Inside News September 2023

Stage III unresectable NSCLC that has not progressed post platinum-based CRT

EXTEND THEIR SURVIVAL

*5-YEAR POST-HOC ANALYSIS (34.2 months median follow-up): of patients progression-free with IMFINZI (vs 19% placebo, HR 0.55 95% CI 0.45-0.68); P=not reported 1

43%

33% of patients alive with IMFINZI (vs 33% placebo, HR 0.72 95% CI 0.59-0.89); P=not reported 1

LESS INFUSIONS Q4W

IMFINZI Q4W flat dose halves infusion and treatment visits (13 vs 26 infusions over 12 months, Q4W vs Q2W dosing)

LEARN MORE

PBS Information: Authority required (STREAMLINED) for NSCLC. Refer to PBS Schedule for full authority information.

BEFORE PRESCRIBING, PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ASTRAZENECA ON 1800 805 342 OR www.astrazeneca.com.au/PI

This medicinal product is subject to additional monitoring in Australia. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse events at www.tga.gov.au/reporting-problems.

IMFINZI® (durvalumab) Minimum Product Information. 120mg/2.4mL or 500mg/10mL, Concentrated Solution for Infusion in a Single-Dose Vial. INDICATION: For the treatment of patients with locally advanced, unresectable non-small cell lung cancer (NSCLC) whose disease has not progressed following platinum-based chemoradiation therapy. DOSAGE AND ADMINISTRATION: 10 mg/kg every 2 weeks or 1500mg every 4 weeks administered as an IV infusion over 60 minutes, for one year or until disease progression or unacceptable toxicity Patients with a body weight of 30kg or less must receive weight-based dosing, equivalent to IMFINZI 10 mg/kg every 2 weeks as monotherapy until weight increases to greater than 30kg. Administer IMFINZI prior to chemotherapy when given on the same day. IMFINZI should be diluted prior to infusion, see full PI for compatible diluents. No dose reduction or escalation for IMFINZI is recommended. In general, withhold IMFINZI for severe (Grade 3) immune-mediated adverse reactions. Permanently discontinue IMFINZI for life-threatening (Grade 4) immune-mediated adverse reactions, recurrent severe (Grade 3) immune-mediated reactions that require systemic immunosuppressive treatment, or an inability to reduce corticosteroid dose to 10 mg or less of prednisone or equivalent per day within 12 weeks of initiating corticosteroids. See full PI for recommended treatment modifications and specific management for immune-mediated adverse reactions. IMFINZI has not been studied in patients with severe renal impairment. CONTRAINDICATIONS: Hypersensitivity to the active substance or to any of the excipients. SPECIAL WARNINGS AND PRECAUTIONS FOR USE: Immune-mediated adverse reactions (imARs): Immune checkpoint inhibitors, including durvalumab, can cause severe and fatal imARs, which may involve any organ system. Patients should be monitored for signs and symptoms associated with imARs including: immunemediated pneumonitis/interstitial lung disease, *radiation pneumonitis, hepatitis, colitis, immune-mediated endocrinopathies including hypothyroidism/hyperthyroidism/thyroiditis, adrenal insufficiency, type 1 diabetes mellitus, hypophysitis/hypopituitarism, nephritis, dermatological adverse reactions, and other immune-mediated adverse reactions *(including pancreatitis, encephalitis). See full PI for further information on monitoring and management recommendations for imARs. Infusion-related reactions: Monitor patients for signs and symptoms, severe reactions have been reported. Efficacy in patients with PD-L1 expression <1%: efficacy may be different, see full PI. Paediatric use: safety and efficacy not established in patients less than 18 years. Use in pregnancy: Category D. Durvalumab has the potential to impact maintenance of pregnancy and may cause foetal harm. Not recommended during pregnancy; women of childbearing potential should use effective contraception during treatment and for at least 3 months after the last dose. Use in lactation: lactating women should be advised not to breastfeed during treatment and for at least 3 months after the last dose. ADVERSE REACTIONS: IMFINZI monotherapy pooled data: Very common (≥10%, any grade): cough/productive cough, diarrhoea, rash, pyrexia, upper respiratory tract infections, abdominal pain, pruritus, hypothyroidism. Common (≥1% and <10%, any grade): Pneumonia, oral candidiasis, dental and oral soft tissue infections, influenza, hyperthyroidism, pneumonitis, dysphonia, aspartate aminotransferase or alanine aminotransferase increased, night sweats, myalgia, blood creatinine increased, dysuria, peripheral oedema, infusion related reaction. See full PI for other listed adverse reactions including immune-mediated adverse reactions. Date of first approval: 2 October 2018. December 2022.

*Note changes in Product Information.

CI: confidence interval; CRT: chemoradiation therapy; HR: hazard ratio; NSCLC: non-small cell lung cancer; Q2W: every 2 weeks; Q4W: every 4 weeks. References: 1. Spigel DR, et al. J Clin Oncol 2022;40:1301-1311. 2. Antonia SJ, et al. N Engl J Med 2018;379:2342-2350. 3. Antonia SJ, et al. N Engl J Med 2017;377:1919-1929. 4. IMFINZI Approved Product Information. IMFINZI ® 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 or to report an adverse event or product quality complaint: Telephone 1800 805 342 or via https://contactazmedical.astrazeneca.com or email Medical Information enquiries to medinfo.australia@astrazeneca.com.

AU-16245. ASTR0875/EMBC Date of preparation: April 2023

RANZCR acknowledges the Traditional Owners of Country throughout Australia. We recognise the continuing connection of Aboriginal and Torres Strait Islander people to the sky, lands, waters and culture and we pay our respect to their Elders past and present and emerging. RANZCR acknowledges Mäori as tangata whenua and Treaty of Waitangi partners in Aotearoa New Zealand.

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About a year ago, the Commonwealth initiated a ‘rapid review’ of the government processes regulating overseas health practitioners applying to work in Australia. The independent review by retired senior public servant Robyn Kruk AO seeks to improve how we assess international medical graduates (IMGs), specifically registration and recognition of their skills and qualifications. Kruk issued her interim report in April for comment, with her final report expected this year. Among the interim recommendations are bureaucratic reforms to improve the applicant’s experience—for example, by removing duplication and streamlining steps such as visas and criminal history checks—as well as policy proposals such as expanding the use of comparable health system pathways (CHSPs). A CHSP, based on a government list of countries deemed to have a comparable health system, would ‘fast-track’ applications, allowing emigrating doctors in these jurisdictions to gain registration without sitting further exams.

Under the current system, specialist medical colleges such as RANZCR play an essential role in the assessment of IMGs in determining suitability for registration by comparing their qualifications and training against those of Australian-trained specialists and Fellows. Kruk believes the current system lacks consistency and is too slow and costly for applicants. Hence, she has recommended the so-called

IMG Assessments Under Review

A faster, cheaper and less collegiate system for IMGs—what could go wrong?

‘equivalence assessments’ undertaken by the colleges be transferred to the Australian Medical Council (AMC), with the colleges continuing in an advisory role only.

The interim report puts forward many reasonable suggestions but the thinking behind some is flawed. A telling sign is the 30 or so mentions of ‘medical colleges’, without mention of any specific Australian or NZ college (save for the Australian College of Rural and Remote Medicine which trains, certifies and represents doctors in rural general

have any impact for prospective IMGs in radiology and radiation oncology. The Medical Council of New Zealand presently uses a CHSP list totalling 24 nations, including Australia, the US, Canada and 18 European countries, with no Asian entries other than Singapore and Hong Kong. The vast majority of IMG applications the RANZCR receives are from nations currently not on this CHSP list. In any event, we do not accept that comparability applies evenly across the health system. For example, the UK’s health system may be broadly comparable to Australia’s but it’s not so in radiology. The Royal College of Radiologists (RCR) training program is narrower in scope than ours and applicants for fellowship of the RCR are eligible to sit the exam after just three years of training.

practice) or any attempt to distinguish between the different medical professions. Taking a one-size-fits-all approach like this fails to acknowledge the wide variations in doctor training across different specialties. Greater use of CHSPs may have some value in some specialties but it is unlikely to

It is disappointing that the Kruk review has not to date meaningfully engaged with the College, especially on the supply of radiology services in rural and regional Australia. We conduct more area-of-need assessments than all the other specialist colleges combined (save for general practice), and four of the five most senior positions in the College are currently occupied by former IMGs. Yet, instead of seeking our unique knowledge and insight, the report prefers to highlight a comment by an unnamed and uninformed WA Health official that ‘medical colleges have a vested interest in controlling the number of specialist practitioners practising in Australia’. At least as far as

Clin A/Prof Sanjay Jeganathan

Taking a one-size-fitsall approach fails to acknowledge the wide variations in training across specialties.

our two specialties are concerned, the College assesses IMG applications fairly and transparently in accordance with the standards set by the AMC, the very body that Kruk says should be in charge of assessments. Further, the number of IMG applications to be considered each year is controlled not by the medical colleges but government regulation and requirements. We just do the hard part: ensuring that any overseas-trained radiologist is educated to the same standard and scope of practice as our Australian- or NZ-trained radiologists. Our members provide their time and expertise for these assessments at no cost to government. With the exception of general practice, radiology IMG numbers are among the highest of all the specialties.

The Kruk review is predicated on the Australian Government’s desire to address growing shortages of health practitioners, especially among GPs, and especially in rural and regional areas where the shortages are worst. We support that, and proposed changes to how we process IMG applications may be part of the solution but they cannot be the long-term solution. Ultimately, we have to be self-sufficient in health training to achieve this without lowering our enviable, world-class standards in healthcare and without putting patient safety at risk. To date,

neither the Federal Government or the state governments have engaged with specialist medical colleges to seek the advice of the experts on how we could collectively work to address the workforce shortage.

Machinations over the registration of IMGs need to be viewed in the light of other recent government actions related to education and training. These include concerns among state and federal ministers over the medical colleges’ accreditation of training sites—specifically decisions in which the accreditation of a site was withdrawn— and action by the Tertiary Education Quality and Standards Agency against colleges that award diplomas. Taken as a whole, the narrative which appears to hold sway in government circles is one in which the medical colleges are portrayed as an impediment rather than a safeguard in the delivery of healthcare.

