Volume 15 No 4 / September 2019
Quarterly publication of The Royal Australian and New Zealand College of Radiologists
INTEROPERABILITY Creating digital health solutions for patients
Also Featured in this edition
Changes to College Exams
ASM 2019
Program announced
Silicosis The College responds to the growing crisis
Kick start your career with our new junior consultant program I-MED Radiology are offering a brand new initiative for graduate FRANZCR radiologists starting in 2020. The 12 month development program is designed to support your successful transition into private practice radiology. You will have some of the best doctors in Australia as your mentors, participate in relevant clinical development initiatives, and learn valuable non-clinical skills such as management of staff and referrer marketing. Contact us now for more detailed information.
Discover new horizons with I-MED Radiology For radiologists seeking new horizons, I-MED Radiology’s national network is uniquely placed to offer career advancement, financial rewards and new life experiences. Speak to us now regarding the following fantastic opportunities: Location Perth, WA Port Macquarie, NSW Central Coast, NSW Kempsey, NSW Gladstone, QLD Albury, VIC Launceston, TAS Cairns, QLD
Role MSK / MRI Radiologist Tier B Interventional Radiologist MRI Radiologist General Radiologist General Radiologist Tier B Interventional Radiologist General Radiologist General Radiologist
If you are interested in joining the I-MED team please contact Chief Medical Officer Ron Shnier on 0418 261 004 or ron.shnier@i-med.com.au. Alternatively contact Leanne O’Brien from the I-MED Recruitment team on 02 8274 1075.
Editor’s Pick 5 7 8 9 11
Patient access is front of mind Consensus leadership in the time of the Strongman Australian Branch News New Zealand Branch News News in Brief
12 15
Silicosis The College responds to the growing crisis ASM 2019 - The Auckland Program announced
What are your thoughts?
19 21
Workshops update
22 25 27 29
A glance at the proposed changes to College Exams
Interoperability: Creating digital health solutions for patients
In Memorium Professor Turab Chakera Targeting Cancer Inside Radiology
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31 40 47 51
From the Faculty of Radiation Oncology
News from the professions College Life
52 53
From the Faculty of Clinical Radiology
College Volunteering: Why get involved
Radiology on the front lines - From the Archives
RANZCR Research Grant update
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
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.
Inside News © 2019 The Royal Australian and New Zealand College of Radiologists® (RANZCR®)
SUPPORT THAT’S AS INDIVIDUAL AS THEY ARE *
*Helping to meet the needs of patients with prostate cancer and healthcare professionals through initiatives such as patient support materials and supporting educational activities.
Zoladex is indicated for:1 Palliative treatment of metastatic ( M+ ) or locally advanced prostate cancer where suitable for hormonal manipulation. Adjuvant and neoadjuvant therapy in combination with radiotherapy for the management of locally advanced prostate cancer in men suitable for hormonal manipulation.
Before prescribing please review full Product Information available on request from AstraZeneca on 1800 805 342 or at www.astrazeneca.com.au/ PI PBS Information: Zoladex 10.8mg. Restricted benefit for locally advanced
( equivalent to stage C ) or metastatic ( equivalent to stage D) carcinoma of the prostate. Zoladex® 10.8 mg Implant ( goserelin acetate ) Minimum Product Information. Indications: Metastatic ( M+ ) or locally advanced prostate cancer; adjuvant and neoadjuvant therapy in combination with radiotherapy for locally advanced prostate cancer. Contraindications: Hypersensitivity to LHRH, LHRH agonist analogues or any components of ZOLADEX. Precautions: Not indicated for use in females or in children; patients with metastatic cancer at risk of developing ureteric obstruction or spinal cord compression - use of ZOLADEX should be carefully considered and monitored closely in the first month; injection site injury, including pain, haematoma, haemorrhage and vascular injury, care with patients of low BMI and /or receiving full anticoagulation medications; bone pain; serum testosterone concentrations may rise if implant is omitted or delayed; loss of bone mineral density; hyperglycaemia and increased risk of developing diabetes – periodically monitor blood glucose and /or glycosylated haemoglobin ( HbA1c ). Androgen deprivation therapy may result in prolongation of QT/QTc interval- consider benefits versus risks in patients with congenital long QT syndrome, congestive heart failure, frequent electrolyte abnormalities or taking drugs known to prolong the QT interval. Correct electrolyte abnormalities. Monitor for symptoms and signs of development of cardiovascular disease and manage appropriately. Effects on fertility – see full PI. Adverse reactions: Very common ( ≥10% ): decreased libido, hot flush, abnormal blood pressure, hyperhidrosis, erectile dysfunction, gynaecomastia, breast tenderness, paraesthesia, decreased bone mineral density; Common ( ≥1% to <10% ): impaired glucose tolerance, spinal cord compression, incontinence/urinary frequency ( post-radiotherapy ), rash, bone pain, arthralgia, injection site reaction, cardiac failure, myocardial infarction, increased weight, mood swings; For less common adverse reactions, see full PI. Dosage: One implant ( 10.8 mg ) injected subcutaneously into anterior abdominal wall every 3 months. Caution should be taken while inserting ZOLADEX into the anterior abdominal wall due to the proximity of underlying inferior epigastric artery and its branches. Use extra care when administering ZOLADEX to patients with a low BMI and /or who are receiving full anticoagulation medication. Date of first inclusion in the ARTG: 22 May 1996. Date of most recent amendment: 16 May 2017. References: 1. Zoladex 10.8 mg Approved Product Information. Zoladex® is a registered trademark of the AstraZeneca group of companies. Registered user AstraZeneca Pty. Ltd. ABN 54 009 682 311. 66 Talavera Road, Macquarie Park, NSW 2113. www.astrazeneca.com.au. For Medical Information enquiries: 1800 805 342 or medinfo.australia@astrazeneca.com. To report an adverse event: 1800 805 342 or via https://aereporting.astrazeneca.com. AU -5913, WL302306, April 2019
Introduction
Patient access is front of mind The President on equity in healthcare
Dr Lance Lawler
How we measure equity in health outcomes is almost a discipline in itself, but life expectancy at birth is one widely accepted measure. Global life expectancy currently sits at about 72 years,1 but this average subsumes very wide health inequalities that correlate strongly with per capita income, geography and ethnicity. Not all inequalities in health are inequitable simply because they lead to differences in life expectancy. One we tacitly accept is that males do not live on average as long as females. Our acceptance of this is because the inequality is largely the result of factors we consider unavoidable. An unfair health outcome is an inequality that is socially avoidable. For RANZCR these are chiefly those inequalities related to access to high-quality patient care for diagnosis and treatment and the factors which inhibit access. Take, for example, the health gap between Indigenous and nonIndigenous people in Australia and New Zealand, especially among those in rural and remote areas. In the most recent Closing the Gap report, it was evident that, while life expectancy among Indigenous men and women was improving, progress over the last five years in narrowing of the gap between Indigenous and non-Indigenous was not statistically significant.2 In absolute terms, the life expectancy of Australian Indigenous men is same as that of men in Romania, where per capita health expenditure is less than a tenth of that in Australia.3 In 2017, the health gap was still a whopping 8.6 years for men and 7.8 years for women, and the disparity gets worse when we add remoteness or
income to the analysis.4 Increasingly it is evident the missing ingredient in the policy mix is equity in health. RANZCR is playing its part in addressing inequities in health outcomes arising from patterns of access and treatment. Why do we do this? First, our commitment to best practice is fundamentally more than an exercise in technical training and knowledge—it
“In absolute terms, the life expectancy of Australian Indigenous men is same as that of men in Romania, where per capita health expenditure is less than a tenth of that in Australia.” has a moral dimension which entails compassion towards all patients and fairness in the provision of care. Second, as clinicians, we have the means, supported by government policy, to make real advances in creating a fairer health landscape. We simply have to choose to do what is right and persuade governments to agree. The College is working to improve equity generally through better access to our services and higher practice standards, but also among specific disadvantaged groups via more culturally safe and competent care. Early this year, in response to our advocacy efforts, the Coalition parties committed to issue an additional 50 MRI licences to
improve access, while the ALP promised it would eliminate out-of-pocket costs for cancer patients needing diagnostic imaging. We also recently achieved a government commitment to indexation in the Medicare rebate for ultrasound, a measure which benefits patients struggling with out-of-pocket medical expenses. In the Indigenous health sector RANZCR has recognised that we need to do more and will be taking steps to increase the Indigenous participation rates in clinical radiology and radiation oncology— both as patients and as practitioners. These steps will include curriculum development to improve members' understanding of Aboriginal and Torres Strait Islander and Māori and Pasifika cultures. New initiatives to support increased recruitment of Indigenous people into our training programs, relationship building with Indigenous health organisations, and most critically plans for formal representation of Indigenous views within the College governance structure are also being laid out. We have some distance to go on these issues, and the policy terrain is rather rugged, but we are surely headed in the right direction.
References 1 World Health Organization (WHO), World Health Statistics 2018 (Geneva: WHO, 2018), 66. 2 Department of the Prime Minister and Cabinet (DPMC), Closing the Gap Report 2019 (Canberra: Commonwealth of Australia, 2019), 124, https:// ctgreport.pmc.gov.au 3 Australia's per capita health expenditure in 2015 was US$4934, while Romania's was US$442. WHO, World Health Statistics, 60 and 64. 4 In remote and very remote areas, the gap in life expectancy between Indigenous and non-Indigenous women was 14 years. DPMC, Closing the Gap Report, 129.
Volume 15 No 4 I September 2019
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What’s in Issue 4? Medical Imaging Original Article: Impact of e‐scooter injuries on Emergency Department imaging Corresponding author: Dr Laura J Mayhew, Radiology Department, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand. Introduction ‐ Since the introduction of a shared e‐scooter service to Auckland in October there have been multiple media reports of associated injuries, but no quantitation of the number or severity of these injuries, or the impact on hospital emergency department services in Auckland. Methods ‐ We performed a retrospective chart review on all patients referred to Auckland hospital ED radiology with the indication containing ‘e‐scooter’ between 15 August 2018 and 15 December 2018. All requests were screened to ensure that the injury was caused by an e‐scooter. Recorded data included patient demographics, type of imaging utilised, injury type, and whether admission or surgery was required. Results ‐ Sixty‐four patients met the inclusion criteria, only one of these was prior to introduction of shared e‐scooters on 15 October 2018. Of these, there were 27 limb fractures, 3 dislocations, a fractured spine, 12 patients with concussion, 1 extra‐dural bleed, 9 facial/skull fractures and multiple soft tissue injuries. Almost 40% of the patients required admission to a specialty service following imaging, and 25.4% required surgery. A total of 221 plain films and 47 CT scans were performed for e‐scooter injuries in the 2‐month period after their introduction Conclusion ‐ Introduction of shared e‐scooters has resulted in a large number of serious related injuries that have required urgent radiology imaging. Many of these patients required further specialist consultation or surgery, and place an increased burden on overstretched emergency department services.
Medical Imaging Pictorial Essay: Giant Breast Masses Corresponding author: Clinical Associate Professor Donna Taylor, Department of Diagnostic & Interventional Radiology, Royal Perth Hospital, Level 3 North Block, 197 Wellington Street, Perth, WA 6000, Australia. In this pictorial essay, we showcase the imaging and pathological findings of a variety of giant breast lesions. Some lesions such as lipomas and hamartomas contain fibrous, glandular and lipomatous tissues and can have characteristic mammographic appearances. Other lesions (e.g. simple cysts, fibroepithelial lesions and some malignancies) may be mammographically indistinguishable and ultrasound (US) may be helpful in further characterisation, for example, by demonstrating posterior enhancement with simple cysts, cystic and solid components in papillary lesions, internal septations on haematomas and abscesses, solid homogeneity or heterogeneity in fibroepithelial lesions and increased vascularity in neoplastic, inflammatory or infective lesions. A diagnostic needle biopsy may be performed in some cases; however, with larger and heterogeneous lesions, there is an increased possibility of diagnostic inaccuracy due to limited sampling, such that full excision of the lesion may be advisable to ensure an accurate diagnosis.
Radiation Oncology Original Article: Measuring (and narrowing) the gap: The experience with attendance of Indigenous cancer patients for Radiation Therapy in the Northern Territory Corresponding author: Dr Scott Carruthers, c/‐ Alan Walker Cancer Care Centre, Royal Darwin Hospital, Rockland Drive, Tiwi, NT 0810, Australia. Introduction ‐ Barriers exist for both Indigenous and remote patients attending cancer care facilities. We sought to measure clinical attendance of all patients referred for consideration of radiation therapy (RT) at the single radiation therapy centre in the Northern Territory (NT), with particular attention to a comparison of Indigenous and non‐Indigenous patients, and to analyse methods introduced to address the attendance of patients. Methods ‐ Patients referred for radiation therapy over a 5 year period from the commencement of the Alan Walker Cancer Care Centre (AWCCC), NT, were analysed for attendance, and for possible improvement over time. Results ‐ Multivariate analysis of non‐attendance prior to RT (pre‐RT) showed significance for Indigenous status (P < 0.001), and female gender (P < 0.001), and during RT showed significance for Indigenous status (P < 0.001) and curative intent RT (P = 0.012). Attendance during RT over the 5 years showed significant improvement over time for Indigenous patients from 70.6% to 81.6% (P = 0.038). There was no significant improvement with pre‐ RT attendance for either the Indigenous or non‐Indigenous cohort. Conclusion ‐ Indigenous patients experienced a lower level of attendance during RT, but this has significantly improved over the first 5 years of operation at AWCCC, as recognition and management of contributing factors has improved.
Radiation Oncology Original Article: Temporal impact of the publication of guidelines and randomised evidence on the adoption of hypofractionated whole breast radiotherapy for early‐stage breast cancer Corresponding author: Dr Kyung Yoon Kylie Jung, Department of Radiation Oncology, Building 19,
Level 1, The Canberra Hospital, Yamba Drive, Garren, ACT 2605, Australia.
Introduction ‐ and/or tumour bed boost radiotherapy (TBBR), chest wall sepJMIROtion distance (CWSD) and patient age were significant predictors of HF‐ WB WBRT) in early‐stage breast cancer patients have accumulated over the last decade. Despite the availability of the published evidence, the adoption rate of HF‐WBRT has been slower‐than‐expected. We sought to assess the temporal impact of the publication of the guidelines and randomised evidence on the practice pattern of HF‐WBRT and identify clinical predictors of its utilisation. Methods ‐ Women with early‐stage breast cancer who received adjuvant WBRT at Canberra Health Services between 2008 and 2016 were identified from clinical databases. The patterns of HF‐WBRT use were analysed in relation to pre‐specified time periods (before and after the guideline publications) in the entire cohort as well as in a patient subset fulfilling the criteria for HF‐ WBRT according to the guidelines (referred to as ‘guideline‐endorsed subset’). The impact of clinical variables, treating clinicians and the time periods on the adoption of HF‐WBRT was assessed by hierarchical multivariate logistic regressions. Results ‐ Of the entire cohort (n = 1171), the guideline‐endorsed subset constituted 51.6% (n = 604) of the patients. HF‐WBRT was utilised in 32.8% of the entire cohort and 46.2% of the guideline‐endorsed subset. Between 2008 and 2016, HF‐WBRT use rate increased from 12.1% to 56.6% in a non‐linear pattern. Release of international and local consensus guidelines significantly correlated with the increase in HF‐WBRT utilisation rate. The use of chemotherapy and/or tumour bed boost radiotherapy (TBBR), chest wall sepJMIROtion distance (CWSD) and patient age were significant predictors of HF‐WBRT use on multivariate analyses. After factoring in the effects of individual clinicians and the time periods on hierarchical multivariate analyses, the use of chemotherapy, TBBR, and CWSD remained as significant variables. Clinicians contributed to the variability in the HF‐WBRT adoption pattern. Conclusion ‐ The temporal uptake pattern and the predictors of adjuvant HF‐WBRT use in early breast cancer patients largely reflected the accumulating clinical evidence and the publication of the consensus guidelines. This study identified potentially modifiable factors associated with slower‐than‐expected uptake rate of HF‐WBRT. Understanding why there is variability in clinicians’ readiness to adopt the abbreviated treatment despite the availability of advanced radiotherapy techniques and the updated evidence is an important step towards formulating effective strategies to optimise the radiotherapeutic management of this common malignancy.
