 3 Day Recertification Course SOLD OUT May 2019 9th - 11th November 2019

The College notes with regret the death of the following members: Dr John Ronald Maxwell, Fellow, Overseas

ASC

RANZCR accredited for 117.5/67 CPD points (Level A/Recertification).

D TE OF CAR

For more information and online registration log on to: www.aicct.com.au or contact us at: info@aicct.com.au

3rd Structural Heart Disease Asia-Pacific Symposium Grand Millennium Hotel Auckland, 4th - 6th April 2019

The SHD-AP Symposium is designed for all health professionals involved in the management of structural heart disease. Our international invited speakers include Dr Michael Reardon (Houston), Prof Douglas Shook (Boston), and Dr Susheel Kodali (New York). The program includes plenary lectures, a wet dissection workshop correlated to advanced cardiac imaging, CT workshop, live interventional simulator workshop for cardiac surgeons, live case transmissions and case in a box presentations. Register now at www.shd-ap.org

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Inside News

Anatomy and Pathology Review Illustrative Cases for Radiologists and Registrars Comprehensive Notes provided to Participants

Speaker: Dr Robin Cassumbhoy Course Conveners: Dr Daniel Saddik and Dr Con Tartaglia

WHY WASTE YOUR LIFE IN TRAFFIC? JOIN #TEAMQXR We’re not your regular Radiology group!

At Queensland X-Ray, we believe in, think about, and do things differently Considering a lifestyle change? We are looking for Doctors to work in our regional practices across Townsville, Mackay, Cairns and Toowoomba In turn we can offer you: The opportunity to report general and subspecialist radiology with the latest equipment in a relaxed and supported setting ▷ Mixed caseload of hospital and community imaging, procedures and subspecialty meetings ▷ Practice management and decision making at a local level ▷ Access to a nationally-supported state-wide integrated PACS, allowing you to report on a range of cases from across the state ▷ Work with a collegiate and supportive group of Radiologists, many with world-class subspecialty experience ▷ Extremely competitive salary and leave allocations with regional allowances ▷

Want to take a closer look? Why not let our friendly skeleton Ray show you around? He’ll give you a good idea of what it’ll be like working as a Doctor in our great team.

Interested in joining #teamQXR? Send an email to: radiologycareers@sonichealthcare.com.au or register your interest via qldxray.com.au/careers

qldxray.com.au

ABOUT COURSES The very successful Intensive Breast and Pelvic MRI courses continue to offer the highest quality educational experience for Radiologists seeking to enhance their diagnostic skills.

INTENSIVE BREAST MRI COURSE Melbourne | May 10-12

Faculty: Dr Ritse Mann, Radboud

The Intensive MRI courses led by Dr Allison Rose (Breast MRI) and Dr Clair Shadbolt (Pelvic MRI) are continually updated to ensure delegates experience actual reporting of a large volume of MRI over 2 or 3 days.

University, The Netherlands INTENSIVE PELVIC MRI COURSE Sydney | October 25-27

Faculty: Prof Gina Brown, Royal Marsden Hospital & Dr Alberto Vargas, Memorial Sloan Kettering Cancer Center

• • •

RECTAL CANCER MDT CURRENT ISSUES Sydney | October 26 (One Day Lecture)

Case Based Lectures by Prof Gina Brown, Royal Marsden Hospital

THE COURSES PROVIDE

• • • •

Internationally recognised experts in their field Individual workstations 100 plus cases, with pathology, to review in the delegates own time A series of lectures from international and local faculty Group case review Expert panel Faculty on site throughout the course to provide individual support

For more information and registration www. tn ia ustra l ia . c om