We have read the same message in Ahpra's plan to open up the continuing professional development (CPD) market to a score of external providers, some of whom are likely to opt for a highvolume/low-service business model. The stated aim is to provide a CPD home for up to 30,000 medical practitioners who are currently without one, but that could be achieved with greater certainty of outcome by asking the colleges to open

up the doors of their existing programs and directing the ‘homeless’ doctors to choose a program. Under the current regime, the fees we collect from CPD are re-invested into member and trainee services. A reduction in this income is bound to lead to a rise in general membership fees or a reduction in services.

What would be the backlash if the engineers, accountants, lawyers and company directors were forced to open their CPD programs to external market players in this manner? Once again, it seems as if the medical colleges are being singled out. What they do not seem to understand is: our two nations have enjoyed the benefits of the highest standards of specialist medical workforce over many decades, and that did not happen by magic. It is the result of thousands of volunteer members of the colleges ensuring the standards are maintained.

You can rest assured that the College will not allow these proposals to sail quietly into practice without comment from us and strong advocacy on behalf of our patients and members who serve them with dedication.

Having worked in several member associations over many years, I know there can be a tendency for staff to develop an inwards focus; an organisational myopia. Over time and immersed in the day-to-day of the business, it can be easy to forget the purpose of our College and that at the end of every action, there should be a member need fulfilled.

The recent pandemic brought about many changes to our lives, some temporary and others seemingly more long term, even permanent. One theme emanating from the pandemic is the blended working model for many office workers, including RANZCR staff. The blended work model has brought its own challenges for business and one of these is how we continue to deliver for our members when we are not all in the office and working closely together. It has been a confusing time for our staff and even more so for new staff members coming into a blended working organisation without the usual “in-person” support network. Added to this is the higher-than-normal staff turnover and difficulty in finding new staff throughout 2022, when the College lost some of its corporate memory that would have helped ease the induction for new staff.

Several members have recently offered thoughtful feedback on what they saw as a decline in member focus by parts of our College. Some of the comments include the College presenting as a large grey wall to its members, who

The Focus on Member Fulfilment

know that something is going on inside, but that they are not sure what that is; frustration at trying to find the “right” staff member to speak to; that staff move around or move on, emails or calls not answered; and that at times, College rules and processes did not deliver member-centric outcomes.

• Our members are our primary customers. Regulators, government funding bodies, politicians, sponsors and the public are stakeholders in what we do.

• If you are not directly working towards member fulfilment, then you should be supporting the person who is. There is no-one in the College who does not link to member fulfilment.

• Members may not always be right, but they always deserve to be treated with respect.

We also looked at some behaviours and attitudes that had emerged in recent times, and where we needed to move to. We are refocusing, initially through a multitude of small but important changes.

These members were correct. In some instances, we had lost our focus. And so, we needed to lift our collective gaze to the horizon, reconnect with our purpose and concentrate on our members.

At our recent EOFY all-staff review session, I delivered a presentation to our staff that reflected on our activities and achievements during the past year, and signalled our priority focus areas for the next financial year. One of those key areas is member fulfilment.

During our meeting, it was confirmed that:

• We are, at heart, a service organisation, and so our purpose is to offer a service to our members.

Staff are now required to return any phone calls received by them on the Dialpad system, whether a message has been left or not. Some of our members have commented on this happening recently, so it is working, but please, leave messages when you call. All staff are now in the Dialpad system to answer calls, including the CEO. And recently, we hired a temp to answer member calls during our peak times. Staff are embracing the “sticky hands” approach and “owning” the member until another staff member agrees to take them on.

We’ve introduced a new-look member renewal letter this year, offering greater detail into the revenues and expenses of the College. The RANZCR board now

In December, I wrote about the need for respectful interactions between members and staff. In this column, I want to talk about the reverse side of this dynamic.

Duane Findley

And so, we needed to lift our collective gaze to the horizon, reconnect with our purpose and concentrate on our members.

issues a communiqué after its board meetings and our advocacy and policy unit has issued its first biannual report into its activities and its successes.

Following discussions with our SIGs, we have now made the RANZCR organisation chart available on our website so our members can understand the structure of the College, and we have dedicated this edition of Inside News to promoting our SIGs. We’re making changes to our IT systems, with the aim of making payments easier and automating some of our more problematic processes.

We are planning on mapping several “typical” member life cycles and

identifying member needs and pain points, with a view to addressing these. There will be times where we cannot or should not accede to every member request. But it is important that we listen to our members and treat them with respect. It’s your College and we want you to feel like you belong here.

This has led RANZCR to expand our physical workplace footprint. We’ve now taken back a sub-lease in the Wellington office to provide our New Zealand committees with a suitably sized space to hold their meetings. We have also entered into a trial program with the College of Surgeons to sub-lease some of its office space in Melbourne for our

growing Melbourne staff cohort to meet, work and connect.

The story of RANZCR from its inception to this time has been one of continuous, sometimes momentous change. All successful organisations accept and embrace change and RANZCR is no different. We live in the fabled ‘interesting times’ and continued adaption to face the changing environment will see RANZCR well placed for the future.

The SIGs SPECIAL ISSUE

RANZCR has a growing number of Special Interest Groups (SIGs) in areas of specific interest to members within clinical radiology and radiation oncology. This issue we invited each of our SIGs to outline their goals and objectives, and shine a light on the work they’ve been doing.

CLINICAL RADIOLOGY

The Abdominal Radiology Group of Australia and New Zealand (ARGANZ)

ARGANZ was founded in 2006 as a Special Interest Group within the College. ARGANZ strives to improve the quality of abdominal imaging in Australia and New Zealand for the advancement of healthcare through education and research, collaboration and advocacy.

EDUCATION AND RESEARCH

Since 2009, ARGANZ has hosted a weekend Annual Scientific Meeting in an Australian or New Zealand city every year, which in recent years has expanded to include an on-site Friday workshop. There is also a dedicated School of ARGANZ session at the meeting, hosted by current RANZCR abdominal radiology examiners for registrars, including tips for the RANZCR phase 2 exam. In addition, ARGANZ has organised virtual workshops on subspecialised topics throughout the year.

Original research and review papers can be presented orally or as poster presentations at the ARGANZ scientific meeting. To encourage registrar participation in research, ARGANZ proudly offers the Mendelson Research Prize to an accredited radiology registrar for the best oral presentation on an original research in abdominal radiology. This prize includes airfares, accommodation and registration to attend an ESGAR (European Society

of Gastrointestinal and Abdominal Radiology) meeting in Europe. There are also ARGANZ Research and Education Grants available to all members, with up to $20,000 grant funding each year.

Our 2023 Annual Scientific Meeting in Adelaide attracted more than 400

delegates and presented the first ESGAR liver-imaging workshop in Australia. It was also the first meeting where we provided complimentary registration to junior medical officers and radiology registrars, to engage with and promote abdominal radiology to the next generation of radiologists.

ARGANZ executive members continued

COLLABORATION

ARGANZ continues to build upon its relationship with international abdominal imaging societies such as the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and the Society of Abdominal Radiology (SAR). As a result of the collaboration, ARGANZ has been able to offer our members free access to ESGAR meeting content. ARGANZ also collaborates with Australian and New Zealand clinical specialty groups and societies, such as the Gastroenterological Society of Australia (GESA), the Australasian Gastro-Intestinal Trials Group (AGITG) and the Colorectal Surgical Society of Australia and New Zealand (CCSANZ).

Our members have been invited to speak at local and international meetings. Members have also been invited to contribute to Australian, New Zealand and international clinical guidelines and consensus statements. Locally, our members have contributed to the GESA HCC guideline; the clinical practice guidelines for the prevention, early detection and management of colorectal cancer; the New Zealand national bowel cancer screening program; and the New Zealand central cancer region CT oncology protocols for abdomino-pelvic cancer imaging. Internationally, our members have contributed to LI-RADS, the ESGAR consensus statement on the imaging of fistula-in-ano, and the French guideline for staging and re-staging of rectal cancer, to name a few.

ARGANZ is proud to partner with Radiology Across Borders (RAB) to engage with radiologists from developing nations to exchange scientific knowledge and to provide outreach education. ARGANZ has provided virtual lectures through the RAB platform and hopes to attend on-site visits in the near future.

ADVOCACY

ARGANZ provides expert opinion and advice to RANZCR, government and other clinical organisations on relevant scientific and policy matters. An example of this is the position statement released by ARGANZ on CT colonography at the beginning of COVID-19, which provided a unified position on the use of CT colonography in Australia and New Zealand when COVID limited the availability of optical colonoscopies. Other examples include ARGANZ’s recent contribution to the Victorian Government’s Safer Care Victoria colonoscopy roundtable discussion and ARGANZ providing advice to RANZCR on Cancer Council guidelines.

ARGANZ provided advice to RANZCR when MRI prostate reporting was challenged by a clinical group and defended the existing training requirement for MRI prostate reporting.

ARGANZ is frequently consulted for advice on Medical Services Advisory Committee (MSAC) applications which involve abdominal imaging. ARGANZ regularly gives advice to RANZCR regarding draft item descriptors for Medicare rebate item proposals, most recently on MRI for renal tumours and the revision of the descriptor for MRI liver. One of the executive members of ARGANZ was one of the main driving forces behind the initial MRI liver MSAC application. Currently ARGANZ is involved in lobbying the Department of Health through RANZCR to increase the scope of the rectal MRI Medicare rebate beyond initial staging.

These successes are built on the efforts of many who have kindly donated their time to ARGANZ over the years. I would like to thank the team of current executive members, Dr Kirsten Gormly, Dr Joe Feltham, A/Prof Tom Sutherland, Dr James Seow, Dr Gabriel Lau, Dr Teng Han Tan, Dr Sarah Skinner, Dr Won Kyung Sung, Dr Arj Somasundaraum and Dr Dean Rabinowitz. I would also like to thank the past ARGANZ chairs Prof Richard Mendelson, A/ Prof Andrew Little, Dr Kirsten Gormly, A/Prof Tom Sutherland and all past executive members for their hard work building and fostering ARGANZ to the organisation that it is today.

WHY YOU SHOULD BE PART OF ARGANZ

There are already more than 1,000 ARGANZ users, and becoming an ARGANZ user is completely free. There is a wealth of resources on our website www.arganz.org, including reporting templates, scanning protocols and free access to prior years’ meeting content. From time to time, we would like to inform our users of government policy changes such as new or revised Medicare rebate items, publication of new imaging guidelines and upcoming events.