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!
Introduction
Consensus leadership in the time of the Strongman The Chief Executive Officer reflects on leadership Ms Natalia Vukolova Democracy or the ‘rule by the people’ is out of fashion. Or so argues the Quarterly Essay ‘Follow the leader, democracy and the rise of the strongman’ by Laura Tingle. The essay highlights the growing focus on the person of the President in democratic societies, and the resultant obsession with the President’s personal authority and charisma. Elections as a result increasingly turn into a personality contest. Examples are given that showcase how after WWII and the appalling rise of Hitler and fascism the world was wary of charismatic autocrats. It was understood that groups of people who had to negotiate and build consensus are a better model of government and governance. In recent years this understanding has been eroded and many people appear tired of committees and want a strongman to ‘fix’ real and perceived societal ills. The essay eloquently argues these points and I thoroughly recommend it as a read. The Quarterly Essay made me reflect on the College structure and membership. When speaking to members, I often hear about the weight of expectation that is tacitly placed on the College office bearers: the President, Deans and Chief Censors. Members often imply in conversation that they expect a level of autocratic heroism from these individuals, some sort of transcendental approach to ingrained systemic challenges for the profession, the health system or the College. Indeed, I found myself on several
occasions asked by members directly and without irony how I, as CEO, ‘plan to fix radiology?’ Are these sentiments a reflection of a broader societal trend of fatigue with democracy? Are we tired of the necessary debate, tensions, disagreement, committees and compromise that democracy creates? At the same time, when members disagree with a direction taken by the College on a matter, the lead office bearer often gets targeted. Somehow it is understood that perceived missteps could have been remedied if the ‘right’ person was in the top job. So there is a sense of tension in what is expected: decision-making but not too much; verve but in the right direction; constrained leadership yet transformative change. The idea of decision-making through representative groups is at the heart of College structure. The Board of Directors, Faculty Councils and key committees are all comprised of elected members or those who volunteered through an open expressions of interest process. The College actively encourages new members to engage with College work by having limited terms that any person can stay in their College role. This is also the reason why we consult with membership on key policy documents and encourage feedback. The office bearers are important, yes, but they are not the ultimate arbiters on most issues of College’s policy, standards or approach. These decisions principally vest in the College’s decision-making committees:
on significant matters - directly, on more minute or immediate matters – via a pre-agreed set of policy views and approaches. It is important that the precious value of these volunteer groups, who argue and toil to build consensus on many tricky issues, is seen and understood by the broader membership. In this democratic structure a good leader is a person who can deftly navigate opinions and politics, stay focused on patient benefits and facts, and understand the College’s strategy. Most crucially, they must build consensus for change among their peers. I believe that good, thinking, proactive individuals have an enormous role to play in our College and society in general. The Quarterly Essay quotes Ronald Heifetz from Harvard who defined leadership as ‘helping a community embrace change’. We should value leaders but what we should value even more is the frustrating mess and the community that we call democracy.
Volume 15 No 4 I September 2019
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News
Australian Branch News
Finding your own story:
NSW Branch news:
VIC Branch News:
In the last issue, College CEO Natalia Vukolova spoke about doctors finding their own stories. We received a surprising response from members and some wishing to share their own story.
The NSW Branch hosted its first Anatomy Mock exam for Part 1 candidates on March 6 and will be hosting a further session on the 7th August 2019. The forum was hosted by Dr Rajiv Rattan (NSW Branch Education Officer), Dr Pramod Phadke (NSW Branch Chair) and two senior trainees: Dr Sally Ayesa and Dr Merribel Kyaw and was held at Royal Prince Alfred Hospital, Sydney.
On July 4, the Victorian Branch held their third annual dinner at il Duca Restaurant in East Melbourne. 75 Victorian radiologists and radiology registrars braved the cold and light rain, and travelled from all corners of the metropolis, to share warm food, wonderful wine and to catch up with friends and colleagues.
There were approximately 20 candidates who attended, from newly appointed first years to rresitters, and a Newcastle Candidate also dialed in. Candidates had a trial exam covering both Paper 1 and Paper 2 questions followed by discussion on exam style, techniques, tips and strategies. We wish all exam candidates the best of luck in the upcoming second sittings for 2019.
The topic of the night was Artificial Intelligence (AI). Two registrars, Dr Jarrel Seah of The Alfred and Dr Jennifer Tang of The Royal Melbourne, spoke on some practical applications and the potential helpful uses of AI. The main event of the evening was a presentation by Professor Meng Law, Professor/Director of the Alfred Imaging department, who managed to leave no one in doubt about the potential limitless applications of AI and how it dwarfs even the peak of our human potential. The excellent presentations were followed by an interactive question and answer time, and an exceptional time was had by all. Old bonds were renewed, new friendships were made, and the Victorian cohort of radiologists has grown closer than before. Plans are already being made for next year’s dinner and for many more to come. We hope that the tradition of the annual dinner has been established.
Dr Rajiv R from NSW writes: I did a lung biopsy for a lovely 84 year old gentleman recently. During the consent process I was chatting to him and just held his hand for a few moments. His eyes became moist and he said “Doc I am in your hands. I trust you completely. I was feeling terrified before but now I am relaxed.” A small thing on the face of it but for the patient and family it has such a huge impact. A few years ago, there was this 93 year old at a non-metro hospital who came with acute cholecystitis febrile and delirious - really sick. No surgeon would touch her because of high anaesthetic risk. I did an ultrasound guided cholecsytostomy for her to drain the infected bile. She kept moving throughout the procedure, it was not possible to give her too much sedation. In short it was by no means easy to get a drain into the gallbladder. I was at another hospital the next morning and I sent the nurse around to see her the next morning. The nurse called me after visiting her in the ward. She was jumping with joy when she called me. “You will never believe what I saw!! Our girl who was delirious and sick yesterday was sitting up in bed applying lipstick and ready to tuck into some brekky” This is the reward of Medicine- the only high, I dare say and really this is what makes all the stress worthwhile. If you have a story you wish to share with members, please send it to editor@ranzcr.edu.au
8
Inside News
News
New Zealand Branch News
Dr Gabes Lau
Kia ora. We’re now over halfway through the year and it has been a busy one.
Cancer Care plan At the “Cancer Care at a Crossroads” conference held in January 2019, New Zealand’s Minister of Health (Hon Dr David Clark) promised “to get the ball rolling in regard to improving Kiwis access to fair and consistent cancer treatment”. At the Radiation Oncology Horizon Summit held in Wellington on 9 May, Dr Clark reaffirmed the government’s commitment to developing a new cancer plan, with “an equity of outcomes as a priority”, and later commented that the Health and Disability review has supported the goal of "achieving equity of outcomes". The College’s response to the Health and Disability review had a focus on the need for a nationally coordinated approach in the management of cancer in New Zealand and supported the goal of achieving an equity of outcomes. The College welcomed the announcement on Sunday 4 August, when Prime Minister Jacinda Ardern pledged to spend millions upgrading radiation machines (replacing five linacs by the end of 2019) and make cancer treatment more accessible in the regions. Linacs will be purchased for Taranaki, Hawke’s Bay and Northland, meaning that cancer sufferers in these regions will not have to travel to a larger centre for treatment.
The long-awaited New Zealand Cancer Action Plan was released by the NZ Minister of Health on 1 September for consultation and was distributed to all New Zealand members for their feedback.
Centralised recruitment for registrars starting in December 2019 A successful round of centralised recruitment has been completed for another year. We had 36 applications to fill 19 clinical radiology training positions and 7 applications to fill four radiation oncology training positions, who start training in December 2019. This represented an increase on 15 positions in 2018 for radiology, and a decrease on five positions in 2018 for radiation oncology.
Branch Education Officer – Dr Lisa Sweetman Dr Sweetman is stepping down at the end of this year as NZ Branch’s Branch Education Officer (BEO), and I would like to acknowledge all the hard work and effort that she has put into the role of BEO over the past four years, as well as six years as Alternate BEO, and over six years on recruitment panels.
Health and Disability Review update Dr Carol Johnson and I met with Heather Simpson in May to discuss the College’s priorities for the review. The NZ Branch submitted two responses (radiology and radiation oncology) to the Health and Disability Review on 31 May. Our responses covered off: • Workforce issues, such as workforce fragility, ethical referrals and waiting times in public hospitals • Systemic issues such as, funding, data gathering for radiology, IT systems and AI, and ethical referrals • Issues affecting patients, e.g. decision-making (and where decisions should be made, equity of outcomes (see President’s piece), and a nationally coordinated approach for radiation therapy / cancer treatment A discussion document by the Review Panel was released in September. The review is expected to be completed in March 2020.
continued over...
On behalf of the NZ Branch I would like to thank Dr Sweetman for the excellent work she has done for the Branch over a significant period of time.
Volume 15 No 4 I September 2019
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LEAD THEM ALL. EXCLUSIVE BENEFITS FOR RANZCR MEMBERS.
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News
2020 New Zealand ASM The 2020 ASM for New Zealand will be held in Wellington from 7-9 August 2020. Over 200 delegates attended the Queenstown ASM, and the success of this ASM was largely due to the excellent programme developed by the Convenors. It is incredibly important that the New Zealand Branch has its own ASM, as this provides NZ members with the opportunity to showcase local speaking talent and to network with colleagues.
Getting involved at the College The College is currently seeking a person to fill the key role of Training Network Director (Radiation Oncology). This is a great opportunity for Fellows and Educational Affiliates in the Branch to come on board and get involved with the College. Please contact nzbranch@ranzcr.org.nz, telephone (04) 472 6475 or visit the College website for more information.
News in Brief MBA reviews IMG process RANZCR is currently reviewing the Medical Board of Australia (MBA) commissioned report, "External review of the specialist medical colleges performance – specialist international medical graduate; assessment process, to ensure the College aligns with the MBA Practice Guidelines guidelines for the specialist international medical graduate assessment process". RANZCR will provide stakeholders with relevant information on any amendments required in order for our processes to align with the MBA Good Practice Guidelines.
Silicosis Support Network created The Asbestos Disease Support Society has created a Silicosis Support Network. The Society is a not-forprofit charity registered with the Australian Charities and Not-For-Profit Commission (ACNC). The Silicosis Support Network was established in response to the emerging trend of new cases of silicosis, a preventable occupational lung disease occurring as a result of exposure to silica dust.
If you have some news to share, please contact the Inside News staff at editor@ranzcr.edu.au
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Volume 15 No 4 I September 2019
11
Features
Silicosis:
The College responds to an emerging crisis for accurate, reliable screening and timely diagnosis of silicosis. It is paramount that we continue to do so. We have been working with the Royal Australasian College of Physicians (RACP) and the Thoracic Society of Australia and New Zealand (TSANZ) to develop a collaborative patient-focused strategy for the management of silicosis and other pneumoconiosis. The College is grateful for the contribution from members of our Professional Practice Committee and the Australian and New Zealand Society of Thoracic Radiology (ANZSTR) who were tasked with developing recommendations around training requirements for radiologists and diagnostic pathways for at risk, symptomatic and asymptomatic workers. Silicosis is an emerging public health crisis affecting workers and stonemasons who have been exposed to manufactured stone materials commonly found in kitchen, bathroom and laundry stone benchtops. RANZCR and our senior members are at the forefront of the response to this crisis in both Australia and New Zealand. Silicosis is caused by the inhalation of respirable crystalline silica dust from the manufacture or cutting of products, which scars the lungs and causes progressive respiratory impairment. Unlike natural stone such as granite, which typically contains up to 30 per cent silica, artificial stone can have silica concentrations of over 90 per cent (RACP, 2019). Accelerated silicosis is being seen in Australia and can result from only 3 to 10 years of exposure. The installation and renovation of kitchens, bathrooms and laundries using artificial stone is widespread throughout Australia and New Zealand. There is currently major concern that dust control practices within this industry have
12
Inside News
generally been poor resulting in many workers being exposed to extremely high levels of silica dust. Although the number of workers who may be affected is currently unknown, the amount of registered businesses undertaking kitchen benchtop manufacture in Queensland suggests at least 1,000 workers at risk of accelerated silicosis in that state alone (RACP, 2019). According to WorkSafe New Zealand, 52 people had contacted the agency between June and August "concerned about accelerated silicosis" and requesting more information. Given this, it is deemed that the number of affected or at-risk workers across Australia and New Zealand is significant. Imaging plays a central role in diagnosis and monitoring of occupational lung diseases including silicosis and other diseases resulting from exposure to engineered stone. This issue was highlighted in the June 2019 edition of Inside News and the College has continued to respond proactively to provide recommendations
The Australian Government has established a National Dust Disease Taskforce to develop a national approach to the prevention, early identification, control and management of dust diseases in Australia. In recognition of the key role that clinical radiology plays in both the screening and diagnostic setting, the Minister for Health, Greg Hunt, accepted the Collegeâ&#x20AC;&#x2122;s request to include a radiologist on this panel. The taskforce began work in August and is expected to provide Minister Hunt with interim advice by the end of the year. The taskforce will provide their final report to the Council of Australian Governmentsâ&#x20AC;&#x2122; Health Council by 31 December 2020.
Features
The Government has also provided $5 million to support the taskforce and related measures, including establishing a National Dust Disease Register, and new research to support the understanding, prevention and treatment of preventable occupational lung diseases. Internally, the Thoracic Special Interest Group has worked to develop reporting templates and learning materials for clinical radiologists to be equipped with necessary tools to appropriately diagnose and manage patients. A position statement to inform the screening and diagnosis of silicosis
has also been developed and sent to members for consultation. While historically chest X-ray has been the primary imaging modality used to detect lung disease due to silica exposure, CT has a higher sensitivity for detecting early disease, and greater accuracy in characterising the patterns of disease. For these reasons, and in the context of the findings described in Australian workers, CT of the chest is strongly recommended in the position statement as the primary imaging modality to be used for screening exposed workers.