The next ARGANZ meeting is in Melbourne, 24–25 February 2024. Come join us in Melbourne for a weekend to learn, discuss, connect and socialise, and stay updated by following us on X (formerly Twitter, @arganz_online) and Facebook (@arganzradiology).

Dr Jessica Yang Chair of ARGANZ

Past chairs: Prof Richard Mendelson, A/Prof Andrew Little, Dr Kirsten Gormly, A/Prof Tom Sutherland, Dr Jessica Yang.

ARGANZ executive and 2023 international speakers

The Australian and New Zealand Society of Thoracic Radiology (ANZSTR)

The Australian and New Zealand Society of Thoracic Radiology (ANZSTR) was established in 2017 to provide a platform for RANZCR members with an interest in advancing knowledge, learning or clinical expertise in thoracic radiology.

ANZSTR’s objectives are:

• Establishing an inclusive network of members interested in the field of thoracic radiology including cardiac imaging and thoracic intervention. Everyone with an interest from generalist to subspecialist is welcome.

• Promoting excellence in thoracic radiology in Australia and New Zealand.

• Promoting and supporting collaboration, education and the exchange of knowledge and ideas in the field of thoracic radiology.

• Liaising with similar international bodies or societies and working collaboratively on matters of common interest.

The current executive members of ANZSTR are co-chairs Stefan Heinze and Sharyn MacDonald, and executive members Sam Ellis, Catherine Jones, Hannah Rouse and Miranda Siemienowicz.

As a RANZCR SIG, ANZSTR has provided expertise to RANZCR to assist with responding to consultation documents and guideline development requests, and had members represent RANZCR at meetings and working groups requiring thoracic imaging expertise. Work completed over the past couple of years includes the development of a position statement on silicosis in engineered-stone workers, guidance for the use of thoracic imaging in COVID-19, and responding to the consultation document on lung cancer screening in Australia (with more work to come following the recent Federal Government announcement).

With the support of the RANZCR, a collaboration agreement is in place

between ANZSTR and the US-based Society of Thoracic Radiology (STR) (www.thoracicrad.org). This enables us to work together to promote networking and exchange of ideas in the field of thoracic radiology. The STR has an excellent website that includes free online educational resources including a curriculum for residents/ registrars complemented by online lectures on key topics in thoracic and cardiac imaging for medical students, residents/registrars and practising radiologists. Sharyn and Stefan are both members of the STR Intersociety and Global Outreach committee.

Our international connections have also seen the ANZSTR committee join forces with ANZSTR member colleagues to organise the RSNA 2022 and 2023 Chest Imaging Case of the Day exhibit.

With the disruption of the last couple of years behind us, we are keen to refocus on promoting excellence and supporting education. We want to ensure members are aware of guideline changes that matter, with a related initiative being to promote consistent reporting of thoracic incidental findings that can impact health outcomes. The RANZCR NZ Branch ASM in Queenstown in August, and the RANZCR ASM in Brisbane in October both have thoracic streams with ANZSTR input.

We are looking forward to reconnecting and would welcome new members members, including trainees and IMGs).

members may have on how the ANZSTR group could add value and support you in your practice. Membership enquiries and ideas can be sent to: anzstr@ranzcr.edu.au

Executive members of ANZSTR We want to ensure members are aware of guideline changes that matter... [and] to promote consistent reporting of thoracic incidental findings that can impact health outcomes.

Obstetrics and Gynaecology Special Interest Group (OGSIG)

OGSIG was officially ratified by RANZCR’s Faculty of Clinical Radiology in 2019. It was formed to establish a network of clinical radiologists who are interested in obstetrics and gynaecology reporting in Australia and New Zealand. OGSIG’s logo of concentric circles symbolises the intrauterine fetus within the woman, follicles within the ovary, as well as circles of support for radiologists.

In the four years since its inception, OGSIG has organised three Annual Scientific Meetings – two virtual, and one in-person and on-demand. These meetings have proven to be extremely popular, attracting both general and subspecialist radiologists from around the world. OGSIG’s annual meetings have been closely aligned with that of Abdominal Radiology Group of Australia and New Zealand (ARGANZ), with many radiologists taking opportunities to attend both meetings given the natural synergy and crossover with pelvic imaging.

In addition to the meetings, OGSIG works closely with the Faculty of Clinical Radiology, with the OGSIG executive providing ongoing support to RANZCR when it has been consulted on best practice, policy and, for example, Medicare/Medical Services Advisory Committee (MSAC) submissions among others. It liaises with the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) and the Australasian Society of Ultrasound in Medicine (ASUM) to ensure high standards and adherence to current best-practice policies. OGSIG assists with issues regarding trainees and Fellows, and has ongoing input regarding the curriculum and examinations.

As clinical radiologists report well over 75 per cent of all obstetric and gynaecological imaging performed in Australia and New Zealand, OGSIG aims to ensure that the reporting is of the very highest quality, so that patients and referrers benefit.

The current executive members of OGSIG are Emmeline Lee (Chair), Virginia Saxton (Deputy Chair), Lynne Brothers (Treasurer), Rachael McEwing (Secretary) and Ekaterina Alibrahim (Executive Member). As OGSIG is growing, it is looking to expand the numbers on the executive.

The next OGSIG Annual Scientific Meeting will be held in Melbourne in late February 2024 (probably on Thursday 22 February 2024).

Please email ogsig@ranzcr.edu.au or visit www.ogsig.org

OGSIG’s logo of concentric circles symbolises the intrauterine fetus within the woman, follicles within the ovary, as well as circles of support for radiologists.

Australian and New Zealand Emergency Radiology Group (ANZERG)

ANZERG is a diverse group who share a common special interest in enhancing the accuracy of imaging diagnoses in acutely unwell medical, surgical and trauma patients. We advocate for the pivotal role emergency imaging plays in diagnosis for these patients and aim to raise the standard of care for urgently imaged patient and their clinical teams. Other core objectives of the group include:

• To establish a network of members interested in emergency and trauma radiology.

• To conduct educational activities at the RANZCR ASM and subsequently establish independent scientific meetings.

• To be the advisory body to the College on matters relating to emergency and trauma radiology on scientific, educational, patientcentred operational issues.

• To liaise with similar international bodies or societies such as ESER, ASER and SER and work collaboratively on matters of common interest.

ANZERG was founded in 2015 by A/Prof Dinesh Varma, A/Prof Meredith Thomas, A/Prof Craig Hacking, A/Prof Gerard Goh and Dr Sean Skea.

The group will be hosting the Emergency Radiology session at the upcoming Annual Scientific Meeting in Brisbane, to be held on Thursday 19 October, and a Group AGM.

We aim to hold interesting-case meetings in the near future open to any member who is interested in presenting and discussing key learning points from interesting emergency and trauma cases.

We welcome all new members. To join the group, please email Traci JamesScott at anzerg@ranzcr.edu.au

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

metropolitan centres of Australia and New Zealand.

The ANZ Rural Radiology SIG has the following aims:

1. Improve communication between and collaboration of radiologists who live and work outside the major metropolitan centres of Australia and New Zealand.

2. Provide a means to share knowledge and enhance continuing professional development for radiologists who live and work outside the major

3. Be the expert advisor to the College on matters that impact on the provision of radiology services to non-metropolitan communities. Rural radiologists enjoy excellent collegiate links and camaraderie with other craft groups providing healthcare to underserved communities. Radiologists are heavily involved in communication and education, from choosing the right test to post-test recommendations particular to the rural clinical context. There is great opportunity to upskill in areas where metropolitan centres may be more rigidly subspecialised, giving people maximal professional flexibility and sustained interest in a wide range of professional spheres.

Rural work for a new consultant makes them much more employable and marketable in the long term, due to the ability to develop a diverse, well-rounded skill set that is highly

desirable over one’s professional lifespan. There are opportunities galore throughout regional and rural Australia and we welcome enquiries from those who are considering working in nonmetropolitan communities.

Thirty per cent of Australia’s population live regionally, rurally and remotely and there is probably a similar distributionin New Zealand. They live in areas that still have incredible natural beauty.

It should also be remembered that in Australia, regional, rural and remote communities provide 90 per cent of Australia’s fresh food and 80 per cent of its export income. So they are the true powerhouse of the nation and this was clearly evident during the pandemic. Thus there are incredible opportunities in being a rural radiologist.

We welcome new members and any interest in joining the executive or otherwise getting involved. Email anzrrsig@ranzcr.edu.au

Dr John Vedelago

Dr Nick Stephenson

Australian and New Zealand Society for Paediatric Radiology (ANZSPR)

ANZSPR members include general radiologists who have an interest in paediatric imaging and specialist paediatric radiologists who have completed additional subspecialty training in paediatric imaging and primarily see children in their day-today practice. There are members and associate members of ANZSPR in the imaging departments of children’s hospitals, general hospitals and private practices throughout Australia, New Zealand and around the world. ANZSPR promotes high-quality, low-radiation imaging for children through a childand-family-centred approach.

The focus of the ANZSPR committee over the past year or so has been on change, reinvigoration and engagement. As we struggle through the hangover of COVID, our society is at a fork in the road where we can choose to be a small-part player in the wider radiology landscape, or we can forge ahead and embrace a brave new world. In 2023 we moved our annual conference away from the main College ASM and headed to the beautiful Great

Barrier Reef for a meeting themed “Paediatric Radiology in the Reef— Navigating the Depths of Paediatric Imaging”. We hope that this destination conference set a new standard for future organising committees. In 2024 we venture to Broome (14–17 June) in the magical Kimberley where we will explore the role of diagnostic and interventional radiology in paediatric oncology.

At our last AGM we voted to amend our terms of reference to allow allied health professionals to become members of ANZSPR. We will have details of how we plan to progress this initiative in the near future, but it goes without saying that we hope this will significantly swell our numbers and generate a new wave of enthusiasm within paediatric radiology.

And finally, we have started the process of significantly upgrading our website, which we anticipate will become a vibrant hub and resource for our members before too long. While we are still in the planning and implantation phase, the scaffolding is now present. Please head over and register your individual log-in as soon as possible at www.anzspr.org to access future members-only content.

If you have a passion for research, clinical case presentations and opinions, collaborative guidelines or anything else paediatric radiology related, we’d love you to get involved. Please email me at anzspr@ranzcr.edu.au

Nuclear Medicine Special Interest Group (NMSIG)

The College has recently established a Nuclear Medicine Special Interest Group (NMSIG) to provide a forum for interested members to create a bi-national group to advocate and promote the role of nuclear medicine in radiology. Nuclear medicine is seen as a cornerstone of future cancer treatment and, with the Federal Government’s commitment to safeguarding the future of critical nuclear medicine supply, there is no better time to get involved with RANZCR to help shape the future.

New members joining NMSIG will deal with all aspects of nuclear medicine in radiology, with the main objectives

identified as discussing any key issues in nuclear medicine, keeping RANZCR and the Faculty of Clinical Radiology updated with significant national and international policies and practices in nuclear medicine that are influential to radiology patients in Australia and New Zealand, as well as advancing professional expertise in nuclear medicine within radiology in the region.

Beyond cancer diagnostic imaging, nuclear medicine continues to evolve with recent developments in theranostics and neurodegenerative imaging, and the imminent introduction of a number of novel radiotracers

into wider clinical use. The NMSIG aims to promote nuclear medicine education within RANZCR, including collaboration with other SIGs in areas of common interest, to help the broader radiologist community keep abreast of developments in this subspecialty. Through advocacy and engagement, the NMSIG strives to continue to improve patient outcomes, both directly and as an integral component of multidisciplinary teams at all levels within Australia and New Zealand.

If you are interested in joining this new SIG as a member, please contact us at nmsig@ranzcr.edu.au

Our society is at a fork in the road where we can choose to be a smallpart player in the wider radiology landscape, or we can forge ahead and embrace a brave new world.

Australian and New Zealand Palliative Radiation Oncology Group (ANZPROG)

The Australian and New Zealand Palliative Radiation Oncology Group is a special interest group established for interested members to share the clinical experience of radiation therapy provision in the palliative oncology setting.

Founded in 2019, the current ANZPROG executive consists of Prof Daniel Roos (SA), Dr Amy Shorthouse (ACT), Dr Melissa James (NZ), Dr Kathy Pope (VIC), Dr Ramkumar Govindaraj (SA) and Chair Dr Minjae Lah (QLD).

The work of ANZPROG is multi-faceted involving advocacy on behalf of patients, including promoting palliative radiation therapy for symptom relief in cancer patients and promoting the Radiation Oncology Targeting Cancer Campaign.

ANZPROG acts as an advisor to RANZCR and the Faculty of Radiation Oncology regarding future trends, technical advances and clinical opportunities in palliative radiation oncology, based on national and international best practices.

Recent work of ANZPROG includes ANZ surveys on uptake of Rapid Access Palliative Radiotherapy Clinics1 and a Palliative Radiotherapy Utilisation survey. The latter was designed around five case studies to assess the current utilisation of advanced palliative radiation therapy techniques and technologies in ANZ. ANZPROG worked with project lead, radiation

oncology trainee Dr Pav Pathmanathan, in developing and conducting the survey. This was the topic of the ANZPROG members' forum in April 2023. The forum also included an update on CNS Stereotactic techniques and practicalities by Radiation Oncologist Dr Neda Haghighi, with ANZPROG executive member Dr Melissa James providing the NZ perspective. After a presentation of the survey results by the ANZPROG project team, members were encouraged to discuss their own opinions and experiences on the use of advanced techniques and technologies in the palliative radiation therapy setting.

ANZPROG will deliver a session at the College’s ASM, hosting a forum on the ‘Evolving landscape of palliative radiation therapy’. In addition, ANZPROG is currently working on a project to establish the utilisation of palliative radiation therapy near the end of life across Australia and New Zealand.

ANZPROG is a young SIG with an enthusiastic executive looking to expand both the activities and membership of the group. For the remainder of 2023 and beyond, ANZPROG will work on fostering inter-disciplinary relationships with key professional bodies involved

in palliative care in Australia and New Zealand. These include the Chapter of Palliative Medicine of the Royal Australasian College of Physicians (RACP) and the Australian and New Zealand Society of Palliative Medicine (ANZSPM).

ANZPROG will soon begin recruiting for executive membership positions. The EOI campaign will feature in the College’s Faculty e-news and the College website. For those who do not have time to commit to executive responsibilities, perhaps consider joining ANZPROG as a non-executive member. This will ensure you are kept up-to-date with the latest research, developments and events in the palliative oncology sector.

To request to join ANZPROG as a non-executive member or for further information, please email frosigs@ranzcr.edu.au

ANZPROG Forum

ANZPROG executive

“

ANZPROG is a young SIG with an enthusiastic executive looking to expand both the activities and membership of the group.

FRO Paediatric Special Interest Group (FRO PAED SIG)

The Faculty of Radiation Oncology Paediatric Special Interest Group (FRO PAED SIG) is a niche group of radiation oncologists who subspecialise in paediatric, adolescent and young adult malignancies.

The group was first convened in 1994 and was chaired by Martin Berry for the first 10 years. Original members included Roger Allison and Robyn Cheuk (Brisbane), Verity Ahern and Bob Smee (Sydney), Chris Atkinson (Christchurch), Martin Borg (Adelaide), John Childs (Auckland), David Hamilton (Wellington), Maree Sexton and Charles Yang (Melbourne) and Margaret Wallington (Hobart). One of the first activities of the group was to hold a teaching weekend on paediatric radiation oncology for trainees in 1996, and the teaching event has occurred every two years since then. Early on, a bi-national registry of paediatric radiation therapy was established; although now closed, this provided useful patterns of practice information over time.

The group’s objective is to promote good radiotherapeutic and oncological practice for children, adolescents and young adults (up to the age of 25 years) who receive radiation therapy as part of their cancer treatment, by fostering collaboration and peer support among members of RANZCR’s Faculty of Radiation Oncology and other professional colleagues.

The group aims to:

• Provide quality assurance of radiation therapy delivered to children and adolescent and young adult patients via a fortnightly virtual national peer review meeting.

• Provide educational opportunities in paediatric and adolescent and young adult radiation oncology to Fellows and trainees through a biennial registrar teaching course and other teaching forums.

• Participate in protocol design or review of new studies proposed by the Australian and New Zealand Children’s Haematology Oncology Group (ANZCHOG) or similar groups where there is a radiation therapy component.

• Provide a point of contact for interaction or collaboration with other professional groups with similar interests, such as the Paediatric Radiation Oncology Society and the Children’s Cancer and Leukaemia Group in the UK.

The group currently has a supportive network of 12 radiation oncologists who regularly attend a fortnightly virtual peer review meeting (held on Wednesdays, 6–7 pm AEST) to discuss paediatric and adolescent and young adult cases, and review treatment volumes and radiation therapy plans. This supports one of RANZCR's continuing professional

development activities (reviewing performance and reflecting on practice) and we strongly encourage radiation oncologists involved in the care of paediatric and adolescent and young adult patients to present cases at this forum. We also look forward to taking on the role of a paediatric and adolescent and young adult reference panel as part of the National Particle Therapy Referral Pathway, in preparation for the opening of the Australian Bragg Centre.

The group is excited to announce that our Biennial Paediatric Radiation Oncology Registrar’s Teaching Course this year will be run in conjunction with the ANZCHOG Annual Scientific Meeting from 22–24 August 2023 at the Sir Charles Gairdner Hospital in Perth, with Prof Arnold Paulino from the MD Anderson Cancer Centre, Texas, joining the local Faculty. This is an excellent opportunity for trainees who have limited exposure to paediatric/ adolescent and young adult patients during their training to improve their knowledge base in preparation for part two examinations, and hopefully will inspire some to consider subspecialisation in paediatrics/ adolescent and young adult cancer in the future.

We welcome any College members interested in joining. If you would like to know more, please contact Kirsty Wiltshire on kirsty.wiltshire

@petermac.org

FRO Paed SIG members

Asia-Pacific Radiation Oncology Special Interest Group (APROSIG)

The Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) aims to support radiation oncologists and other radiation oncology professionals in Asia-Pacific low-income and middleincome countries (LMICs) in the provision of safe and effective radiation therapy. We focus on equipment availability and also staffing levels and training, standards of treatment delivery and levels of quality assurance and quality control.

This SIG was established in 2013 at the instigation of the late Prof Graeme Morgan and its activities are coordinated by an elected executive with administrative support from the Association Specialists. The current executive consists of Andrew Oar and Iain Ward (co-chairs), Eng-Siew Koh, Madhavi Chilkuri and Sean Hassan (student member). We meet virtually every two months and any interested Fellow or student member is welcome to attend to learn more about our activities.

In recognition of the multidisciplinary nature of radiation therapy, APROSIG works closely with the Asia-Pacific Special Interest Group (APSIG) of the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) and the Global Medical Radiation Practitioner Reference Group (GMRPRG) of the Australian Society of

Medical Imaging and Radiation Therapy

(ASMIRT). Multidisciplinary teams have supported the establishment of a modern radiation treatment facility at Calmette Hospital in Cambodia and have assisted in the transition from cobalt teletherapy and 2D planning to linac-based 3D conformal radiation therapy at the National Cancer Centre in Mongolia. This has been achieved through short educational visits and longer volunteer placements. We also facilitate visits of LMIC colleagues to radiation centres in Australia and New Zealand.

A current focus is Papua New Guinea, where a new cancer centre is set to open later this year at Port Moresby General Hospital (POMGen). APROSIG is facilitating a visit of several weeks by a team of clinical oncologists, physicists and radiation therapists to Waikato Hospital in New Zealand, where they will become familiar with the Halcyon linac, which will be installed at POMGeN.

A follow-up visit to Port Moresby is planned for 2024.

Other important collaborations include the Clinical Oncology Society of Australia (COSA) Global Oncology special interest group, particularly for medical oncology and oncology nursing in Papua New Guinea, and the International Atomic Energy Agency (IAEA). APROSIG members

(as individuals or representatives of the Special Interest Group) have participated in IAEA assessments of cancer services in Papua New Guinea, Fiji and Cambodia, and have led IAEA technical cooperation projects. One such project is the Asia-Pacific Radiation Oncology Network (ASPRONET) virtual tumour board, which provides a monthly forum for LMIC radiation oncologists to discuss challenging cases in a setting that acknowledges resource limitations. Australasian participants are welcome (email iain.ward@cdhb.health.nz).