Finally, a full session exploring imaging in the diagnosis and management of occupational lung diseases will take place at the Annual Scientific Meeting (ASM) in Auckland on Friday 18 October. We will continue to keep our members informed as this important work on silicosis continues, and we look forward to hearing your feedback as we develop proposals, training and educational materials, and other documents. If you have any contributions, thoughts or comments, please contact Amy Young, Standards Unit at professionalpractice@ranzcr.edu.au
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Volume 15 No 4 I September 2019
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WE’RE NOT YOUR REGULAR RADIOLOGY GROUP! JOIN #TEAMQXR
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
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Practice management and decision making at a local level
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Access to a nationally-supported state-wide integrated PACS, allowing you to report on a range of cases from across the state
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Interested in joining #teamQXR? Send an email to: radiologycareers@sonichealthcare.com.au or register your interest via qldxray.com.au/careers
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Features
Program announced! On October 17, the City of Auckland will play host to the 70th Anniversary of the ASM, bringing together practitioners from around the world for a weekend of information and entertainment. Over four days, minds will be expanded, ideas debated and hopefully, a good time will be had by all. For many of you, this will be your first visit to Auckland, (and some, New Zealand). This is an amazing location and close to so many other exciting experiences that we encourage you to give yourself a little time to explore this magnificent region. From Wine tours, and volcanic islands, to the natural wonders of the country and the only Island Dark Sky Sanctuary, there is much to be found and experienced nearby. The ASM itself will be no less impressive with a collection of experts coming together to speak on a range of topics including talks on Intelligence 19, AI in Healthcare. You can find copy of the program on the ASM website.
Women in Medical Leadership Breakfast â&#x20AC;&#x201C; Thursday 17 October After the success of the inaugural Women in Medical Leadership Breakfast in Canberra 2018, the breakfast is back and will be held at SkyCity overlooking the stunning city. Dr Valerie Jackson, President of the Radiological Society of North America (RSNA) will be sharing her insights around increasing the presence of women in medical leadership roles. An expert in breast imaging, Dr. Jackson is executive director of the American Board of Radiology (ABR). She is the Eugene C. Klatte Professor Emeritus at Indiana University School of Medicine where she has had numerous academic appointments, including Chair, Department of Radiology and Imaging Sciences. She has published over 100 peer-reviewed articles and 20 books and book chapters emphasising breast imaging and radiologic education. She is a highly regarded lecturer, having given more than 320 scientific and educational presentations worldwide.
University Radiologists (AUR), Academy of Radiology Research, Society of Breast Imaging (SBI), American Board of Radiology and the American College of Radiology (ACR). She joined the RSNA Board of Directors in 2012. Recipient of numerous honors, she is an ACR fellow and has received gold medals of the IRS, AUR, SBI and ACR. The Valerie P. Jackson Education Fellowship recognises her work with ACR.
Dr Valerie Jackson
Dr Jackson has held leadership positions in several radiologic organizations, including the Indiana Radiological Society (IRS), American Roentgen Ray Society (ARRS), Association of
continued over...
Volume 15 No 4 I September 2019
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Features
Guest Speakers CLINICAL RADIOLOGY Speaker Spotlight – Dr David Sacks Dr David Sacks received his undergraduate degree in chemistry from Princeton University, his medical degree from the University of Pennsylvania, and completed his residency in diagnostic radiology and fellowship in interventional radiology at the University of Pennsylvania. He has been an interventional radiologist at Reading Hospital since 1985. He has served at the local level as President of the Philadelphia Angiography and Interventional Radiology Society and at the national level as Chair of the Technology Assessment Committee, Councilor for the Standards Division, and President of the Society of Interventional Radiology.
Speaker Spotlight – Dr Michelle S. Ginsberg Dr Michelle S. Ginsberg, MD is Vice Chair for Education and Director of Cardiothoracic Imaging in the Radiology Department at Memorial Sloan Kettering Cancer Center. She is a Professor of Radiology at Weill Cornell Medical College. She completed her radiology residency at Montefiore/ Albert Einstein College of Medicine in 1995 and an Oncologic Imaging fellowship at Memorial Sloan Kettering Cancer in 1996. Dr Ginsberg was named the 2018 New York Roentgen Society Distinguished Radiologist. She has served as President of the New York Roentgen Society. Dr Ginsberg’s research focuses on detection, characterisation and measurement of thoracic malignancies and improving techniques to assess tumor response. She has authored more than 133 original peer reviewed publications, invited reviews and chapters.
RADIATION ONCOLOGY Speaker Spotlight – Dr Drew Moghanaki Dr Drew Moghanaki is a radiation oncologist and clinical investigator within the US Department of Veterans Affairs. He is a member, scientific advisor, and chair of multiple national committees with the American Cancer Society, American Society of Radiation Oncology, Lung Cancer Alliance, and Lungevity Foundation. He leads the Phase 3 lung cancer Surgery vs SBRT trial in the VA that is known as “VALOR”, and has received over $36M in funding for lung cancer research and implementation.
Dr Drew Moghanaki
Dr David Sacks
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Inside News
Features
Speaker Spotlight – Prof Arjun Sahgal Prof Arjun Sahgal is an international clinical and research leader in the field of high precision stereotactic radiation to the brain and spine for both metastases and primary tumors. After training at the University of Toronto in radiation oncology, he completed a radiosurgery fellowship at the University of California San Francisco. He has published, as lead or contributor, over 250 peer reviewed papers including in high impact journals like the Journal of Clinical Oncology, Lancet Oncology, and New England Journal of Medicine. He has been the recipient of several distinguished awards and visiting professorships, served as past-meeting chairman and board member of the International Stereotactic Radiosurgery Society (ISRS), and current steering committee member for the AOSpine Tumor Knowledge Forum. He is the principle investigator for a national Phase 3 randomised trial (SC-24) evaluating spine SBRT to conventional radiation. Currently, he serves as Deputy Chief of the Department of Radiation Oncology at the University of Toronto affiliated Sunnybrook Odette Cancer Centre.
Prof Arjun Sahgal
Social Events There will also be plenty of opportunities to catch up with friends, colleagues and peers over the weekend with Faculty dinners, the Targeting Cancer Fun Run and the RANZCR Gala Dinner.
RANZCR ASM 2019 – Mike King, Nisbet Orator The Royal Australian and New Zealand College of Radiologists' are thrilled to announce Mike King as 2019’s Nisbet Orator. The 2019 New Zealander of the year, Mike is a mental health advocate and shines much-needed light on the issues of depression, alcohol and drug abuse and suicide in New Zealand. By drawing on his personal experiences, Mike has shown leadership, courage and empathy to vulnerable people, particularly Māori, children and young people, throughout the country.
HAVE YOU PLANNED YOUR OUTFIT? Don’t be OUTATIME There will be a number of social program highlights in the 2019 program, but the stand out event will be the RANZCR Gala Dinner, where we are encouraging you to channel your inner 80’s spirit and dress in theme as we dance the night away to some iconic 80’s music. Shoulder pads, perms, Mullets, Double Denim and fluorescent clothing are all welcome. RANZCR and platinum sponsors Varian are thrilled to host this incredible fourday event. Registration is available at http://www.ranzcr2019.com
Mike King will be presenting the Nisbet Oration at The RANZCR Annual Ceremony which will be held on Friday 18 October 2019 at the SkyCity Convention Centre, Auckland.
Mike King
Volume 15 No 4 I September 2019
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EXPAND YOUR BOUNDARIES. ENHANCE YOUR OPPORTUNITIES.
At the heart of Everlight is our team of Radiologists; valued, supported and recognised as the driving force behind Everlightâ&#x20AC;&#x2122;s ability to deliver quality patient care. Create the work-life balance of your choosing with Everlight Radiology. We currently have openings for FRANZCR Radiologists who want to report on Australian and New Zealand cases during awake hours, from exciting new global locations. This opportunity is designed for you. Work from exciting destinations abroad and to hours that suit your needs â&#x20AC;&#x201C; the choice is yours. No matter what stage of your career, we provide
the opportunity to advance, excel and grow as a professional and as a person. Join our dynamic team of 350+ consultant radiologists reporting from 36 locations around the world today. Learn more at https://bit.ly/2LyTEIZ or email PHay@everlightradiology.com to arrange a confidential discussion.
Education
A glance at the proposed changes to college exams Effectiveness of examinations depends on reliability, validity, educational impact, acceptability and feasibility. With this framework in mind, both Steering Committees have undertaken a rigorous review of the College examinations, as part of the Training and Assessment Reform. In consultation with various exam panels and Australian Council for Educational Research, they have proposed changes to current exams to make sure they are fit-for-purpose and aligned to the curriculum.
Clinical Radiology Part 1 Exams The new Anatomy and AIT examination formats will commence in Series 1 in March 2021, and will apply to all trainees, including new trainees commencing in 2021, as well as current trainees who will be required to sit the Series 1 2021 examinations for various reasons. Trainees will be permitted to apply to sit the Part 1 Anatomy Examination and Part 1 AIT Examination independent of each other.
Anatomy Exam
Current
Future
Two papers of
One paper based on radiological anatomy in three hours:
• 15 short answer questions in two hours and • Eight questions based on radiological anatomy in two hours
• 120 Diagram Labelling • 60 Multiple Choice Questions (MCQs) • 30 Very Short Answer Questions (VSAs) • 20 Short Answer Questions (SAQs)
Applied Imaging Technology (AIT) examination
Two papers of • three written essay format questions in two hours and • 100 questions multiple choice format in two hours
One paper based on content comprising imaging technology, quality and safety in three hours with: • written essay format questions in two hours • MCQs in one hour
Clinical Radiology Part 2 Exams Part 2 written exams will still comprise of Film reporting, Radiology and Pathology. However, the duration and format of questions will be changed to better assess the depth and breadth of trainees’ knowledge. Viva is a capstone assessment to assess trainees’ competencies in clinical reasoning, clinical judgement, medical knowledge, communication, and professionalism. Some key changes have been proposed to improve the consistency and reliability of the Viva exam: • Viva to be undertaken after all written exams are successfully passed • Standardised digital cases will be used to align with the contemporary practice and to reduce the variation in cases. • Structured questions will be presented to ensure candidates have the same opportunity to display knowledge • Standardised marking templates with rubrics will be used More details will be communicated once the exam changes are finalised. continued over... Volume 15 No 4 I September 2019
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WE KNOW HOW IMPORTANT BALANCE IS IN LIFE
THAT’S WHY WE STRIVE TO CREATE A FLEXIBLE WORK ENVIRONMENT FOR OUR TEAM. We want YOU to join our team of happy, fulfilled and dedicated Radiologists – today! What we can offer: • • • • • •
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To find out more about Exact Radiology, please contact Cari Clarke on 0407 091 190 for a confidential discussion or email hr@exactradiology.com.au
Our care, service and diagnosis are Exact
Education
Radiation Oncology Phase 1 Exams The new Phase 1 exams will be rolled out in March 2022, and will apply to all trainees, including new trainees commencing in 2021, as well as current trainees who will be required to sit the Series 1, 2022 examinations for various reasons. There will be two exam sittings every year, in early March and early September. Current
Future
Two written papers of two and a half hours each, to assess
Three separate papers to comprise of
• Anatomy • Radiation oncology physics • Radiation and cancer biology Each paper has six short answer questions (SAQs) (with sub parts). Candidates sit both papers on the same day.
• Two-hour anatomy exam with diagram labelling, MCQs and SAQs • Two-hour radiation oncology physics exam with MCQs and SAQs • Two-hour radiation and cancer biology exam with MCQs and SAQs Trainees can sit for the three papers separately and a pass of any paper can be carried over to next in the Series.
Radiation Oncology Phase 2 Exams The Phase 2 exams are considered to be fit-for-purpose overall. However, there will be minor changes to both written exams and viva to ensure a more comprehensive and integrated approach in assessing trainees’ competency in clinical practice. More details will be communicated once the exam changes are finalised. If you would like more information or have any questions regarding the exam changes and the TAR project, please contact Ms Legend Lee, Educational Developer at the College at legend.lee@ranzcr.edu.au.
Upcoming Workshops – Until 30 December 2019 Stoller: A Comprehensive Tutorial in Musculoskeletal Imaging, Sydney NSW, 04 – 06 October ESTRO School FALCON Workshop - Lymphoma Cancer, Online, 10 – 17 October Musculoskeletal MRI Conference, Melbourne VIC, 12 – 13 October New Zealand Lung Cancer Conference, Christchurch NZ, 17 – 18 October RANZCR Annual Scientific Meeting 2019, Auckland NZ, 17 – 20 October ANZSPR Annual Scientific Meeting 2019, Hanmer Springs NZ, 21 – 23 October Rectal Cancer Multidisciplinary Team: MRI & Current Issues, Sydney NSW, 26 October ESTRO Multidisciplinary Management of Non-Melanoma Skin Cancer course, Brussels Belgium, 07 – 09 November ESTRO School FALCON Workshop – Head and Neck Cancer, Australia Wide, 07 – 14 November Fundamentals of MRI Course, Adelaide SA, 09 – 10 November Webb, Müller & Naidich: A Masters Course in Chest Imaging in Hawaii, Hawaii USA, 11 – 14 November Australasian Vascular Anomalies Network (AVAN) NZ Meeting 2019, Wellington NZ, 06 – 07 December ESTRO Meets Asia 2019, Singapore, 06 – 08 December 2019 Events may be subject to change. Visit RANZCR Events page for further details.
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Feature
Interoperability Creating digital health solutions for patients The College strongly supports the adoption of eReferral in radiology. Secure electronic networks can improve how clinical and administrative information is exchanged between healthcare providers, resulting in better delivery of care for patients. In prioritising patient choice, an exchange repository model is preferred, based on the use of virtual ‘cloud’ technology where a referral is automatically transmitted to a secure virtual database and is then accessible to any provider chosen by the patient. Furthermore, standardised terminology for referrals to radiology, or an ‘orderables catalogue’, is a key building block to ensure referrals to radiology are compatible and would create a foundation for other digital health priorities. Even 10 years ago, it would have been difficult to envisage the effect that technology and digital innovation would have on our society. From smart phones, online shopping and streaming entertainment, the digital revolution has fundamentally transformed how we live our lives and in turn our expectations of the services we access. Patients’ expectations of the healthcare sector is no exception. Currently, the Australian Government through the Australian Digital Health Agency is working on multiple aspects of digital health, most notably My Health Record. The Australian Digital Health Agency was created to lead collaborative work to ensure that digital health solutions implemented in Australia support the delivery of safe, high quality patient care. Unfortunately, many of the projects currently underway are being progressed in isolation of each other without proper consideration to creating a holistic digital health solution for Australian patients.
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Inside News
Clinical radiology and radiation oncology are mature digital sectors with advanced informatics and highly evolved standards. The College has an ambitious agenda in digital health, and through our response to the National Health Interoperability Roadmap, has called for a shared vision for digital health beyond the Australian Digital Health Agency’s My Health Record. Our aim is to ensure that patients and doctors have access to all relevant healthcare information, to reduce duplication of imaging, waste and costs, and enhance patient safety.
What are the College’s top priorities for an interoperable health system? Our top five priorities for an interoperable health system are the adoption of an eReferrals system, access to historic images, standardised terminology, development of imaging guidelines and managed roll out of artificial intelligence.
Interoperability is at heart, about sharing clinical information between clinicians to improve patient care. Given the core role of imaging in patient management, it is imperative to ensure that referrers and radiologists can have access to historical images. Patients inevitably attend for care across multiple settings, for example public and private providers, community clinics and hospitals, and substantial clinical benefits flow from images and reports being readily available when needed. This would also result in a reduction in duplicate imaging, save time and radiation exposure (from certain modalities), and potentially reduce out of pocket costs for patients. Patient care would also benefit from the introduction of imaging guidelines and clinical decision support (CDS) tools. These guidelines would increase appropriateness of referrals, enhance patient safety, provide educational opportunities and feedback to referrers on the appropriateness of the selected examination. To be effective, the
Feature
College has recommended that CDS must be digitally integrated into the workflow of clinicians. Clinical radiology and radiation oncology are data rich and already using advanced technologies and informatics software. Because of this, our professions are well positioned to adopt artificial intelligence and machine learning. The College has progressed work on ethics, standards development, upskilling for members and advocating for better regulation. Other stakeholders must also recognise the potential and risk of AI and the integral
role it could play as interoperability projects progress.