A new project, led by Associate Professor Mei Ling Yap, will support member states in the use of departmental oncology information systems to collect and interpret data for the purposes of quality improvement.

APROSIG welcomes new members. You are also encouraged to come to the global oncology session on Papua New Guinea at the RANZCR Annual Scientific Meeting (ASM) in Brisbane in October. Our AGM will also be held at the ASM. One position on the executive (for a student member) will be open for election.

Please email aprosig@ theassociationspecialists.com.au to be added to our contact list or for an invitation to our executive meetings to learn more.

APROSIG executive

Breast Interest Group – Faculty of Radiation Oncology (BIG-FRO)

of Radiation Oncology and is frequently called upon to give feedback and provide peer reviewers for external organisations in the area of breast cancer management.

FRO with support from SIG Executive members Dr Steven David (VIC), Dr Shahistha Naidoo (NZ), Dr Nicola Lowrey (QLD) and A/Prof Kirsty Stuart (NSW).

BIG-FRO will chair the Breast Session at the College ASM in October, inclusive of scientific abstract presentation and panel discussions on topical issues.

BIG-FRO is an Australian and New Zealand collaboration of radiation oncologists dedicated to promoting the best clinical practice for the management of breast cancer, and enhancing the profile of radiation oncology within the breast cancer setting.

BIG-FRO acts as an expert advisory group to RANZCR and the Faculty

BIG-FRO also collaborates on research with other organisations such as the Australia and New Zealand Breast Cancer Trials Group (ANZBCTG) and the Clinical Oncology Society of Australia (COSA). In 2023, BIG-FRO is led by an executive who are enthusiastic to grow this Special Interest Group and expand on research, advocacy and delivery of educational events. Cochairs Dr Carmen Hanson (NSW) and Dr Apsara Windsor (NSW) lead BIG-

Joining BIG-FRO presents the opportunity to be kept abreast of the latest research in breast cancer management, to be informed on key events in the field, and provides a platform to collaborate with peers with interest and expertise in breast cancer management. BIG-FRO is actively recruiting for new non-executive members and welcomes enquiries from interested parties.

To join BIG-FRO or to find out further information about the group, please email frosigs@ranzcr.edu.au

The Faculty of Radiation Oncology Genito-Urinary Group (FROGG)

The value of a genito-urinary (GU) specialist interest group was recognised and discussed at a urological meeting in 2001 organised by A/Prof Martin Berry. This led to inception of The Faculty of Radiation Oncology Genito-Urinary Group (FROGG) workgroup, the founding members including A/Prof Martin Berry, Dr Keen-Hun Tai, A/Prof Sandra Turner, Dr Gillian Duschenne, Dr Kumar Gogna and Dr Andrew Kneebone. The first FROGG workshop was held in 2002, and focused on developing evidence-based guidelines for the implementation of 3DCRT for prostate cancer. The consensus process involved radiation oncologists, radiation therapists and medical physicists from around Australia and New Zealand. The guidelines were published in 2004, and it was the first time specialists representing professional radiation therapy practice across Australia and NZ worked together to develop best-practice guidelines.

The success of FROGG in the mid 2000s has subsequently led to

the establishment of several other specialist interest groups within the radiation oncology faculty. FROGG is endorsed by the Faculty Council, and the group has now expanded to include 12 radiation oncologists within the executive committee, as well as a trainee representative. Newest additions to the FROGG executive include Dr Neetu Tejani and Dr Shreya Armstrong, and Dr Anna Lawless as the trainee representative. The primary goal of FROGG is to promote quality evidence-based practice, endorse multi-disciplinary patient management, facilitate research and collaborative initiatives, and serve as a recognised radiation oncology reference group to advisory bodies. FROGG is proud to be affiliated with the Targeting Cancer campaign and patient advocacy groups including PCFA and BEAT.

Through the years, FROGG has held several successful workshops and published multiple consensus guidelines. One of the key topics discussed at the

most recent workshop in Hobart in October 2022 reviewed patterns of practice for post-prostatectomy radiation therapy (including a survey circulated to FROGG members and urology colleagues). The results were presented by Dr Anna Lawless, and will be prepared for manuscript submission, along with revised post-prostatectomy radiation therapy guidelines. The next FROGG workshop is planned for 2025.

The executive committee is dedicated to supporting trainee education in 2023 and looks forward to facilitating teaching webinars and sponsoring a prize for the best proffered urology paper at the college ASM. The executive committee is always interested in what activities or resources are of most value to the GU community.

If you would like to be involved in the group or have any enquiries, please email faculty@ranzcr.edu.au or any of the executive members for more information.

BIG-FRO co-chairs and members

Gynaecological Oncology Radiation Oncology Collective (GOROC)

links with oncology research organisations including ANZGOG and TROG.

GOROC was an active participant in developing the recently published Gynaecological Brachytherapy Professional Development Guidelines and is considered a trusted advisor to the College and Faculty of Radiation Oncology on matters related to the management of gynaecological cancers. The Endometrial Cancer Guidelines are currently under review by GOROC.

Yin Lin, Dr Ruth Angell, Dr Khadiga Mohammad and Dr Tiffany Daly. New members are always welcome and membership of GOROC will allow you to keep abreast of the latest developments, research and events in the gynaecological cancer sphere. Those interested in joining GOROC as a non-executive member can email frosigs@ranzcr.edu.au

The Gynaecological Oncology Radiation Oncology Collective (GOROC) is a special interest group established to facilitate and promote best practice in gynaecological cancers through the establishment of clinical guidelines for practice in this area.

GOROC’s work includes raising awareness of the role of gynaecological brachytherapy in the treatment of gynaecological cancers. GOROC promotes research activities in gynaecological cancers by encouraging the participation in national and international trials and has developed

In 2022, GOROC representatives attended the Eliminating Cervical Cancer Workshop where they raised the issue of brachytherapy funding, thereby placing it on a national scale. During 2023, GOROC will continue its advocacy work partnering with the College to develop strategies for securing government funding for brachytherapy services. This work includes advocating for the reinstatement of the Radiation Oncology Health Program Grants Scheme.

GOROC will continue to run its own educational events and promote the events of other organisations that may be of interest to GOROC members.

GOROC is ably led by co-chairs Dr Carminia Lapuz and Dr Robyn Cheuk with support from executive members Dr Geetha Govindarajulu, Dr Ming

Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC)

The Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) was established to create a national group of radiation oncologists to promote the role of radiation therapy in the management of lung cancer.

FROLIC is a trusted advisor to the College and Faculty of Radiation Oncology, and will often be called upon to provide opinion on consultations involving lung cancer and other thoracic malignancies.

FROLIC plays a role in the development of standards for the radiation therapy treatment of lung cancer as well as acting as an educator to healthcare professionals and consumers on radiation therapy treatment.

Membership of FROLIC is an opportunity to keep abreast of the latest developments, education, research and events in the field of radiation therapy in lung cancer. Membership of a SIG in a non-executive

capacity is open to College members including trainees as well as medical and allied health associates.

Those interested in joining FROLIC can request membership by emailing frosigs@ranzcr.edu.au

TO FIND OUR MORE ABOUT RANZCR’S SIGs, VISIT www.ranzcr.com/college/ special-interest-groups

Dr Carminia Lapuz

GOROC will continue its advocacy work securing government funding for brachytherapy services.

Future Focus

Dr Pey Ling Shum is a first-year radiology registrar at Austin Hospital, who has published articles on the subject of environmental sustainability in radiology. Here, she outlines the results from an environmental waste audit at Austin Hospital and explores the ways radiology departments could reduce their waste generation.

Healthcare contributes enormously to the world’s carbon footprint: 7,000 tonnes of solid waste can be generated by one hospital alone in a day.1 In its 2022 Annual Report, Victoria’s Austin Health (comprising Austin Hospital, Heidelberg Repatriation Hospital and Royal Talbot Rehabilitation Centre) reported that each patient produced, on average, 8.92 kg of total waste per occupied bed day. 2 Meanwhile, one Interventional Radiology (IR) department studied in New York emitted ~23,500 kg CO2 emissions over five consecutive weekdays. 3 This

is equivalent to burning 9,900 L of gasoline and an average of 243 kg CO2 generated per IR procedure. 3 Climate change is already happening and the situation is quite worrying. Australia’s average temperature has increased on average by 1.44 ± 0.24 °C since national records began in 1910. 4 In addition, climate forecasts show that extreme weather events such as heat waves, drought, hailstorms and flooding are getting more frequent and severe. We are already seeing the negative impacts of climate change and global warming. The ‘Black Summer’

Victoria’s Austin Health reported that each patient produced, on average, 8.92 kg of total waste per occupied bed day.

bushfire season in 2019–2020, the 2022 flash flooding in New South Wales, 2023 flooding in Auckland, and coral bleaching throughout the Great Barrier Reef are just some examples of recent local events.

There are both direct and indirect health consequences of climate change— from morbidity and mortality directly resulting from natural disasters to the indirect consequences of mental illness, air pollution, vector-borne disease and impaired access to clean water. For example, rising global temperatures will increase the climate suitability

Austin Hospital, Melbourne.

of mosquito-borne diseases such as malaria and dengue, increasing the length of the transmission season and expanding the population at risk who might be immunologically naïve and unprepared. 5

AUDITING AT AUSTIN HOSPITAL

Recognising the importance of environmental sustainability and the impacts of climate change, we evaluated our practice at Austin Hospital and performed an audit to measure the amount of waste that was generated in each neurointerventional radiology procedure. Seventeen neurointerventional procedures were audited, including digital subtraction angiograms, endovascular clot retrieval, coiling and embolisation cases. We found that an average of 8 kg of waste was generated per case with coiling procedure producing the greatest waste burden of 13.1 kg.6 The majority of waste was clinical waste, which constituted about 63 per cent, followed by general waste, accounting for 20 per cent.6 When this is compared to international benchmarks, the amount of clinical waste was significantly higher, because clinical waste should not be more than 15 per cent of total waste. 7 This excess of clinical waste has significant impact on the environment because it requires treatment prior to safe disposal, unlike general waste which goes straight to landfill. Most clinical waste is incinerated, releasing toxic fumes and heavy metals into the environment —incineration of 1 kg of clinical waste produces approximately 3 kg of carbon dioxide.8

Therefore, appropriate waste segregation is one of the most important sustainability initiatives. Waste can be classified into general, clinical, cytotoxic, radioactive, recyclable, pharmaceutical and sharps. Brassil et al. found that waste is 60 per cent more likely to be inappropriately segregated when the risk bin was physically closer to the interventionalist than the non-risk bin during procedures.9

Misclassification of waste has a financial impact, too, resulting in an increased cost of up to 20 times to treat and dispose of waste appropriately. The cost of general waste disposal in 2019 was

AU $0.15/kg compared to AU $0.95/kg for clinical waste.6 On the other hand, it is free to dispose of cardboard, paper, PVC and soft plastic if the items are segregated individually.

Staff education is crucial to prevent misclassification of waste, and bins should be labelled with clear signage and examples. Ongoing staff education could be achieved by incorporating waste-training requirements into existing compulsory health and safety training, as well as using posters and signs to increase awareness. Forming hospital ‘green teams’ can also increase staff awareness and bring knowledge into practice.

Another significant finding from our waste audit is that a substantial amount of packaging and user manuals were generated. One coiling with tumour embolisation procedure produced 2.7 kg of packaging boxes and 2.6 kg of user manuals.6 These paper instructions are thick and none of them are read prior to procedure. We suggested that paper instructions can be substituted with online manuals via web pages or Quick Response (QR) codes.

OTHER WAYS TO REDUCE WASTE

In day-to-day radiology department general practice, there are many ways to reduce paper waste such as the use of digital notepads, double-sided printing, the use of recycled paper and envelopes, reduced printing of request forms and provision of scrap paper for internal notes.

At Austin Hospital, there has been a move to single-stream recycling (where all materials are collected in one location). There are also small, specialised recycling streams such as single-use metals, excess or expired stock, electronic waste and soft plastics. We should choose to purchase products from manufacturers who have strict green policies and are committed to recycling and reusing their products, if not disposing of their expired equipment in an environmentally friendly way. Recently, Stryker has launched a pilot program in Victoria to collect and recycle all its InZone coil detachment devices at zero cost to the hospital. The printed circuit board, which includes 213 microchips and two

kg of user manuals.

AAAA batteries, is repurposed, while the five plastic mouldings and six screws are recycled.

Polyvinyl chloride (PVC) accounts for 25 per cent of single-use waste in hospitals. The PVC Recycling in Hospitals Program collects three specific medical products (IV bags, face masks and oxygen tubing) for recycling into useful new products such as hoses for fire extinguishers and play mats for children.

Opened but unused items are another significant source of waste, which can be prevented by opening devices only when necessary, using operator preference cards, educating staff and having better communication between operators and support staff. Unused equipment can be donated or repurposed. Moreover, interventional radiologists can engage with suppliers to redesign procedure packs according to local preferences to minimise unnecessary items and packaging. Procedural packs should be reformulated so that items that

One coiling with tumour embolisation procedure produced 2.7 kg of packaging boxes and 2.6

Packaging boxes at Austin Hospital.

are not used regularly are removed and packaged individually for occasional use. Electricity and water use are other key considerations when evaluating overall environmental impact.

Electrical usage in radiology departments is immense considering the need to power CT, MRI, ultrasound, fluoroscopy and PACS monitors. We encourage radiologists to shut down their PACS stations after work and set monitors to go into sleep mode if not in use for more than 20 minutes – a simple action that can save an immense amount of electricity consumption. Prasanna et al. found that 83,866.6 kWh of electric consumption and USD $9,225.33 annually can be saved by just shutting down workstations and monitors after an eight-hour workday.10

We encourage radiologists to shut down their PACS stations after work and set monitors to go into sleep mode if not in use – a simple action that can save an immense amount of electricity consumption.

Alcohol-based hand rubs are one way to reduce water (and drying towel) waste. In fact, swapping from scrub soap to alcohol-based waterless scrub solutions could save up to 2.7 million litres of water in a year.11 A UK study showed that a standard three-minute surgical hand wash for one staff member used up to 18.5 L of water compared to an average volume of 15 ml of alcohol rub.12 Moreover, alcoholbased hand rubs are less likely to cause

hand dermatitis compared to surgical scrubbing.

In a nutshell, we should reflect on our day-to-day practice and advocate for changes to reduce waste and achieve environmental sustainability in radiology departments. We encourage everyone to discuss this issue within their department to increase staff awareness. Every small step counts towards protecting the environment for future generations.

1. Weiss A, Hollandsworth HM, Alseidi A, Scovel L, French C, Derrick EL, Klaristenfeld D. Environmentalism in surgical practice. Current problems in surgery. 2016 Apr 1;53(4):165-205.

2. Annual Report 2021-22 [Internet]. Austin Health; [cited 2023 Jul 9]. Available from: https://www.austin.org.au/Assets/Files/Austin%20Health%20 Annual%20Report%202021-2022_Online%20version%20(1).pdf

3. Chua AL, Amin R, Zhang J, Thiel CL, Gross JS. The environmental impact of interventional radiology: an evaluation of greenhouse gas emissions from an academic interventional radiology practice. Journal of vascular and interventional radiology. 2021 Jun 1;32(6):907-15.

4. Australian climate change observations [Internet]. AdaptNSW; [cited 2023 Jul 9]. Available from: https://www.climatechange.environment.nsw.gov. au/australian-climate-change-observations#:~:text=Australia’s%20climate%20has%20warmed%20since,night%2Dtime%20temperatures%20 have%20increased.

5. Colón-González FJ, Sewe MO, Tompkins AM, Sjödin H, Casallas A, Rocklöv J, Caminade C, Lowe R. Projecting the risk of mosquito-borne diseases in a warmer and more populated world: a multi-model, multi-scenario intercomparison modelling study. The Lancet Planetary Health. 2021 Jul 1;5(7):e404-14.

6. Shum PL, Kok HK, Maingard J, Schembri M, Bañez RM, Van Damme V, Barras C, Slater LA, Chong W, Chandra RV, Jhamb A. Environmental sustainability in neurointerventional procedures: a waste audit. Journal of neurointerventional surgery. 2020 Nov 1;12(11):1053-7.

7. Wyssusek KH, Keys MT, van Zundert AA. Operating room greening initiatives–the old, the new, and the way forward: a narrative review. Waste Manag Res. 2019 Jan;37(1):3-19.

8. McGain F, Jarosz KM, Nguyen MN, et al. Auditing operating room recycling: a management case report. A & A Case Reports 2015 Aug 1;5(3):47-50.

9. Brassil MP, Torreggiani W, Govender P. Recycling in interventional radiology—steps to a greener department. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019, Barcelona, Spain.

10. Prasanna PM, Siegel E, Kunce A. Greening radiology. Journal of the American College of Radiology. 2011 Nov 1;8(11):780-4.

11. Wormer BA, Augenstein VA, Carpenter CL, Burton PV, Yokeley WT, Prabhu AS, Harris B, Norton S, Klima DA, Lincourt AE, Heniford BT. The green operating room: simple changes to reduce cost and our carbon footprint. The American surgeon. 2013 Jul;79(7):666-71.

12. Jehle K, Jarrett N, Matthews S. Clean and green: saving water in the operating theatre. The annals of the Royal College of Surgeons of England. 2008 Jan;90(1):22-4.

Show of Support

“I wanted to be a doctor from the age of three and told my teacher on my first day at school. Mrs Loggie, a memorable teacher, assured my parents I could be a doctor but, more importantly, that it was affordable: the government would pay tuition fees. My parents’ support was unwavering.

My local high school was the best in Scotland (I now mentor would-be doctors there). On Hogmanay [the last day of the year] 1963 my unconditional acceptance from Edinburgh Medical School, my dream school, arrived. I enjoyed my time there, not least the characters who taught us. On graduation my intention was to be a surgeon.

I approached Dr Mary Douglas (who later worked in NZ as Mary Brand), the visiting radiotherapist/oncologist at my local DGH where I was a medical HO, about study jobs in radiotherapy. She directed me to Prof Bill Duncan ('WD') who made plain it was a real job, not a study one, but would give me the two days for the exam. Following that I began surgical training in Edinburgh’s professorial units. I passed the fellowship; I survived the irascible Prof Sir Michael Woodruff’s broadsides in theatre; and I loved working for Prof Sir Patrick Forrest who was developing his breast unit with the help of two Aussie senior registrars, each unlike the local equivalents.

By the time of the exam I realised surgery did not satisfy my need for longer-term patient connection and my trainer encouraged my move to 'radiotherapy', where WD was holding me a DMRT place. Cancer care was what I hoped it would be.

As radiotherapy registrar I worked for the best clinician/diagnostic radiologist and teacher in my career, (Prof) Allan Langlands AM, known as 'AOL' to us. Many Aussies will understand: for me it meant a life-long example to follow. Later, Roger Allison left for Brisbane in time for me to take his lecturer post working fully for WD in uro-oncology XRT, testicular chemotherapy and neutron therapy in the MRC trials. It was excellent experience not least because as WD said, we did his work when he was away – and when he was there! Post-FRCR saw me in the MD Anderson Hospital working under the uniquely amazing Dr Gilbert Fletcher ('GHF').

After I was appointed to what had been AOL’s “breast” job in Edinburgh, GHF rearranged my remaining schedule to allow more breast experience with the incredible Dr Eleanor Montague. GHF wanted me fully indoctrinated in US fractionation as he decried the UK overuse of “hypofractionation”. What would he say now to 15 and 10 fraction regimes based on UK trials?

He succeeded: the Edinburgh department allowed me to double the breast fractionation to daily and we saw, from audit, reduced toxicity with no increase in recurrence. Gill Kerr, the statistics lecturer whose name is on many AOL papers, analysed the study. By then APMF’s Edinburgh Breast Unit was established with a multidisciplinary

team and a breast-care nurse, one of the first in UK. Working with surgeons, scientists, trials staff, support nurses, radiologists, oncologists and pharma was the model for improved patient care. WD’s departmental audit system facilitated it, an example I copied in Melbourne.

As oncology clinical director I could pull some strings, opening the Borders clinic and moving the Breast Unit to the Oncology Centre, both better for patient care. Gill and I were working

Prof Alan Rodger has made an enormous contribution to radiation oncology in both Scotland and Australia. Here, he reflects on the people who have contributed to his success from his parents and school teachers to his clinical teachers, mentors and husband and offers some words of wisdom to trainees.