At the forefront of revolutionising patient care The College is currently developing a white paper to outline a common vision for digital health in clinical radiology between government, consumers, referrers and the radiology sector. We are committed to the development of an overarching plan and vision toward healthcare, demonstrating how clinical radiology can interact digitally and share
its valuable inputs with the rest of the healthcare system, not least radiation therapy. Done right, the creation of an interoperable health system will provide a more efficient system and truly revolutionise patient care in Australia. If you have further questions about creating digital health solutions or interoperability, please contact Melissa Doyle, Executive Officer at the College at melissa.doyle@ranzcr.edu.au
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Feature
SRI LANKA COLLEGE OF RADIOLOGISTS “Wijerama House”, 6 Wijerama Mawatha, Colombo 07. Tel/Fax:+94112698142 E-mail: lankaradiology@yahoo.com Web site: www.radiologist.lk
President Dr. Prasad De Silva prasaddes@hotmail.com Vice President Dr. P. Hettiarachchi pandula69@icloud.com Hon. Secretary Dr. UdayaJayakody udaya.jayakody@gmail.com Asst. Secretary (Social) Dr. R.K.J.S. Rajapakse sathrajapakse@yahoo.com Asst. Secretary (Academic) Dr. S.H. Palihawadana sumudu.hp18@gmail.com Hon. Treasurer Dr. W.K. Sathkorala wasanthawk@yahoo.com Asst. Treasurer Dr. C. lokubalasooriya chandrasiri69@yahoo.com Council Members Dr. B.M.P.Bandaranayake bmpbandaranayake@yahoo.com Dr S. Dilakkumar dilakkumar@gmail.com Dr. E. Ganewatte erangaganewatte@ymail.com Dr. K.M. R. Kannangara rupakannangara@ymail.com Dr. U.P. Kumarasena druditha@yahoo.com Dr. W.A. DileepKarunaratne drdileep2003@gmail.com
19th of July 2019
A message of Condolence
It is with deep sadness and emotion that I write this condolence message on behalf of the Sri Lanka College of Radiologists. Professor TurabChakera was a dear friend and a mentor of the Sri Lanka College of Radiologists from the time he was the President of the Royal Australian and New Zealand College of Radiologists. He visited us as an external examiner for several years, encouraging excellence and ensuring the standards of Radiology in par with the rest of the world. He initiated the fellowship training positions for Sri Lankan registrars at Royal Perth Hospital. I am deeply grateful and honored to be one of his trainees. Professor Chakera’s passing away is a great loss to the entire Radiology profession, including our little island. His gentle demeanor, kind disposition and humility towards all who knew him is highly commendable. May all those he mentored, continue to serve the patients and the profession for which he dedicated his professional career. The entire membership of the Sri Lanka College of Radiologists joins me in extending our heartfelt condolences to Mrs. Margaret Chakera, the members of his family and loved ones. May he rest in peace. Thank you,
Dr. JanakaKalubowila Janaka.kalubo@gmail.com Dr. S. Nimalan dasnimal@yahoo.com Dr. S.A.S.R. Siriwardana shrmsiriwardana@gmail.com Dr. P. Udayakumaran udaikuma@gmail.com (Immediate past president) Dr. A.S. Pallewatte asp31263@hotmail.com
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Inside News
Dr. Prasad De Silva President Sri Lanka College of Radiologists
Feature
In Memoriam
Prof Turab Chakera AM â&#x20AC;&#x201C; 1/3/1943 to 13/7/19 appointed Head of Department (HOD) in 1978 after Dr. ApSimon stepped down and remained in this role until 2000 retiring in June 2016. He was afflicted by a progressive neurodegenerative process, which eventually left him wheelchair bound.
Prof Turab Chakera A man for all seasons and a quiet achiever. It is with sadness and a heavy heart that I write a few lines about the life of Prof. Chakera who departed this world on July 13. Born in Dar es Salaam, Tanzania, he was one of five siblings followed in the footsteps of his father and studied medicine. He was sent to England to study for his A levels and medicine completing his degree at the University of Birmingham in 1966. He followed this with the MRCP before joining the Zambia Flying Doctor Service in 1970. During this time he worked with Margaret, a nurse from New Zealand, whom he later married. He completed his radiology training in Birmingham in 1974. Dr. Chakera met and was mentored by Dr. ApSimon, radiology head at Royal Perth Hospital, who encouraged him to apply for a position there. Dr. and Mrs. Chakera arrived in Perth 1975 for a twoyear period but fortunately for radiology, remained and started a family. Both boys are now also doctors. Dr. Chakera was
As HOD he relentlessly pursued his agenda to make his radiology department the best in Australia for equipment (CT, MRI, ultrasound and digital subtraction angiography), for radiologists with sub-specialty expertise, and both teaching and training. He commissioned a new 12-room department of radiology in the Royal Perth Hospital, a nuclear medicine department and established a dedicated breast unit. Prof Chakera was a considerate, highly educated, erudite, compassionate and wonderful human being always available to discuss any issues. Much of what he achieved was due not only to his hard work, but persistence. Perhaps the best example of this being his 40-year continuous agitation for a University Chair in Medical Imaging, which is finally coming to fruition in 2019.
of his commitments to training and teaching, he became the namesake of the Prof Turab Chakera Award for Excellence in Radiology Teaching awarded annually as determined by the registrars. His insight and sage counsel was fundamental in College affairs. In his three decades with the College, Prof Chakera was WA Branch Chair, WA Education Officer, Clinical Professor, President of RANZCR, (1996-7), Warden (Chief Censor), a senior examiner, member of the Education Board and Chair of the IMG Committee. He was co-chair of the scientific committee with me for the 1986 ASM held in Perth. A College Life Member, recipient of the Gold Medal and was awarded an AM in 2010 for services to diagnostic radiology as a clinician and educator. On a personal level Prof Chakera was a mentor, a boss, a colleague and above all, a very dear friend who lived life to the fullest. His encouragement and direction have guided me and others in their successful careers. He will be missed by all but not forgotten. Professor Mark (Makhan) Khangure
The greatest legacy of Prof Chakera is the impact he had on the teaching and training of radiology registrars. In Perth he, in his usual low key but consistent discussions with other radiology HODâ&#x20AC;&#x2122;s, was responsible for planning and coordinating a state-based radiology training program for registrars. This was the first network of its kind in Australia and has since been used as model in other states and in New Zealand. He was an outstanding teacher and an excellent all round radiologist. He encouraged the radiology consultants to subspecialise and value add and promoted collegiality between full time and sessional consultants. In recognition
Volume 15 No 4 I September 2019
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Education
Targeting Cancer travels to the UK
Targeting Cancer successfully stepped up advocacy efforts in the UK recently as it aims to further increase awareness of radiation therapy as a treatment option for cancer patients worldwide. During an action packed two weeks, Chair of the Targeting Cancer Working and Advisory Group, Dr Lucinda Morris, met with clinical oncologists, radiation therapists, medical physicists, nurses, patients and other long-time supporters and advocates from all across the UK. She also visited major cancer centres including The Christie in Manchester, Leeds Hospital and Mt Vernon in London where she presented to staff about the campaign and ways to raise awareness of radiation therapy as an effective and vital cancer treatment. The presentations provided valuable information on patient pathways, insights from GP awareness events as a
A member of the Leeds Hospital physics team demonstrating the quality assurance and testing of radiation therapy equipment to ensure the safety and accuracy of treatment.
way to increase awareness for referrers, and opportunities for collaboration across our jurisdictions. Feedback from the sessions was extremely positive and generated a lot of productive conversations and excitement across social media about ways to further promote the campaign and the vital role of radiation therapy. Dr Morris also met with the leadership team at the Royal College of Radiologists to give an overview of the campaign and to discuss potential opportunities for support and collaboration with UK stakeholders in the future. Many clinicians and supporters took to social media during the visits wearing branded t-shirts and hats ensuring that the Targeting Cancer message was spread far and wide.
Dr Morris said it was great to have the chance to hear from clinicians about their own public outreach work and share ideas on how multi professional teams can work together to increase awareness of radiation oncology around the globe. â&#x20AC;&#x153;It was inspiring to see so many people sharing how passionate they are about promoting the vital role radiation therapy plays in cancer care with patients, their families, friends and the community more broadly,â&#x20AC;? Dr Morris said. â&#x20AC;&#x153;From radiation oncologists to physics teams and patient advocates, fantastic work is being done to raise awareness and we are seeing the results from the grass roots level right up to policy makers. continued over...
Staff from Royal Blackburn shared their stories with Targeting Cancer and discussed best practice in head and neck cancer treatment.
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Advocacy
“At the grass roots level, it was a particular pleasure to meet Dr Louise Murray who is a clinical oncologist in Leeds doing some really amazing public outreach work and teaching to promote radiation therapy in the community. “She has been presenting at school science fairs, university science expos and departmental open days. Her work continues to be very successful in improving the profile of radiation therapy in the UK.” Also in Leeds, Dr Morris met renowned medical physicist Ane Appelt who, along with her physics team, demonstrated
the quality assurance and testing of radiation therapy equipment to ensure that people with cancer receive precise, safe and accurate treatment. Ane herself is a passionate advocate of radiation therapy and the key role of clinical research around medical physics. Dr Morris also had a discussion with Prof David Sebag-Montefiore, Chair of CTRAD (the UK Clinical and Translational Radiotherapy Research Working Group) about how advocacy and raising the profile of radiation oncology positively influence much needed funding into radiation therapy research.
Dr Lucinda Morris with The Swallows Charity team, all of whom personally were affected by head and neck cancer and now work tirelessly to support and educate others.
28
Inside News
Finally, she had the opportunity to tour Blackpool and Preston Hospitals with Chris Curtis, high profile patient advocate and CEO of the largest head and neck cancer charity in the UK, The Swallows Charity. Whilst there, nurse specialists and patients shared their personal stories, providing valuable insights and reinforcing the importance of raising awareness of the vital role radiation therapy plays in cancer 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
Dr Louise Murray promotes radiation therapy at science fairs, expos and departmental open days across the UK.
Advocacy
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
Celebrating Ten Years From 2006 - 2009 the Quality Use of Diagnostic Imaging Program (QUDI) was focused on achieving improvements to diagnostic imaging services through the provision of accurate, up-to-date information on the appropriateness and safety of diagnostic imaging to referrers, providers and consumers of diagnostic imaging services. This was achieved through the implementation of a number of well designed, evidence-based projects. Two of these projects - consumer focused information about radiology procedures and the QUDI website, culminated in InsideRadiology. During the initial projects, 73 topics were developed resulting in 140 information items divided into broad areas which included womenâ&#x20AC;&#x2122;s health, cardiac imaging, nuclear medicine, interventional (treatment), abdominal imaging and general items. The website began piloting in April 2009 with an official launch in September 2009. In the last decade, InsideRadiology has been busy developing additional items covering topics that were not included in the initial project, as well as recently emerging areas of practice. The website has undergone two redesigns to improve access and usability. Funding has transitioned from a series of Australian Department of Health and Ageing grants to the College.
Promote InsideRadiology to Patients and Colleagues
Information items are regularly reviewed to reflect changes in practice and to ensure that the information answers the most topical and frequently asked questions of both consumers and health professionals. The addition of a GP reviewer in the second phase of the project drastically improved the quality of information for health professionals and along with this, the editorial team has improved the standard question set and provided a critical review of the material drafted by the content experts. The editorial team continues to evolve with the recent appointment of three new clinical advisors to assist with the mammoth task of developing and reviewing the content. There are also plans to recruit additional GP and consumer writers to manage the workload and provide a renewed perspective on the existing material. InsideRadiology is an important advocacy tool for transparency in clinical radiology, as well as the promotion of the role and value of the profession. It is a collaborative project that brings together clinical radiologists, referring clinicians and consumers, with the ultimate aim of improving the quality of medical imaging services through improved health literacy.
InsideRadiology is also an important contributor to rational, evidencebased ordering of diagnostic imaging in primary health care. It provides the referring clinicians not only with resources to support their patientsâ&#x20AC;&#x2122; queries but also provides the answer to many clinician-asked questions about clinical radiology, including prerequisites, contraindications, and alternative tests and procedures for each information item. InsideRadiology currently hosts over 180 information items covering 92 different topics as well as interactive resources for patients and waiting rooms. On our 10th Birthday we would like to acknowledge Ms Ann Revell, Prof Grant Russell, Dr Warren Clements, Dr Arockia Doss and Dr Jules Harvey and all the authors, subeditors, clinical advisors, GPs and consumer writers that have contributed to InsideRadiology over the last decade to ensure that the Australian and New Zealand public have access to accurate, current, critically-reviewed, high-quality information.
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. It has been online since 2009 and covers close to 100 topics, with specific information targeted at both consumers and referring clinicians for most items.
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Education
RANZCR Research Grant update â&#x20AC;&#x201C; Dr Ruth Lim
Radiology and the World Congress of Nephrology. Finally, preliminary data from the study has attracted industry grant funding with recruitment now commencing, allowing validation of the pilot results in a greater number of patients.
RANZCR offers grant funding annually to Fellows and trainees of the College to support relevant radiology research projects. This provides financial support to explore an interesting idea. It provides a springboard to outcomes such as further validation of findings in a larger study; implementation of practice changes or possibly scrapping the idea in favour of a better one. I received funding support from the College in 2015 and 2017 for two prospective projects. The first project was a pilot project of functional MRI in diabetic kidney disease, studying the impact of empagliflozin, a glucose lowering agent with renoprotective effects, on diabetic patients. This incorporated diffusion tensor imaging (DTI), best known for assessing cerebral conduction pathways, to study kidney microstructure, as well as blood oxygen level dependent (BOLD) imaging to assess renal oxygen metabolism, and perfusion imaging for blood flow and
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Inside News
glomerular filtration. The study was challenging to get off the ground. As a trial involving a drug, it attracted rigorous review by our institutional ethics committee. Scan protocol optimisation was a time-consuming process, as these sequences are far from the clinical standard. Finally, recruitment was challenging, as empagliflozin is considered the latest diabetes wonder drug, and it was difficult to find patients who had not yet been started on the drug. Thanks to the College, the study has yielded insights into MRI changes seen in patients with diabetic kidney disease compared to healthy volunteers, particularly with DTI and provided early data regarding impact of empagliflozin on the kidneys. It has also given two trainees invaluable research experience, analysing and presenting results from aspects of the study at the International Society of Magnetic Resonance in Medicine, the European Congress of
The second project proposes to evaluate changes to flow within the aorta in patients with aortic dissection using a 4D phase contrast technique, 4D Flow, to determine whether it can assist in determining if or when intervention is indicated. It is ongoing, with initial sequence optimisation performed in healthy volunteers and now commencement of the next stage, recruitment of patients with aortic dissection. This project also involves academic and industry collaboration, and co-supervision of PhD engineering students performing computational fluid dynamic simulations informed by the MRI data. We are concurrently analysing healthy volunteer data, comparing metrics obtained from 4D flow with conventional (2D) phase contrast imaging, and assessing interscan and inter-reader reproducibility of the 4D flow results. It is anticipated that this component of the project will be submitted for presentation at a scientific meeting in 2020 whilst patient recruitment continues. From my experience, research certainly requires perseverance and problem solving skills, but it can have great rewards too, intellectually, and ultimately (it is hoped) for patient care. There is no better time than now to get involved in radiology research. We are on the verge of major changes to the way in which radiology is practised with the emergence of deep learning imaging applications. Radiologists should be proactive in guiding how our field develops rather than have changes implemented without our input.
Clinical Radiology
Leadership in a dynamic world A Message from the Dean
Clin A/Prof Sanjay Jeganathan
Taking the lead Clinical radiology is a dynamic field that has always been and continues to be at the forefront of the development of new technology and innovation. This allows us to improve patient care by constantly enhancing the services we can provide however, this also brings new challenges as new fields are constantly opening up. This can be particularly challenging when these services overlap with other craft groups. There are several historical examples where we have not been effective in displaying leadership and developing models of service delivery led by clinical radiologists. With the value of hindsight, we all recognise that several areas of clinical radiology are now also delivered by other craft groups because we were somewhat slow to react. The Faculty of Clinical Radiology Council is keen to ensure that we learn from this experience, and going forward, our strategy is to be proactive early on in establishing our role in new technologies, and techniques in medicine relevant to the practice of Clinical Radiology. We consider that the most effective way to do this is to set the standards of practice for these new frontiers of radiology. Once standards are established we have a strong platform from which to advocate our role and negotiate with external stakeholders. A key priority for FCR Council is to take a leading role in the deployment of artificial intelligence (AI) in clinical
radiology and radiation oncology. The AI Committee, established last year, has been very active working on ethical principles, standards of practice and training pathways. The recently published Ethical Principles for AI in Medicine was downloaded more than 1,500 times and I note it is being referenced on an international level. This is already a very significant achievement. No other medical College in Australia is currently active in the AI space, and this technology will ensure we can provide time-efficient, effective and even greater quality of treatment for patients. We are truly leading the pack in this exciting and vital space. FCR Council has identified several other priority areas and we are bringing together expertise from within our membership to develop standards and advise the Council on key issues. This will allow us to take the lead on important emerging areas and ensure our role as Clinical Radiologists is appropriately recognised by external stakeholders.
Theranostics Theranostics is becoming more prominent in cancer diagnosis and treatment, representing a shift towards a tailored individual patient treatment model for specific types of cancers. Theranostics crosses over several craft groups including radiology, nuclear medicine and radiation oncology â&#x20AC;&#x201C; all relevant to our College. We are about to begin work in this area and are establishing a cross-faculty working
group to advise on professional and practice standards, and consumer access. I encourage members keen to be involved in Theranostics to volunteer with this working group.
Post-mortem Imaging Post-mortem imaging is a niche area of radiology that is growing in significance, not only in the forensic environment, but also within hospitals and for pediatrics. Many families wish to understand the cause of death of a family member without an open autopsy being performed. Imaging is a comforting alternative, particularly in the pediatric and neo-natal space. A working group is being established to develop standards to support radiologists practicing in this field. I encourage members keen to be involved in post mortem imaging to volunteer with this working group.
Silicosis Silicosis is emerging as a major public health issue for stonemasons, particularly with the increasing use of manufactured stone. Clinical radiology has a key role to play in both the screening and diagnostic setting. It is critical that the role of radiology is correctly understood by decision makers and that any strategy developed to address silicosis includes radiology. I am pleased to inform you the Federal Health Minister has accepted our Collegeâ&#x20AC;&#x2122;s position to include a Radiologist on the panel of the recently established Federal Government taskforce on Silicosis. continued over... Volume 15 No 4 I September 2019
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Clinical Radiology
Work is currently underway to develop a position statement to inform screening and diagnosis of silicosis. The Thoracic Special Interest Group executive has been working tirelessly to develop reporting templates and learning material for Radiologists to equip themselves with the necessary tools to make appropriate diagnosis and to be involved with management of these patients. In conjunction with the above specific examples of new areas we are working on, our profession is facing the polarising issue of generalist versus subspecialist. Australia and New Zealand continue to need general radiologists,
however with the ever growing complexity of clinical radiology we are being driven toward sub-specialisation. We will be holding a Faculty Forum at the College ASM in Auckland which explores this theme and I encourage those of you who will be at the ASM to attend. Seeing the need to have more focused leadership of the post FRANZCR space, FCR Council last year established a new office bearer position, titled Chief of Professional Practice (CPP), which is held by Associate Professor Dinesh Varma. Along with this role a new committee has also been established called the Professional Practice Committee.
It is only through members volunteering your scarce and valuable time to share your expertise that we can continue to show leadership and assert our important role in these new territories. Volunteering comes in many ways and I encourage you to put up your hand to join a working group or contribute via other means, such as providing feedback on consultations. If you have not done so already, I would also recommend you familiarise yourself with the College’s ‘Get Involved’ pages on the website with initiatives you may be interested in contributing to. It is our College, and all of us need to be involved and engaged.
ESGAR LIVER IMAGING WORKSHOP
Presented by ARGANZ on Friday 27 March. ESGAR faculty members Prof Valérie Vilgrain and A/Prof Giuseppe Brancatelli present case content in this one day workshop.
REGISTRATION OPEN
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Inside News
Clinical Radiology
ACER-Prideaux report guides reforms Chief Censor in Clinical Radiology
Dr Meredith Thomas
In progressing the Training and Assessment Reforms (TAR), RANZCR has continued to engage with Emeritus Professor David Prideaux and Jacob Pearce from the Australian Council for Educational Research, the authors of the 2015 “ACER-Prideaux” RANZCR Assessment Review and Development Report. Their continuing support and expertise enabled the TAR Taskforce and the respective Faculty Steering Committees to ensure that the reforms address the recommendations of the review and align to best practice in contemporary medical education now and in the future. It is important to recognise the extensive work done to date in ensuring best practice around our current examinations, occurring simultaneously with the work to ensure that examinations in the future, best meet the needs of our training program. The majority of the recommendations from ACER have been implemented for our current Part 1 and Part 2 examinations, including: Examiner training • Formal induction processes for new examiners, including observation at Vivas for new examiners • Examiner training workshops Exam development • Formal meetings for collaborative exam development • Greater emphasis on blueprinting to curriculum • Wider involvement in question writing
• Development of link questions between exam series to allow for psychometric equating of exam difficulty Scoring processes • Improved marking templates to give more detailed criteria • Double marking of all written exams with a strict discordance rule Examination review • Formal meetings for exam and candidate result review • Determination of a cut score based on standard setting • Use of an error band around the cut score • Using equating data to adjust cut score for degree of difficulty of the exam based on linked questions Exam feedback • Provision of more detailed feedback to candidates • Provision of more detailed feedback to Directors of Training • Provision of sample answers with practice material Data collection and reporting
While many of the ACER-Prideaux recommendations are intrinsic to the planned reforms there are many that have already been implemented, particularly around governance within the Specialty Training Unit (STU), and these have enabled the reforms: • Development of the Training and Assessment Reform Taskforce and the respective Steering Committees • Appointment of the Chairs of the Examination Review Panel and the Curriculum and Assessment Committee as Deputy Chief Censors • Ensuring that decision-making structures incorporate and utilise the accumulated expertise and wisdom of the Fellows • Increasing resources within STU to ensure there is adequate support for the Fellows in developing and implementing the TARs, including a new learning management system and new electronic examination platforms.
continued over...
• Improved data collection to enable longitudinal psychometric analysis • Improved security around examination material There will be some changes to the duration and format of future examinations. Please see detailed information on Page 19 in this edition.
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Clinical Radiology
The proposed reforms address further recommendations, with incorporation of programmatic assessment into our training program. While our formal assessments currently include various work-based assessments (WBADOPs, Mini-IPX, MSF, CAT), these are mostly assessed as completed or not completed, with limited consideration of level of supervision required, competency, progression over time, or feedback to improve performance. Although trainees are currently assessed informally by multiple assessors in a variety of training activities, there is no record of this assessment or what feedback has been given to guide future learning. Providing WBAs are completed, the decision regarding competence for Fellowship rests entirely on the formal Part 2 examinations., with no capacity to consider performance during training. Our reforms propose the introduction of simple and quick work-based assessments, replacing the current WBA format delivered on a mobile electronic platform, to assess the level of supervision a trainee may require to report a study, perform an ultrasound, screening or a procedure, or present in a radiology or multidisciplinary
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meeting. The assessment will not be a pass-fail assessment, rather the trainees will be assessed on an entrustability scale, with an expectation of improved performance (and a decreased level of required supervision) over time, with provision of feedback. It is expected that the assessments will be trainee driven. Each assessment will become a data-point in considering a traineeâ&#x20AC;&#x2122;s progress, allowing information from multiple sources to be collected and triangulated, and allowing strengths and weaknesses to be identified to guide future learning. With the proposed three phase training program, there will be a number of decision-making points; between Phases, to present for examinations, and to complete training and obtain Fellowship. Progression at these points will either be determined locally by the Directors of Training, or centrally by a College body. Importantly, the programmatic assessment approach allows all collected data to be considered when making these decisions. It will allow the deciding body to consider other relevant assessments, both work based and exams, when making decisions for borderline candidates in Phase 2 written and viva exams.
Enhanced Training Program Implementation It is anticipated that the training reforms will be implemented from 2021. As we move toward this phase of the TAR, the current Steering Committees will end, and Implementation Working Groups will be formed for both Faculties. In Clinical Radiology we ask for representation from each Branch on this committee, to facilitate engagement and communication. If you have experience in training, curriculum and assessment and are interested in this role, please contact your local Branch Education Officer. Additionally, as we increasingly focus on engagement at a training site level, we encourage those who are passionate about improving our training program to become local champions to facilitate implementation in 2021 and beyond. Finally, I would like to thank Emeritus Professor David Prideaux, who has been an active and tireless member of the Steering Committee. Davidâ&#x20AC;&#x2122;s wisdom and experience in medical education has been invaluable, not only in advising about the TAR project, but in educating and up-skilling the committee members.
Clinical Radiology
Clinical Radiology Trainee Matters
Big changes are coming for the radiology training programme, with the new curriculum soon to be finalised. I urge trainees to pay close attention to release of the curriculum and if possible, make sure that you attend talks by the Chief Censor Meredith Thomas regarding these changes (for example at the RANZCR ASM trainee’s day). The changes are aimed at improving a trainee’s progression through the programme and addressing any deficiencies the current curriculum and exams blocks may have. With that in mind, I would strongly encourage all trainees, if at all possible, to try to get to the RANZCR ASM in Auckland this year. The programme that has been put together is outstanding, particularly the trainee’s day on the Saturday, with helpful talks and presentations for all trainee’s, with emphasis on the new curriculum and exam preparation amongst other things. Coming from New Zealand (Auckland to be precise) I can highly recommend coming over to have a look around and enjoy all that the city has to offer. If you have the time I suggest you explore further afield, whether it be up north to places like the Bay of Islands, more locally to Waiheke, or heading south to Wellington, Queenstown or anywhere in between! Now that the first sitting of exams for 2019 is over and results have sunk in, it can be a trying time in a trainee’s career, whether the results have been good or less than ideal. A common phenomenon after passing the Part 2 exams is to become aimless or even depressed. After 15yrs of hard work and countless barrier exams and achievements are passed to have it all suddenly “end” can be quite confronting.
On the other side of the coin if the exams didn’t go as you hoped, this too can understandably be a devastating experience. If trainees or fellows are feeling depressed or worried about a colleague, a good place to look for help is the college well-being page (www.ranzcr.com/trainees/general/ your-wellbeing) This page has links to great medical resources as well as the college policies on help for trainee’s and remediation. Also, apps such as Headspace and CALM are good resources for meditations style short courses, particularly to help with anxiety and sleeping. These resources are all well worth a look even if you a sceptic about these kinds of things.
Dr Ben Addison
Best of luck to all the trainees heading into the second sitting of exams, hopefully you are all utilising the local and Australasian resources you have available to you, and you’re well rested and feeling confident. And for those of you who have been following my Inside News articles (both of you), Matt’s wall is a step closer to becoming a reality, with tenders going out to construction companies. Hopefully Matt stays on the committee and can help in what most certainly be, a be fair and totally legitimate tender process, which is currently being led by a company called “Matt’s constructionmaking RANZCR great again”. No relation I’m sure……… Warmest Regards, Dr Ben Addison
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Clinical Radiology
Chief of Professional Practice
includes consideration of new and innovative models of delivery of care, philosophies of practice and the training and maintenance of an appropriately skilled and empowered workforce.
A/Prof Dinesh Varma
The Professional Practice Committee (PPC) was established by the Faculty of Clinical Radiology (FCR) Council in 2018 to provide guidance and oversight for the development, implementation and review of post-fellowship learning. Our journey to date has considered the followingâ&#x20AC;Ś
Subspecialisation versus generalism Subspecialisation within radiology is the concentration and acquisition of knowledge and experience. It informs the development of standards and helps to advance service delivery. However, it can also lead to system level fragmentation, access to care and an imbalance in the distribution of the radiology workforce. This is particularly relevant for rural and remote regions of Australia and New Zealand, or for patients with multiple system diseases or undifferentiated illnesses. RANZCR, through the PPC are increasingly examining the paradoxes and nuances of the relationship between subspecialisation and generalism. This
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Inside News
The rapidly change space of radiology is continually seeing the introduction of new services, procedures and other technologies. In response, the PPC is currently preparing a scope of practice for radiology to define the professional spectrum of capabilities for radiologists. Initially, the scope of practice will provide the baseline for all new Fellows having completed the RANZCR training program. Further it will offer a foundation in which areas of extended practice, necessary for safe and highquality care, can be added as advanced or extended scopes. The PPC aim to have a draft scope of practice ready for endorsement with the FCR Council at their first meeting in 2020. In the interim, I encourage all members to contribute to the consultation period for this important document, when it is circulated for comment. I expect this will occur towards the end of 2019.
Advanced Training for Interventional Radiology The PPC have established links with other FCR committees, including the Interventional Radiology Committee (IRC). The recent White Paper regarding the future of interventional radiology (IR) and interventional neuroradiology (INR), and the subsequent consultation highlighted the need to formally progress IR and INR as specialties of clinical radiology. Further, it has provided the impetus for a Faculty wide approach to progressing IR/INR as unique specialties to assure safe and high-quality service delivery. In June this year, the FCR Council
approved the development of a framework for advanced scopes of practice and training pathway for radiologists, using IR/INR as working examples. My next challenge as Chief of Professional Practice will be to work with my colleagues from the PPC and associates from the Interventional Radiology Committee to draft a framework of this nature that can be initially applied to IR and INR, and used for future specialities requiring a similar level of consciousness
Special Interest Groups (SIGs) SIGs represent specialty areas of radiology practice and contain a collection of RANZCR members who practice or have an interest in that specialty. They offer valuable insight into the skills, experience and competencies required to safely perform specific areas of radiology practice, including subspecialties and generalism. The PPC has identified SIGs as a valuable resource in terms of their authority on specific topics and has commenced drawing on this expertise to address matters arising. Most recently, the PPC tasked the Abdominal Radiology Group of Australia and New Zealand (ARGANZ) in providing advice on a matter emerging in Queensland. This matter related to the use of MPMRI in prostate cancer diagnosis and subsequent decision to biopsy. The ARGANZ executive were able to provide a comprehensive and timely response to reinforce the College position on interpretation of MP-MRls. The PPC would like to express their sincere thanks to Dr Kirsten Gormley and the rest of the ARGANZ executive group for their thorough and judicious response.