Cancer care was what I hoped it would be.

Prof Alan Rodger

with AOL on the data set he left. In 1987 he wrote saying he was organising for Bicentennial Year “the best breast cancer conference” in a place called Leura. He said I should find the money to come. Three of us did. My partner Peter and I arrived in Australia, I gave a talk at Peter Mac, we had a private tour of the Hunter Valley organised by a patient, and we liked Oz.

In 1991 The Alfred approached me about its new radiotherapy centre. Within 18 months Peter and I had sold our Georgian house and were living in Melbourne, and I was the Alfred’s Professor Director of Radiation Oncology in one of the state’s three new radiotherapy centres, the William Buckland Radiotherapy Centre (WBRC).

The opening of a new radiotherapy department was never going to be easy—or welcomed by all. New to the whole system, I struggled with the recondite mysteries of Medicare, giving up chemotherapy and being called a radiotherapist by surgeons who referred everything to 'their oncologist'. Jo Smylie, our chief RT, kept me right and soon we had one of the best teams of RTs and physicists it has been my privilege to work with.

I could not have recruited better specialists: Sid Davis was my rock and safe pair of hands, Mike Daly established Victoria’s first radiosurgery team while Jeremy Millar established Victoria’s first radio-iodine seed brachytherapy program (Australia’s first free to public patients). Kay Hatherly AM led us into the everyday use of EPI, the AM awarded for that pioneering work.

The NBCC supported Faculty fellows to produce guidelines for the use of XRT in breast cancer, which the College endorsed. The NBCC promoted, with participation of our Alfred team, demonstration projects leading to the establishment of multidisciplinary care and breast-cancer care nurses. That improved patient care, while my quality of life was improved by women leaders like Sally and Onella.

The collective noun for a bunch of professors is an absence and I was living proof. I became involved in the College, cancer councils, trials groups, BreastScreen Victoria (which I chaired for some years) led by Onella Stagoll, and the National Breast Cancer Centre (NBCC) led by Prof Sally Redman AO.

In 2002 I was asked to consider the new post of Medical Director, created following a crisis period, at the Beatson Oncology Centre in Glasgow, UK’s second largest cancer centre, covering 60 per cent of Scotland. In 2003 we moved to a city we did not know and to a service whose staff morale was low. The minister, hugely supportive, found extra revenue and over £100 million for the new centre and its 11 linacs—the third centre I was involved in designing. In my career there was one constant: my partner, later civil partner and now husband, Peter. I knew from my midteens I was homosexual but neither accepted nor did anything about it until I was 28 and connected with a support group in Edinburgh. Later I joined it, even organising the counselling for our transsexual clients.

Do what the public pay you to do: train well, then care for and appreciate your patients as best you can with that training.

Alan Rodger with husband Peter Macaulay; a radium needle implant in the late 1970s; the world’s first isocentric neutron beam unit in clinical use in Edinburgh, late 1970s.

Our President’s message about the College’s determination to improve the specialties’ approach to diversity and inclusivity caught my eye. And what about that inter-collegiate float at the Sydney Mardi Gras, an event we have never attended? Why now? I’d thought there were more 'out' doctors in Australia than here but apparently in Australia, as here in UK, more needs to be done to support our homosexual, bisexual and transsexual trainees and fellow members. I commend the College.

Sexuality does not determine the quality of the care we give but it may affect how we are treated. As a consultant and later 'the boss' it was easier for me. Yet, in the 1980s a colleague, my referee, without mentioning sexuality, said, “Of course, Alan, here you are accepted as you do your work so well”. What if I was someone who did not? Overall, I felt supported by the people at the Alfred and in Edinburgh: life turned out easier than I feared as a student, HO, SHO and registrar.

My advice to trainees is enjoy your mentors, work with them. If you are homosexual, transsexual, bisexual or still wondering/worrying, remember most of your colleagues will be supportive or not bothered. Ignore the minority. Do what the public pay you to do: train well, then care for and appreciate your patients as best you can with that training—it’s not all about money.

Medicine will be very different as your career progresses, so embrace change as it generally improves patient care. Live your life as and with whoever you wish. For most of my cancer career, I have.”

Alan Rodger BSc (Med Sci) Hons, MB, ChB, FRCSEd, DMRT, FRCR, FRANZCR, FAChPM.

Medicine will be very different as your career progresses, so embrace change as it generally improves patient care.

Miss Forman, superintendent radiographer, with an early megavoltage unit at the Western General Hospital, Edinburgh, circa 1960s; radioactive iridium wire implant to the breast, 1981.

Orthovoltage XRT unit, still in use in the 1970s for palliation, Western General, Edinburgh.

Bragg Centre Nearing Completion

An update from the Particle Therapy Working Group.

can be accessed here: www.msac. gov.au/internet/msac/publishing.nsf/ Content/1638-public

Historically, Australian Medicare’s Medical Treatment Overseas Program (MTOP) has supported approved patients seeking funding for treatment abroad, prior to the availability of particle therapy domestically. Unprecedentedly, with the advent of particle therapy in Australia, Medicare will mandate proton-photon comparative planning to pinpoint those patients poised to reap the most benefits from particle therapy as opposed to conventional X-ray-based therapies. To harmonise comparative planning across the network, a multidisciplinary Australian group has published proton-photon comparative planning guidelines, which are worth a read and can be accessed here: https://onlinelibrary.wiley.com/ doi/10.1111/1754-9485.13510

In previous newsletter updates, Associate Professors Hien Le (Adelaide) and Verity Ahern (Sydney) explained Australia’s growing involvement in the field of particle therapy. Now, as the construction of the Australian Bragg Centre for Proton Therapy and Research (ABCPTR) in Adelaide, South Australia, is nearing completion, it’s time to share another update on the development of particle therapy in Australia.

Practical completion of the ABCPTR facility is projected by mid-September 2023, marking a significant milestone in our journey. This sets the stage for the subsequent installation of pioneering proton therapy equipment. We

anticipate the commencement of clinical treatment on a fixed beam by 2025, immediately followed by a phased ramp-up during the installation and commissioning of two gantry treatment rooms.

Important strides have been achieved since our last update. The South Australian Health and Medical Research Institute (SAHMRI) successfully submitted MSAC 1638, thereby securing recognition of proton therapy on the Medicare Benefits Schedule for selected paediatric, adolescent and young adult (AYA), and adults with rare cancers. Further information regarding the MSAC 1638 submission and outcome

The establishment and endorsement of the Australian Particle Therapy Clinical Quality Registry (TROG 21.12 ASPIRE) by the Trans-Tasman Radiation Oncology Group strengthens the systematic implementation of the ABCPTR service, laying the groundwork for an evidencebased future of particle therapy. This registry, a longitudinal observational study of paediatric, adolescent, young adult, and rare adult tumour patients currently undergoing photon therapy treatment is open at the Royal Adelaide Hospital and the Alan Walker Cancer Care Centre in Darwin, NT. A recently published international collaborative study, which determined a consensus set of minimum data elements (MDE) for ASPIRE, can be accessed here: https://onlinelibrary.wiley.com/ doi/10.1111/1754-9485.13557. The national ASPIRE steering committee recently sanctioned the expansion of the registry to four additional sites across Australia

The Australian Bragg Centre for Proton Therapy and Research in Adelaide, South Australia.

in 2024 (Westmead Hospital, Royal Brisbane and Women's Hospital, Sir Charles Gairdner Hospital, and Peter Mac). More information regarding ASPIRE can be accessed here: https:// trog.com.au/trials/trog-21-12-aspire/ In parallel, various regions across Australia are formulating their business strategies to bolster additional proton therapy services. The Queensland group’s recent funding announcement for the Queensland Cancer Centre, which will include a proton therapy unit, is an encouraging development, and similar initiatives are being pursued in the Parkville precinct in Victoria. A business case for a hybrid particle therapy facility (both carbon ions and protons) on the Westmead precinct has been submitted to the NSW Government. In parallel, the NSW Government is evaluating an unsolicited proposal for a hybrid particle therapy facility on the Westmead precinct.

The Australian particle therapy community annually holds symposiums aimed at providing transparent communication, where the latest advancements and updates in the

field are disseminated, inclusive of an educational component. With the continuous evolution of the Australian particle therapy research and education community, specialised training and education initiatives are being proposed by RANZCR, ASMIRT and ACPSEM

development of a comprehensive care model in Adelaide to cater to the influx of patients from across Australia. Collaborative efforts of the Women's and Children’s Hospital, Royal Adelaide Hospital and SA Health have ensured adequate resourcing is in place to provide world-class treatment.

particle therapy specialty interest groups/working groups.

Our endeavour to streamline patient experience has also led to the

In conclusion, this new era of particle therapy in Australia, signified by the nearing completion of the ABCPTR and the concerted nationwide efforts, promises a transformative impact on cancer care in our region. The success we’ve achieved in policy integration, development of comprehensive clinical guidelines, establishment of registries like ASPIRE, and preparation for further expansion reflect our collective resolve to advance patient care. As we stand on the brink of this new frontier in cancer treatment, we also recognise the immense responsibility and opportunity this presents for us as radiation oncologists. Together, let’s embrace this challenge to ensure that the most beneficial and advanced treatment options are accessible to those in our care.

The ProTom Radiance 330 synchrotron accelerator that will be housed in the Australian Bragg Centre for Proton Therapy and Research in Adelaide, South Australia.

This new era of particle therapy in Australia, signified by the nearing completion of the ABCPTR, promises transformative impact on. cancer care in our region.

RANZCR Workshops, Courses and Events 2023/24

19-21

OCT 2023

RANZCR ANNUAL SCIENTIFIC MEETING

Brisbane Convention and Exhibition Centre, Brisbane, QLD

19 CPD Hours can be claimed for full attendance. If you attend only part of this event, CPD hours may be claimed pro rata equivalent to the number of hours attended (1 hour attended = 1 CPD hour).