Clinical Radiology
In addition, the PPC has commissioned the Australian and New Zealand Society for Thoracic Radiology (ANZSTR) to prepare a position statement on the role of imaging in the diagnosis and monitoring of occupational lung diseases, including those resulting from exposure to engineered stone. This comes in response to the rising incidence of disease in workers exposed to silica within engineered stone. The ANZSTR executive have done a stellar job at producing robust advice to inform the College position on this matter. My sincere thanks to Dr Sharyn MacDonald, Dr Catherine Jones and Dr Stefan Heinze for the countless hours you contributed to this important
piece of work. Throughout August, the position statement will undergo a review through relevant committees and member consultation before seeking endorsement from FCR Council. I will look forward to providing an update of our work in the next edition of InsideNews. Yours sincerely, Dinesh Associate Professor Dinesh Varma Chief of Professional Practice Faculty of Clinical Radiology
Keynote Speakers Dr Oscar Navarro, Associate Professor at the Hospital for Sick Children, Toronto, Canada Dr Mika Shapira-Rootman, Senior Paediatric Radiologist, Schneider Childrenâ&#x20AC;&#x2122;s Medical Centre, Israel
To register, go to https://outshine.eventsair.com/nzcpr-20/
New Zealand Course in Paediatric Radiology (NZCPR) 2020 Aimed at registrars/fellows, general radiologists, MRTs, sonographers, radiology nurses and play specialists around New Zealand who are involving in paediatric imaging but who are not specifically trained in paediatric radiology.
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Clinical Radiology
Clinical Radiology Formal Education Program RANZCR’s Accreditation Standards for Education, Training and Supervision of Clinical Radiology Trainees were developed to ensure that a minimum acceptable standard of facilities is available to provide successful training in Clinical Radiology. The Australian Medical Council (AMC) accredits the College and its training programs on a five year cycle. The College liaises with Trainees, Training Sites, Networks, Directors of Training and Clinical Supervisors to ensure that minimum requirements are maintained as per the standards.
• Roster/s of other educational activities
Accreditation site visits ensure that minimum acceptable standards of facilities are maintained, including but not limited to staff equipment, diversity of clinical material, including an assessment of formal education programs. Formal Education Program requirements are indicated in RANZCR’s Accreditation Standards for Education, Training and Supervision of Clinical Radiology Trainees in Standard 3:
Accreditation site visits have indicated that some training sites lack a formal education program, or have one in place which is impacted by different circumstances, namely but not limited to high clinical workload, fluctuating Consultant FTE numbers, lack of adequate administration support within departments, variable Network set ups amongst other reasons.
• The training site participates in a formal network education program for trainees or provides its own education program. The Director of Training has overall responsibility for the structure and quality of training in a Department, in line with the College policies and the specific arrangements within their training Network as well as providing trainees with feedback on their progress. To meet the requirements of the standards, accredited training sites in conjunction with the Network must continually demonstrate the presence of the following: • Timetable for formal teaching/lecture sessions covering the Radiodiagnosis Training Program curriculum requirements
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Inside News
• Timetable of available clinical meetings An accredited training site is required to demonstrate a formal education program aligned to the curriculum. The accreditation status may be affected if otherwise. In some cases, a recommendation for improvement or a downgrade of the accreditation status may result. Absence of a formal education program may result in withdrawal of accreditation from a training site.
Where trainees fall short of curriculum requirements or under-perform, the processes for identification, support and management of trainees in difficulty are outlined in the following policies published in November 2018: • Performance and Progression (Clinical Radiology) Policy • Remediation in Training (Clinical Radiology) Policy • Withdrawal from Training (Clinical Radiology) Policy Criterion 3.4.2 in Accreditation Standards for Education, Training and Supervision of Clinical Radiology Trainees requires training sites to be aware of the above policies.
The College is available to assist accredited training sites in ensuring they meet the requirements of the curriculum. Ultimately, a formal structured education program is crucial to ensure patient safety and to ensure trainees are safe to practice Clinical Radiology on completion of their training program. For any enquiries, about accreditation, please contact Bettina Brooke at accreditation@ranzcr.edu.au. Dr Mark Phillips Clinical Radiology Chief Accreditation Officer
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Radiation Oncology
Working together to improve patient care A Message from the Dean
Dr Madhavi Chilkuri
Increased investment in New Zealand Following the New Zealand Radiation Oncology Horizon Summit, the College has secured a significant investment from the New Zealand Government into the replacement of linear accelerators and relocation of two machines into regional centres. This is an important step to ensuring that cancer patients have access to the latest technology delivering targeted, safe and costeffective cancer treatment. The interim New Zealand Cancer Action Plan was announced for consultation by the Minister of Health on 1 September. The College will be formulating a submission by 13 October.
Services), met with Ms Natalia Vukolova (RANZCR CEO), Mr Mark Nevin (Senior Executive Officer) and Ms Leila Stennett (Manager, Advocacy and Media) to discuss commitments made during the election campaigns and future plans for Australia’s health agenda. • Dr Ashley Bloomfield, DirectorGeneral of Health, New Zealand, met with Dr Lance Lawler (RANZCR President), Dr Carol Johnson (Chair, NZROE), Ms Vukolova and Mr Nevin following the successful Horizon Summit in May to further advocate the vital role radiation therapy plays in cancer care.
• Senior members of the Urology Society of Australia and New Zealand (USANZ), including Dr Stephen Mark (USANZ President), and Dr Tony Sparnon (President, Royal Australasian College of Surgeons) met with myself, Dr Amy Hayden (Chair, FROGG), A/ Prof Dion Forstner, Ms Vukolova and Mr Nevin to further develop an ongoing relationship between the two organisations. • Dr Cary Adams, Chief Executive Officer of the Union for International Cancer Control (UICC) met with Ms Vukolova and Mr Nevin to discuss future collaboration opportunities.
I would like to acknowledge the tremendous amount of work that Dr Carol Johnson, our New Zealand colleagues, and College staff have put into raising the profile of radiation oncology in New Zealand.
Meetings with key stakeholders Engaging with our external stakeholders is an ongoing, critical process. Over the last few months there have been several meetings with many of our stakeholders to discuss our priorities and ensure that we are all working towards a common aim – improving care for our patients. • Australian politicians, including Hon. Greg Hunt (Minister of Health), Hon. Mark Coulton (Minister for Regional Services), Hon. Chris Bowen (Shadow Health Minister), Hon. Jason Clare (Shadow Minister for Regional
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Inside News
Dr Cary Adams, Natalia Vukolova and Mark Nevin
Radiation Oncology
• Prof Jeff Dunn (Chief Executive Officer of the Prostate Cancer Foundation of Australia (PCFA)) met with myself, A/ Profs Andrew Kneebone and Dion Forstner, Dr Amy Hayden, and Ms Vukolova to discuss the Memorandum of Understanding between our organisations, and was followed up with a secondary meeting to strengthen avenues for collaboration.
MBS Review Following the Report from the Oncology Clinical Committee in late 2018, the Faculty is working with the Department of Health to model and pilot the proposed radiation oncology item descriptors. It is encouraging to see the level of collaboration between the Department and College. We are in the early stages of this work, with much still to do.
FRO Facilities Survey Thank you to all of those who have provided responses to the 2019 Facilities Survey. I am pleased to report that for the fourth consecutive survey, we have had a 100% response rate. This a very pleasing result. I appreciate that for some centres, participating in activities like this can be a large ask on top of the regular day-to-day demands. Collecting this information is extremely valuable and forms an important tool in our advocacy efforts.
Dr Madhavi Chikuri and Prof Jeff Dunn
RANZCR ASM
Getting involved
The 2019 RANZCR ASM is nearly upon us. I am very much looking forward to seeing what our New Zealand Convenors have organised for us in Auckland. We have some worldrenowned international speakers, including Dr David Beyer, Dr Drew Moghanaki, and Prof Arjun Sahgal. The scientific program has much to whet the appetite, whether you are interested in proton therapy or incident reporting and quality issues, or the trainee learning day, there is something for all.
We are often looking for volunteers to join committees or working groups, to provide input to various professional documents, or to provide advice on requests from external organisations. How do we find people to help us? Where possible, we put calls out through the monthly Faculty eNewsletter but there are times where we are unable to use this channel. The College’s membership database not only allows for members to update their contact details, there is capacity for members to update areas of interest (both clinical and non-clinical) and areas in which they may wish to get involved. If you have not already done so, please take some time to update your details. This will ensure you have every opportunity to participate in initiatives in your specific areas of interest and provide valuable input to the College’s work. For information on how to update your details see page 52 of this issue.
The annual Targeting Cancer fun run will take place—this time around the beautiful Auckland waterfront. I would like to acknowledge the continued generosity of GenesisCare for sponsoring this event.
If you have any questions or comments about this article please contact Philip Munro, Executive Officer, on faculty@ranzcr.edu.au
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Radiation Oncology
Learning outcomes the focus of enhaced training program Chief Censor in Radiation Oncology A/Prof Margot Lehman
Training and Assessment Reform (TAR) Project Update On behalf of the TAR Steering Committee, I am very pleased to report that the new training program will be completed by the end of August 2019. It is important to emphasise that while the program is referred to as new, it is really an enhancement of the “old” training program. We have removed or reworked elements that were not serving their purpose and we have added components that will facilitate trainee learning and allow tracking of trainee progression. The enhanced training program will comprise learning outcomes; a suite of work-based assessments; practical learning experiences; Clinical Supervisor and Director of Training (DOT) Appraisals; and a variety of feedback tools. The components of the enhanced training program have been piloted in several training centres, and presented for review and comment at the Training Network Directors meeting, the DOT meeting, and Faculty Council. Learning outcomes have been sent out for stakeholder review. The response to date has been overwhelmingly positive and we are very grateful to all who have provided detailed and constructive comments. The Phase 1 and 2 examinations will remain and changes to these are highlighted on page 21 of this edition. In the second half of 2019, we will transition into Implementation Phase of the project. I am very grateful to Dr Matthew Seel who will lead this phase. It is acknowledged that the success of the enhanced training program will
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Inside News
be dependent on a comprehensive communication and training program for all Fellows and Trainees. This work will be carried out throughout 2020, prior to the launch of the program in 2021. I would like to extend my personal thanks to the many Fellows and College staff who have contributed so much of their time and expertise to this project. Particular thanks to Sandra Turner, Yaw Chin, Matthew Seel, Lucinda Burke, Claire Hardie, Tanya Holt, Mark Pinkham, Pat Dwyer, Trang Pham, Sean Brennan, Alex Tan, Ben Chua, Andrew Potter, Legend Lee, Julia Snedic, Pamela Spoors, Jodie Aitken and Professor David Prideaux.
Trainee Wellbeing We believe that the enhanced training program outlined above will provide the best educational tools to facilitate our trainees’ learning. However, we must also ensure that learning environments are safe and supportive and that trainee wellbeing is prioritsed. It is therefore timely to highlight the RANZCR policies designed to support trainees as they navigate through training, including: The reconsideration, review and appeals policy, The consideration of special circumstances policy, The interrupted and part-time training policy and the Grievance Policy. More recently, the Trainee in Difficulty policy has been replaced with three new policies: Performance and progression policies, Remediation policies and Withdrawal from training policies. These new policies were developed following feedback from trainees and supervisors. The feedback highlighted stigma
associated with being identified as a ‘trainee in difficulty’, and that the trainee in difficulty policy did not clearly outline the responsibilities for the training site or the trainee. The new policies aim to advocate for trainee support during training and provide a framework for management of issues in a transparent and supportive environment, while working towards a resolution. Another important resource is the Trainee Liaison Officer (TLO). The TLO functions as a conduit between trainees and the College, outside of the accreditation space. The TLO engages with trainees to provide support, advice and information and monitors trainee issues occurring across training sites. The TLO is bound by confidentiality but can identify issues and report trends so that the appropriate committee and RANZCR departments respond effectively. Trainee health and wellbeing is also promoted in the ‘Your Wellbeing’ information page on the RANZCR website. This page provides information on the support available within the College and identifies external resources which offer support and advice for trainees and members. I would also like to draw your attention to the Supporting Trainees and Reducing Burnout article from Prof Michael Poulsen, published in the September 2017 Inside News issue and the Unwinding Tips and Tools to Avoid Burnout in the Sept 2018 edition of Inside News dedicated to wellbeing. Copies of these editions can be found in the Newsletters section of the College website.
Radiation Oncology
Radiation Oncology Trainee Matters Examinations
Events
The Phase 1 examination was held on 6 September and the second sitting of the Phase 2 examination series took place from July through to early August. Congratulations to the trainees who were successful in these sittings and best of luck to those who are studying for upcoming examinations.
There are a number of other fantastic meetings coming up over the next few months for those interested in attending.
RANZCR ASM and Trainee Day
Dr Mihir Shanker
Dr Anna Gubbins has been tirelessly working with the Convening Committee of the upcoming College Annual Scientific Meeting in Auckland, New Zealand to produce an exciting and stimulating ASM Trainee Day on Saturday 19th October 2019. The day will consist of educational sessions by local and international speakers, trainee presentations and a Training and Assessment Reform forum which will provide all attendees with an opportunity to raise and share any feedback on the new training and assessment changes within the training program. The session will additionally serve as an opportunity to provide feedback on trainee related issues or concerns, and any feedback for the ROTC and College staff. I strongly encourage everyone to make the journey to Auckland this year and attend.
• ESTRO School Falcon Workshop (Online) - Lymphoma Cancer: 10-17 October 2019 • New Zealand Lung Cancer Conference (Christchurch): 17-18 October 2019 • ESTRO Workshop: Multidisciplinary Management of Non-Melanoma Skin Cancer (Brussels, Belgium): 7-9 November 2019 • ESTRO School FALCON Workshop – Head and Neck Cancer: 7-14 November 2019 • ESTRO Meets Asia 2019 (Singapore): 6-8th December. As always, I encourage anyone who requires any guidance on any aspect of the training program to seek support via myself and/or other members of the ROTC, your Director of Training, Network Training Director or the College Trainee Liaison Officer. Best wishes Mihir Shanker ROTC Chair
ROTC 2020 Election The nomination and voting process for the 2019 ROTC has taken place. Many thanks to all the trainees who participated in electing their incoming ROTC members who will continue championing our concerns. I look forward to welcoming the new committee for 2020.
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Radiation Oncology
Radiation Oncology Accreditation Update Dr Vanessa Estall
Standards for Training Networks and Sites: Working together to achieve goals The responsibility to train future radiation oncologists lies not only with the College but with all Fellows of the College. Within the College itself, the Faculty of Radiation Oncology takes pride in its registrar training program and is constantly looking at ways to improve outcomes. To ensure sites and Networks are supported and able to conduct the training required, the College established the â&#x20AC;&#x2DC;Radiation Oncology Accreditation Standards and Criteria for Training Networks and Sitesâ&#x20AC;&#x2122; in July 2016 (updated in July 2017). This can be accessed via the College website. We would be grateful if all Clinical Supervisors could familiarise themselves with the current standards, and when the time comes, provide input regarding any potential changes. Since the establishment of these standards, accreditation panels consisting of at least two radiation oncologists and College staff have conducted 20 accreditation site visits across all Networks in Australia and New Zealand. The Accreditation team endeavours to not only assess individual training sites and Networks with regards to their adherence to the minimum standards, but also aims to provide constructive feedback, support and suggestions where appropriate, to improve the trainee and trainers experience. In addition, we are also grateful for the feedback from participating sites as to how our input can be more helpful and how the standards and accreditation process can be improved.
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Inside News
Over the last 12-18 months, we have identified a number of areas in which the current standards can be clarified and improved for the benefit of all. It is also clear that the delivery of radiation oncology itself has evolved in recent years and will likely continue to evolve. There has recently been an increasing number of rural and private centres opening, an increase in the availability and accessibility of high precision radiation therapy techniques and changing treatment paradigms in the era of immunotherapy. All these factors can impact on how future radiation oncologists will be trained. In response to this, the Accreditation team plan to update the current standards to simplify and clarify the accreditation process, as well as to ensure the College is responding appropriately in regards to changes in practice. This will require an in-depth revision of the current standards and wide consultation with Directors of Training, Network Directors, Clinical Supervisors and trainee representatives. We feel strongly that this should be a consultative process with the College Fellowship and we will be seeking feedback from the general membership regarding any changes before they are finalised. We anticipate that this process will take at least six months and in future, the standards will be updated on a regular basis to ensure they continue to remain relevant and useful. Dr Vanessa Estall Deputy Chief Accreditation Officer
Radiation Oncology
Quality Corner It’s only a matter of time Quality is defined as “the standard of something as measured against other similar things”.
treating 45-50 patients per day. The capacity to compensate by twice daily treatments is not always there.
Quality improvement can come from identifying (and managing) our own practices that are at risk of falling below the accepted standard. After six years in a regional, single machine centre in Bundaberg, it is obvious that we are at risk in the timely delivery of radiation therapy.
Without installing a second machine (that would be nice!) we need to be robust in our scheduling – service days at weekends, treating on public holidays (or the closest Saturday), looking at the expected finish date so that (when it is important), treatment does not straddle an extra weekend. By rigorously managing the predictable we are better placed when the inevitable, unexpected delay happens.
The publication from Royal College of Radiologists1 provides a starting point to help identify the scale of the problem and generate solutions. However, the document assumes centres have “ready access to a minimum of two fully staffed and operational linear accelerators at all times, either within the centre or at a second centre situated close by.” Regardless of guidelines and policies to enable seamless transfer of treatment to our centre in Hervey Bay, patients are reluctant to travel more than three hours per day when machines breakdown. Both centres are busy, sometimes
A machine failure that is fixed quickly in the city can shut us down for more than a day waiting for parts. Thankfully it does not happen often, but when it does, we have a policy to identify quickly those patients at immediate risk from a delay (only a few). We can prepare for the worst for those patients in case the break is extended, knowing that we have scope to compensate other patients once the repair is complete.
The number of patients at risk escalates rapidly with each day of interruption and becomes a major problem by day four (thankfully not yet)! But in that event at least we will have flagged the scale of the issue early within our network and be able to manage as effectively as possible. All centres have their own unique risks – small centres probably have more. But by thinking in advance about quality and the standards expected, we can hopefully draw up policies aimed at reducing those risks so that we can be the best we can be. Dr Gerry Adams
1. Timely delivery of radical radiotherapy: guidelines for the management of unscheduled treatment interruptions, fourth edition. BFC0(19)1. https://www.rcr.ac.uk/publication/timely-deliveryradical-radiotherapy-guidelines-managementunscheduled-treatment
Notice to members: Dr John Kearsley In response to queries from Fellows the College can confirm: In August 2016 Dr Kearsley was sentenced in respect of criminal proceedings to which he pleaded guilty, being one count of administering an intoxicating substance to another person with intent to commit an indictable offence and one count of indecent assault. Upon appeal, determined in March 2017, Dr Kearsley was sentenced to an aggregate term of imprisonment of 18 months commencing in August 2016, with a nonparole period of nine months. The College can confirm that Dr Kearsley no longer holds medical
registration on the basis that it was cancelled and/or prohibited on 23 May 2019. That information is publically available on the AHPRA Register for Medical Practitioners. Dr Kearsley’s offences were serious. RANZCR takes any form of harassment extremely seriously and will not tolerate any form of harassment, including sexual harassment or bullying. Of utmost concern to RANZCR is the wellbeing of our trainees and oncology specialists. Dr Kearsley’s Fellowship of the College was terminated by the College Board of Directors in 2015. The College is unable to comment further at this time.
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Radiation Oncology
Changing conditions guide direction and focus review TROG Cancer Research looks to the future
such studies could be incorporated into the portfolio.
TROG Cancer Research are currently in the final year of their 2017-2019 strategic plan. On Friday 2 August 2019, TROG Cancer Research held a strategic planning meeting with key stakeholders to discuss the direction and focus for the upcoming three years. The workshop facilitated by Ms Alison Evans, Health Consultant, was well attended with over 25 participants from Australia and New Zealand. As a collective we reflected on recent progress and key challenges as well as considering crucial questions regarding the changing research environment.
Mr John Stubbs (Consumer Representative) reinforced the importance of consumer engagement to ensure research is of relevance and meets patient needs. He also suggested that there is opportunity for consumer engagement across the Australian Collaborative Cancer Trial Groups.
• What role will TROG Cancer Research play in the next three years? • How is the clinical trials environment changing? • How is radiation oncology research changing? To provide context of the changing research environment we were fortunate to have key stakeholders provide their perspective including: Prof Trevor Leong (TROG Scientific Committee Chairperson) provided an overview of the TROG Trials Research Portfolio and the changing radiation oncology research landscape as well as global trends in clinical research. Dr Peppe Sasso (TROG Board President) provided insights into the influence of new technology and techniques, including the opportunities for artificial intelligence and machine learning. Prof Martin Stockler (Genomics Cancer Collaborative Trials Initiative) provided a snapshot of recent and emerging cancer trials which had a biological (genomics) component and suggested that TROG Cancer Research should consider how
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Inside News
Discussions from the strategic planning workshop reinforced that a primary focus of TROG Cancer Research should be the conduct of high-quality patientcentred research to ensure safe and effective use of radiation in cancer control. Several other themes emerged which further support this focus including strengthening collaboration and partnerships; enhancing the impact of radiation research; and ensuring organisational capacity and sustainability.
Already confirmed to present is Prof Sabe Sabesan, Director of Medical Oncology at the Townsville Cancer Centre, Townsville Hospital and Health Services and the Clinical Dean, College of Medicine and Dentistry of the James Cook University. Prof Sabesan has designed, implemented and published on various teleoncology models to enhance rural access to cancer services closer to home. As the chair of the QH State-wide Teletrial Working Group and Co-chair of the Australian Teletrial Consortium of COSA, he has been leading the implementation of the teletrial model in Queensland and across Australia.
Key Dates Abstract Submissions Open: 9 September 2019
Outcomes of the TROG strategic planning meeting will be circulated in due course with the plan to be implemented for 2020-2022.
Registration Opens: 1 October 2019
Collaboration will continue to be an important focus as part of TROG’s strategic plan. TROG Cancer Research has had a strong collaborative partnership with RANZCR, which we are pleased to continue well into the future.
Early Bird Registration Closes: 10 January 2020
Announcing TROG's 32nd Annual Scientific Meeting 16 – 19 March 2020 International Convention Centre, Sydney We are pleased to announce that the Trans-Tasman Radiation Oncology Group (TROG) Annual Scientific Meeting will take place 16 – 19 March 2020 at the International Convention Centre, Sydney.
Abstract Submissions Close: 4 November 2019
Express your interest online at www.asm.trog.com.au to be kept informed about the ASM, including additional speakers and educational workshops.
News from the Professions
Interventional Radiology Society of Australasia The 2019 IRSA ASM took place over 3 days, from the 9th – 11th July, in Uluru. The meeting proved a great success, and IRSA would like to personally congratulate convenors Dr Jim Koukounaras, Dr Ashu Jhamb, and Dr Cosmin Florescu for their hard work in producing an excellent meeting. IRSA would like to thank the international speakers, Dr Laura Findeiss, Dr Kelvin Hong, Prof Otto van Delden and Dr Raman Uberoi, for their valued contribution to the meeting, and recognize the continued support of Industry colleagues and partners. Following the executive committee elections, we’re pleased to announce the following committee members will represent members on the IRSA Executive for 2019 - 21. Dr Gerard Goh – President Dr Brendan Buckley – Secretary Dr Chris Rogan – Treasurer Dr John Vrazas continues in his role as past president.
IRSA would like to thank all applicants for the IRSA/CIRSE Registrar competition. There were 14 abstracts submitted, 8 entrants shortlisted, and we would like to congratulate Dr Heather Moriarty from the Alfred Hospital, Melbourne on winning the inaugural IRSA/CIRSE Registrar presentation prize! Dr Moriarty will receive a trip to the CIRSE ASM with complimentary flights, accommodation and registration. IRSA would like to express thanks to Dr Gabriel Lau who steps down from the executive after 2 terms as treasurer. Dr Lau, together with Professor Tim Buckenham has committed to convene the next IRSA ASM, which will return to Queenstown for 2020. This meeting is likely to take place in early August, and once a venue is confirmed a ‘save the date’ email will be circulated to members. The Aus/NZ EBIR will again be held just before the ASM. Expressions of interest were invited from members to convene the next registrar conferences for 2020-2021. Dr Jonathan Langton and Dr Paul Leschke will be
the coordinators in the Sunshine coast. Dr Warren Clements, Tim Joseph and Julian Nguyen are to be congratulated for hosting the highly successful conference in Melbourne for the past 2 years. This year the Australia and NZ EBIR examination had 19 candidates and continues to grow in popularity. Dr Gerard Goh concludes his term as the EBIR chief examiner and with the new EBIR exam format Dr Gabes Lau has been appointed at the new EBIR chief exam supervisor. The executive committee has had a busy 2 years working on strategic priorities. The IRSA constitution was reviewed and more detailed terms of reference for the executive committee and office bearer positions were created. Amplexa Consulting has been contracted to provide high level support around advocacy and strategy for the society. The new IRSA executive look forward to steering the direction of the society over the next 2 years.
Neuroradiology and Head & Neck News On behalf of the new executive and society members, my first task is to extend sincere gratitude to the previous President, Professor Peter Mitchell and Secretary-General Dr Catherine Mandel for their tireless and dedicated service to the society. Peter has served as president for the past three years and Catherine as Secretary-General for the past three years. Their immense contribution is very much appreciated by all our members and they have both left very big shoes to fill. I would also like to thank Prof. Alan Coulthard for his work as the departing inaugural chair of the Conjoined Committee for Recognition of Training in Interventional Neuroradiology (CCINR). We welcome Dr Steven Chryssidis as the incoming Secretary-General. Steven has served as South Australian councillor for the past seven years, and convened the 2014 and 2019 ANZSNR Annual
Scientific Meetings. He brings a wealth of experience and expertise to the role. I am looking forward to working with him and the council including newly elected members Dr Andrew Cheung (NSW), Dr Elaine Lui (VIC) and Dr Tim Phillips (WA) to serve the society. I would like to remind all College Members of the upcoming 2020 ANZSNR ASM to be held in Brisbane on 12 – 15 March. The meeting is being convened by Drs Kate Mahady and Jennifer Gillespie. As has been the format for the past few meetings, there will be 3 educational streams comprising of Diagnostic Neuroradiology, Head & Neck/ENT & Interventional Neuroradiology. Additionally, a focus of the Brisbane meeting will be to cater for general radiologists and trainees looking to refresh and update their Neuroradiological & Head/Neck skills. Please visit our website www.anzsnr.org.au for details.
Finally, on behalf of our society, I would like to extend deepest condolences to the family of Professor Chakera. Prof Sanjay Jeganathan has already paid tribute on behalf of the College to the monumental contribution of Prof. Chakera to the service of Radiology including, Neuroradiology. On a personal note, I was fortunate enough to train as a registrar under Prof Chakera’s leadership. Turab was a supreme rolemodel and as a teacher second to none. Rarely does a working day go by when I do not draw upon the vast reserves of wisdom & knowledge he so generously imparted. We are all the poorer for his passing. Dr Con Phatouros President ANZSNR
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News from the Professions
Facilitating the implementation of 3D conformal radiotherapy in Mongolia: an APROSIG collaboration with the National Cancer Centre, Ulaanbaatar
An opportunity arose via IAEA contacts to establish collaborative links between RANZCR via the AsiaPacific Radiation Oncology Special Interest Group (APROSIG), the AsiaPacific Special Interest Group (APSIG) of the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM), and key clinical leaders from the National Cancer Centre Mongolia. Mongolia has a population of 3.15 million and is classified by the WHO as a lower middle-income country. Cancer is now a major public health issue and one of the leading causes of mortality, comprising 22% of all deaths. The major provider of cancer care is the National Cancer Centre of Mongolia (NCCM) located in Ulaanbaatar, with the introduction of 3D conformal radiation planning and radiation protection/safety identified as a national priority in cancer management. A successful RANZCR International Development Fund grant and additional support from delegate departments enabled a one-week visit in September 2018 to NCCM coinciding with their inaugural Mongolia Society for Radiation Oncology (MOSTRO) ASM. The delegation comprised two radiation oncologists A/Prof Kumar Gogna (Qld) and Dr Eng-Siew Koh (NSW); Ms Nikki Shelton, a medical physicist (Vic) and Cesar Ochoa, a radiation therapist (NSW). The three main objectives of the visit were to participate in their inaugural MOSTRO ASM, secondly to provide hands-on education and training in 3CDRT and thirdly to scope and establish opportunities for future collaboration. The MOSTRO ASM was a highly successful one day meeting attended by over 150 delegates, including representation from Mongolian cancer
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Inside News
control bodies, government and industry. The program comprised oral presentations by local and international faculty from Japan, Korea and Australia. During the week-long visit the APROSIG-APSIG delegation led many small group and practical sessions, as well as workshops and lectures on site-specific radiation oncology topics, radiation therapy themes and medical physics topics respectively. These spanned a broad range of topics including quality assurance, radiation safety, treatment planning and linac commissioning. NCCM continue to have major equipment challenges due workforce and skills shortages contributing to delays in linear accelerator commissioning and incorporation of CT simulation equipment into their workflow. Despite this, there is a very cohesive team culture, strong leadership and an openness to professional learning and innovation in a resourceconstrained environment.
Together with the input of local and other Asia Pacific regional partners and the APROSIG and APSIG members, the National Cancer Centre of Mongolia has stronger foundations for the successful implementation of 3DCRT. The ongoing focus has been on upcoming linear accelerator commissioning, upskilling of their workforce and targeted training with subsequent visits to NCCM made by medical physicist, Abdurrahman Ceylan and radiation therapist, Toby Lowe, in 2019. There remains significant opportunity for productive ongoing future collaboration. Dr Eng-Siew Koh on behalf of APROSIG Radiation Oncologist, Liverpool Hospital, NSW
News from the Professions
PCFA launches Australian-first monograph: Improving QOL for men with prostate cancer The position statement and monograph have been developed by PCFA in collaboration with experts from the NHMRC-funded Centre for Research Excellence in Prostate Cancer Survivorship. “The monograph is the culmination of many years of work with experts across clinical and allied health fields, to improve care and better support men affected by the disease,” Prof Dunn said. “At a practical level, the Position Statement recommends that men who have been affected by prostate cancer should be screened for distress so that any psychological and quality of life concerns can be identified and managed.
A ground-breaking position statement on prostate cancer is set to transform the way Australian radiologists, clinicians, and health professionals manage the deadly disease. The statement has been endorsed by the Royal Australian and New Zealand College of Radiologists. PCFA CEO, Professor Jeff Dunn AO, said the statement would help to deliver quality cancer care for the significant number of men who currently go through treatment for prostate cancer without adequate psychosocial support. “Every year 1.3 million men worldwide are diagnosed with prostate cancer,” Prof Dunn said. “Alarmingly, Australia has one of the highest incidence rates internationally, with 1 in every 7 Australian men likely to be diagnosed during their lifetime. “While survival rates for prostate cancer are high, with over 95% of men likely to survive at least five years, the diagnosis of prostate cancer is a major life stress that is often followed by challenging treatment-related symptoms and
Before and after prostate cancer treatment up to one in four men experience anxiety and up to one in five report depression, with an increased risk of suicide.
“Partners of men with prostate cancer have also been found to experience clinically significant levels of distress, with more research needed to identify effective diagnostic tools and interventions to prevent mental ill health and the ripple effects that so easily destroy the fragile thread of family and community life.
“An estimated 20,000 men nationally will be diagnosed this year and over 200,000 Australian men are alive today after a prostate cancer diagnosis,” Prof Dunn said.
“The Position Statement calls on clinicians, governments, researchers, and policy makers to prioritise investment in prostate cancer survivorship by making it a national health priority.
“We have made great progress in saving lives and helping more men survive prostate cancer — delivering ground-breaking new treatments, next generation medicines, and clinically advanced options for surgery and disease management.
“Quality of life is core to wellbeing and must be regarded as an essential aspect of care during all stages of prostate cancer treatment and survivorship.
heightened distress.”
“While our achievements have been tremendous, we have more work to do, particularly in providing men and their families with much greater psychosocial support and care after their diagnosis and treatment for prostate cancer. “We face vast challenges in defeating prostate cancer and meeting the needs of those affected.”
“Our goal is not just to defeat prostate cancer, but to restore hope in a future free from both physical and psychological pain,” he said. Go to www.pcfa.org.au for copies of the Position Statement on Screening for Distress and Psychosocial Care for Men with Prostate Cancer and the Monograph: A Psychosocial Care Model for Men with Prostate Cancer. continued over...
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News from the Professions
ABOUT PROSTATE CANCER FOUNDATION OF AUSTRALIA Prostate Cancer Foundation of Australia (PCFA) is the peak national body for prostate cancer in Australia. We are dedicated to reducing the impact of prostate cancer on Australian men and the people who care about them. We do this by: • Promoting and funding world leading, innovative research into prostate cancer
• Implementing awareness and advocacy campaigns and education programs for the Australian community, health professionals and Government
For further information about Prostate Cancer Foundation of Australia, please visit pcfa.org.au or call 1800 22 00 99.
• Supporting men and their families affected by prostate cancer through evidence-based information and resources, support groups and Prostate Cancer Specialist Nurses
Anne Savage, Head of Communications anne.savage@pcfa.org.au M: 0417 709 869 P: 02 9438 7016
PRESS CONTACT
Prostate Cancer Foundation of Australia relies on the generosity of individuals, the community and partnerships to carry out our essential work.
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Inside News
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News from the Professions
College Life – Behind the scenes 13 Special Interest Groups, 197 Committees, Councils and Working Groups. Five Social media accounts; several websites and platforms, training courses and general day to day management of member needs are just some of the roles undertaken by College staff. These are their stories…
Mereana Pokai
If you have ever contacted the College for any assistance, chances are you have had some contact with Mereana Pokai. Her official title is Senior Administrator but this fails to adequately describe the true whirlwind of her day to day. Spending her days assisting Members and Branches with a range of enquiries and helping them solve a myriad of problems, Mereana is involved with everything from helping organise branch meetings and events, to updating membership status and enquiries. Her work days are never the same and seldom boring. Initially started out training as a plumber she was unable to secure an apprenticeship due to the pervading sexism of the time,
and instead embarked on a career that can be described as anything but predictable. Eventually she made her way from New Zealand to Australia and finally, after many adventures, to the College. Though she admits she enjoys her work, one of Mereana’s passions is creating and following processes to ensure that they work and can be used by everyone else. (On a side note, we confirm her work instructions are of the highest quality – Ed) The most challenging part of the job though is trying to help the branch committees. Primarily made up of volunteers, most are working full time and as such, being able to bring everyone together whilst trying to minimise disruption to their lives requires the juggling skills of Penn and Teller. In her own words, "I try and make it easier for them but, for example, in the NSW RO Chapter Committee there are 19 committee members, so trying to arrange a meeting with enough of them to get a quorum is almost impossible."
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General Interest
College Volunteering: Why get involved As a member-based organisation, member engagement is, and always will be, a key priority for the College. We are proud to say that, on average, one third of our members – that’s around 1,500 of you – volunteer their time and expertise each year to support our work, and we are enormously grateful for the important contributions and commitment that these members make. If you are wanting to get involved with the College, there are a broad range of activities available. Different activities require varying degrees of time commitment and draw on a variety of skillsets and areas of expertise so you can choose to be involved in something that holds appeal for you. Remember, it’s not all about committee meetings (although we do have a lot of those…). So why volunteer? With so many existing demands on your time – and energy – what are the benefits of getting involved with the College? We asked some of our existing volunteers this very question, and this is what they had to say:
1. Have your voice heard: If you have opinions on what the College should be doing, be the change you want to see and help to make it happen.
• Check our website for details of current volunteering opportunities at www.ranzcr.com/ currentopportunities
2. Give back to your profession: Help to ensure that your professions remain strong and are given the respect they deserve.
• Email the Editor at editor@ranzcr. edu.au to respond to an article that appeared in Inside News or submit one of your own.
3. Become part of a community: Volunteering offers a sense of belonging and helps you make connections with your peers.
• Update your member profile on the MyRANZCR portal so that we can notify you when relevant opportunities arise in future:
4. Enhance your resume: Valuable experience gained from volunteering activities may give you a competitive advantage in future endeavours.
1. Log in to www.myranzcr.com
5. Collect CPD points: see table for examples.
2. Click on My Profile and scroll down to the section titled “Which College activities are you interested in” 3. Tick any options that apply, then click “Update”
Convinced?
Without our volunteers, the College simply would not be able to achieve its goals. We sincerely thank all our volunteers, both past and present, and hope to welcome many more members into volunteering roles in the future.
If you’d like to become a more active contributor to the College’s work, please:
Earn CPD points while you volunteer… Here are just some of the ways you can get involved in the College’s work…and the CPD points you could collect by taking part*. Governance
Events (local and national)
Board and Faculty Council
Conveners
30-40 points per meeting
Committees and working groups
Co-conveners
10-20 points per meeting
Reference groups/panels
2 CPD points per hour
Abstract reviewers and judges
Special interest group executive
Speakers
Branch committees
Session chairs/panel members
Examiners
2 points per hour
JMIRO associate editor
Branch education officers
2 points per hour
JMIRO reviewer
Research mentors
1 point per hour
Training site accreditation assessors
2 points per hour
IMG assessors
2 points per hour
Training Network Directors / Network Training Directors
2 points per hour
Inside News
1 point per hour
Publications
Training and assessment
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1 point per hour 5-15 points per presentation
5 points 1 point per hour
We also encourage members to get involved by: • Providing feedback on consultations, policies and guidelines • Contributing articles to InsideNews • Supporting our Targeting Cancer and InsideRadiology campaigns *See the CPD Handbook for further information
General Interest
Radiology on the front lines From the Archives Working in the archives, sometimes you come across a very random item that leads you down a rabbit hole. The recent discovery of some petrol ration vouchers from 1941 encouraged us to explore what else we had in the archives from World War 2. It turns out that we have quite a bit. When war was declared, the Collegeâ&#x20AC;&#x2122;s forerunner, the Australian and New Zealand Association of Radiologists stepped forward and did their bit for the war effort. In 1939, the association had 162 members. Early on, the Defence Department requested that all troops being posted overseas receive chest x-rays resulting in 6700 men X-rayed and being diagnosed in around six days. Digging further into the archives we came across an X-ray register from 1941. The book chronicles the work of radiologists inside the fortress at Tobruk (in North Eastern Libya) working whilst under siege from Germanyâ&#x20AC;&#x2122;s Afrika Corps. Major Thomas Tyrer, Warrant Officer Leonard Carroll and Warrant Officer Maurice Anderson were providing their services in the North Africa campaign and found themselves in the fortress of Tobruk when it was surrounded by the Erwin Rommelâ&#x20AC;&#x2122;s Afrika Korps. The documents we uncovered reveal the constant work of these men despite supply shortages, constant aerial bombardment and artillery fire. Though there are many stories of heroism that came from this campaign, it is a nice reminder that medical professionals were also there in the thick of it doing their best under trying circumstances.
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 archives@ranzcr.edu.au Donations to the archive are assessed on a case by case bases
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General Interest
Cardiac CT Training 2020 We go beyond simply meeting training requirements: l
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The College notes with regret the death of the following members:
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Maximum allowable course based live and library cases for ANZ credentialing. RANZCR accredited for 117.5/67 CPD points (Level A/Recertification). AICC Officially sponsored and endorsed by GE Healthcare for more than10 years. Live scanning at second highest global NS DI TITU recruiting site in SCOT-HEART study. TE OF CAR Unrivalled venues - Now at Zest, Point Piper, Sydney.
2020 COURSE DATES: 5 Day Level A Course: 21st - 25th May 2020 3 Day Level A Course: 23rd - 25th May 2020 For more information and online registration log on to: www.aicct.com.au or contact us at: info@aicct.com.au
Prof Geoffrey Benness, Life, NSW Dr Sean Skea, Fellow, NZ Prof Turab Chakera, Life, WA Dr Edward Johnston, Fellow, QLD
FLINDERS MEDICAL CENTRE PATHOLOGY COURSE 15 & 16 FEBRUARY 2020 The Division of Medical Imaging at Flinders Medical Centre will offer a two day Pathology Course, consisting of lectures and “pots” sessions to be held on Saturday 15 and Sunday 16 February 2020 at the Adelaide Convention Centre. The course will be of particular value to registrars and candidates preparing for the Part II FRANZCR examination. It will also provide an overview of pathology for practising radiologists who are encouraged to attend.
Presented by Associate Professor Marc Agzarian With MRI progressing rapidly, a sound understanding of the physics, technology and equipment is required to fully exploit MRI’s potential. MRI safety, image quality, artefacts and optimisation strategies are covered throughout the course.
Closing date for registrations is: Friday 29 November 2019 For registration form and further information please contact Helen Sainsbury: helen.sainsbury@sa.gov.au / (08) 8204 4405
With all original, vendor neutral content, this course will benefit radiologists, radiology registrars, radiographers, neurologists, cardiologists, neurosurgeons, researchers and medical physicists wanting to gain a better understanding of MRI.
New ZealaNd luNg CaNCer ConferenCe 2019 17th - 18th October 2019 The Piano, Christchurch For more information please visit the TSaNZ website at:
https://www.thoracic.org.au/
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COURSE
9-10 November 2019
Pullman Hotel Adelaide 16 Hindmarsh Square Adelaide, South Australia
BOOK NOW www.registernow.com.au/ secure/Register.aspx?E=35434
For more information and to view the full program visit www.ncevents.com.au/events ncosta@ncevents.com.au
Healthcare Imaging Services UK Trust Fellowship Program Flexiblity | Growth | Opportunity
Call for applications and expression of interest. Healthcare Imaging Services, one of Australia’s largest imaging providers is pleased to announce our UK Trust Fellowship program.
The program is for radiology trainees and recent graduates of RANZCR. Applications are encouraged from any interested radiology trainees and recent RANZCR graduates (3 years). The Trust fellow program matches Australian/NZ junior radiologists with training consultant positions in the UK.
Successful applicants can choose a hospital location in the UK: • Bristol • Birmingham • Central London • Leeds • Liverpool • Salisbury • Worcester and several others Sub Specialties available include: • MSK • Neuroradiology • Interventional • Emergency • Abdominal • Women’s Imaging • Chest and others by negotiation
Queen Elizabeth Hospital Birmingham
Have you considered a subspecialty fellowship to complete your radiology training? In recent years good fellowship positions have been scarce, as the UK and US have become difficult or impossible destinations. There have been problems with state licensing in the US. In the UK non-EU doctors have faced difficulties with obtaining GMC registration and a working visa. Fellowships are usually low paid, and fellows sometimes can’t enjoy all the opportunities of the host city/country. The HIS Trust Fellow program takes advantage of recent changes in UK immigration and GMC registration which make it easier for non EU doctors to work in the NHS. Healthcare Imaging Services provides financial support to make the fellowships attractive to junior consultants, who may want to spend a year in Europe and enjoy the travel and cultural opportunities. Appointments in the UK will usually be for a year, and are part of a three year scholarship that includes 2 years as a VMO with Healthcare Imaging Services. The location and work mix of those two years will be tailored to the applicant, and Healthcare Imaging Services Australia can offer all subspecialties and all geographical locations in mainland Australia. There is considerable flexibility about dates of commencement, to meet the needs of the successful candidates. The UK component can be worked as any year of the three.
For further information Please contact
Fellows will: • Be employed and paid as an associate specialist radiologist in their UK department • Be fully registered with UK General Medical Council • Be sponsored by their NHS Trust for a full working visa • Be under a named supervisor in their subspecialty • Be able to take a full part in the clinical and academic activities of the host department • Receive a Healthcare Imaging Services educational grant of $100,000 at the beginning of their year in the UK, to defray rental and relocation costs, and to help provide a good standard of living in the UK • Receive business class airfares from Australia to the UK for themselves and their partner • Receive sponsorship to attend ECR or RSNA, or similar as a representative of Healthcare Imaging Services • Be able to supplement their income, if they wish, by teleradiology work with Healthcare Imaging Services Interested radiology trainees and recent RANZCR graduates (3 years) are invited to make contact for an informal discussion.
Dr Tom Snow FRANZCR
Clinical Director of Imaging Mobile: +61 432 207 558 Thomas.Snow@qdi.com.au
Sue Pohlmann
National Clinical Education Manager Mobile: +61 435 961 559 Sue.Pohlmann@healthcareimaging.com.au
RECTAL CANCER MDT CURRENT ISSUES Sydney
26 October 2019
Case Based Lectures by Prof Gina Brown, Royal Marsden Hospital
INTENSIVE PELVIC MRI COURSE Melbourne
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Internationally recognised experts in their field
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Individual workstations
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100 Plus cases, with pathology, to review in the delegates own time
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A series of lectures from international and local faculty
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Group case review
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Expert panel
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Faculty on site throughout the course to provide individual support
1-3 May 2020
Faculty: Prof Andrea Rockall, Imperial College & Dr Svetlana Balyasnikova, Royal Marsden Hospital, London UK
Singapore
THE COURSES PROVIDE:
14-16 September 2020
Faculty: Ass Prof Fiona Fennessy, Brigham and Women’s Hospital, Boston, USA & Dr Stephanie Nougaret, Montpellier Cancer Institute, France
ALL NEW CEDM COURSE Melbourne
8 February 2020
21-23 August 2020
Following the successful introduction of a segment on CEDM at the Intensive Breast MRI Courses we are pleased to announce the introduction of a 1-Day intensive, workstation-based, Contrast Enhanced Digital Mammography course to be held in Melbourne.
Faculty: Dr Ritse Mann, Radboud University, The Netherlands
The CEDM Course will be led by Dr Allison Rose and the faculty from the highly successful Intensive Breast MRI Courses.
INTENSIVE BREAST MRI COURSE Melbourne
date to be confirmed
For more information and registration w w w. t n i a u s t r a l i a . c o m