Registrations Open! www.ranzcrasm.com/

24

NOV 2023

RADIATION ONCOLOGY PHASE 2 COURSE

ParkRoyal, Darling Harbour, Sydney

Save the Date!

www.ranzcr.com/whats-on/events/ranzcrphase-2-exam-preparation-course2023

18-19

Details for these events and many more can be found on our website: www.ranzcr.com/whats-on/events

For regular updates, in addition to the website listing, please “like” and “follow” our RANZCR social media accounts:

ACR INSTITUTE FOR RADIOLOGIC PATHOLOGY COURSE

Crown Plaza, Sydney

The AIRP, a program of ACR®, provides a unique radiology training experience. This course is recommended for registrars.

Sold Out!

Please email events@ranzcr.edu.au to be placed on a waitlist.

12

NOV 2023 MAR 2024

SMART WORKSHOP

Newcastle Conference and Exhibition Centre, NSW

Topic: Study design concept

Save the Date!

Further information to follow.

If you have any questions relating to any College events, please contact the Events team at events@ranzcr.edu.au

REMEMBER EVENTS ARE A GREAT WAY TO GAIN CPD HOURS

Program Highlights

1. Brisbane in October is beautiful. The poincianas and jacarandas are in full bloom. The days are crisp and clear. People are in a good mood. It’s contagious!

2. This year’s theme, Beyond, will be sure to fulfil (almost) all your desires, academic or social. It is a great chance to catch up with old friends and make new ones. Radiologists and radiation oncologists are special people. We are great at collaborating and supporting each other. Working and learning together is always better, and the ASM will allow you to have fun while you do it.

3. Our conference will start on a high with our Nisbet Orator – Li Cunxin AO, Director of the QLD Ballet, and author of Mao’s Last Dancer

4. For radiology we have four keynote international speakers of global repute: Prof Mini Pathria from California, Prof Stuart Taylor from London, Prof Cornelia SchaeferProkop from the Netherlands, and Prof Christopher (Risto) Filippi, from Boston. All of our speakers are excited to be heading to Brisbane, to enjoy the collegiate and fun atmosphere of the ASM, as well as imparting their expert knowledge.

5. We are fortunate to have many other international speakers, including Prof Suresh Mukherji, the renowned H&N specialist from Michigan, Prof Adrian Brady, President of ESR from Cork, Ireland, and Assoc Prof Lily Wang, neuroradiologist from Cincinnati. Prof Elizabeth Dick, expert in trauma and emergency imaging from Imperial College, London, is also returning to speak at our ASM.

6. We have the best of our local and national talent presenting, including, in the Women’s stream: the brilliant Emmeline Lee and Clair Shadbolt, for MSK, expert on sports imaging: James Linklater, for AI and Neuro

streams Meng Law: a favourite speaker and leader in both fields, and for Chest: Miranda Siemienowicz, sharing her mastery of cardiothoracic imaging, including how not to biopsy pneumonia.

7. For radiation oncology our keynote international speakers include Prof Karyn Goodman from Icahn School of Medicine, Mount Sinai (who is an internationally recognised expert in gastrointestinal cancers) and Prof Sean Collins from Georgetown University Hospital (who is a leader in the field of SBRT in the treatment of prostate cancer). Prof Matthias Guckenberger (University Hospital Zurich), Prof Jeff Michalski (Washington University School of Medicine) and Assoc Prof Francis Ho (National University Cancer Institute, Singapore) will also be contributing.

8. Radiation oncology sessions will be tumour stream focused, with many sessions including MDT style discussions and contouring demonstrations. We have a session focusing on “thrivorship” and maximising quality of life after cancer treatment and geriatric oncology.

9. For the first time we have a dedicated interventional radiology and a separate interventional neuroradiology stream. This supports the recognition of these specialties within RANZCR, alongside diagnostic radiology and radiation oncology. The streams will highlight the critical role that image-guided specialties will play in the future of radiology, cutting edge clinical and technical practises in IR and INR, as well as the inaugural IR and INR careers forum.

10.In Beyond, we will hear from radiologists who have gone above and beyond their usual practice, including Dr Suresh De Silva from Radiology Across Borders. We also have doctors from Brisbane Veterinary Specialist Centre,

who have the first dedicated linear accelerator in the southern hemisphere to treat our four-legged friends with radiation therapy. In our Wellness and Leadership stream there are lectures by experts including Prof Craig Hassed OAM, speaking on Mindfulness for Wellbeing and Peak Performance.

11.The registrar/trainee day on Saturday is jam-packed with tips on how to thrive in your training and exams, and includes a session by renowned sports psychologist Dr Michael Lloyd (currently national psychology manager for Tennis Australia). The Friday night trainee and junior consultant social night out will be held at the beautiful Soleil rooftop bar at the Rydges. This event is a must, and now a tradition at the ASM.

12. Speaking of tradition, this year will see the 8th Targeting Cancer Fun Run. The Targeting Cancer campaign aims to raise the profile of radiation oncology among consumers and other healthcare professionals in Australia and New Zealand, thereby increasing awareness of radiation therapy as a treatment option for cancer.

And, if all that wasn’t enough, we have a trio of musically gifted radiologists, who will be playing a piece in the lead up to the Annual Ceremony on Friday evening. We understand they are already practising their performance, the details of which are being kept a secret—even from the convenors! We look forward to hearing them play.

Be sure to peruse the program for more details on our amazing speakers. And don’t forget to come dressed in theme (Hollywood) for the Gala Dinner on Saturday night.

Looking forward to seeing you soon in Brisbane.

Convenors Dr Jennie Roberts, Dr Liat Barrett, Dr Tuan Ha and Dr Angela Allen.

The 2023 RANZCR ASM in Brisbane is almost here. Have you registered? If not, here are 12 reasons you should.

‘Beyond’ the ASM: A Guide to Brisbane

Beautiful Brisbane is famously laidback – but it certainly doesn’t rest on its laurels when it comes to culinary and leisure options for visitors. And with RANZCR’s Annual Scientific Meeting (ASM) held right in the heart of the lively South Bank precinct, attendees will never be far from something to do or see in Queensland’s bustling and cosmopolitan capital city.

SOUTH BANK

There’s plenty of attractions around the ASM’s home base, the gleaming Brisbane Convention & Exhibition Centre (BCEC). Take advantage of free time before or after sessions to stroll around the tropical riverfront Parklands, or even take a dip in the man-made swimming beach. In this area you’ll also find a raft of cultural institutions, including Queensland Art Gallery and Gallery of Modern Art (QAGOMA) and Queensland Performing Arts Centre. QAGOMA is hosting two Indigenous Australian art exhibitions at the same time as the ASM. Gone Fishing is a celebration of the important cultural and social role of fishing in Aboriginal culture, while North by North-West highlights the differences between regional artistic traditions. Dozens of cafes and restaurants can also be found around this area.

BRISBANE POWERHOUSE

Culture lovers should also make time to stop by Brisbane Powerhouse, a former tram station reimagined into a contemporary arts destination. During the ASM weekend, visitors can view the Brisbane Portrait Prize exhibition, an annual celebration of local artists. And from 6am to midday on Saturday, the popular Powerhouse Farmers

Markets bring together top producers and artisan food makers, including cheesemongers, bakers and more.

FISH LANE

Running adjacent to the BCEC is Fish Lane, a hub frequented by locals for its al fresco dining options and the largescale murals and sculptures that run its length. Here you’ll be able to satisfy your caffeine cravings in the mornings, picking up one of Lune Croissanterie’s world-famous pastries before you head into the ASM. Come evening, it’s all

about sophisticated dining options and monumental light installations illuminating the alleyway with colour. It’s the perfect spot to take advantage of Brisbane’s year-round warm climate.

EAT STREET NORTHSHORE AND HOWARD SMITH WHARVES

If you see out the weekend in Brisbane after the ASM, don’t miss a Sunday afternoon trip to Eat Street Northshore (15 minutes from the CBD), where 180 shipping containers on a disused

From art exhibitions to food markets and adventure activities, here are some ideas for things to do while you’re in town for the ASM.

wharf have been rebooted into micro restaurants, as well as a series of tiny stores with eclectic souvenirs. Live music is a regular feature of the hub, and the odd dance group or cabaret show keep moods high. Dining and entertainment also mingle at Howard Smith Wharves, a thriving waterside destination below the Story Bridge. This is the first site in Brisbane to achieve Heritage Hero Status from the National Trust and is the perfect place to admire both the old and new faces of the city, while also enjoying world-class food.

STORY BRIDGE ADVENTURE CLIMB

Speaking of the Story Bridge, you can book ahead to climb over this heritagelisted landmark, designed by John Bradfield (the Sydney Harbour Bridge’s most famous engineer) and currently the longest cantilevered bridge in Australia. From here you can admire the city skyline and beyond, from the spectacular Glasshouse Mountains to the Gold Coast.

BRISBANE RIVERWALK

Looking for a more down-toearth activity? Walk around and over Brisbane’s ‘Brown Snake’ (the affectionate nickname for Brisbane River) on the Riverwalk. The path stretches from New Farm in the city’s inner north all the way to the central business district, with large parts hovering directly over the water. It’s the perfect way to end an insightful visit to the Sunshine State’s capital. To register for the ASM, view the 2023 program or book accommodation, visit www.ranzcrasm.com

This is the first site in Brisbane to achieve Heritage Hero Status from the National Trust and is the perfect place to admire both the old and new faces of the city, while also enjoying world-class food.

“

ASM PROGRAM HIGHLIGHTS

120+ speakers, MDT sessions, 60+ Poster Displays and 100+ EPOS Submissions

Specific Trainee Day topics on Saturday for Clinical Radiology and Radiation Oncology

New session topics including Diversity and Inclusion and Mindfulness

Dedicated Interventional Radiology and Interventional Neuroradiology stream throughout the 3-day program

Exciting social program including a “Hollywood” themed Gala Dinner

THERE IS STILL TIME TO REGISTER!

INTERNATIONAL SPEAKERS

2023 Nisbet Orator

Li Cunxin AO

Clinical Radiology speakers include:

Professor Mini Pathria

University of California, San Diego, CA, United States

Professor Stuart Taylor

University College, London, United Kingdom

Professor Cornelia Schaefer-Prokop

Meander Medical Centre, Amersfoot, The Netherlands

Professor Christopher G. Filippi

Tufts University School of Medicine, MA, United States

Professor Suresh Mukherji

University of Illinois, IL, United States

Radiation Oncology speakers include:

Professor Sean Collins

MedStar Georgetown University Hospital, DC, United States

Professor Karyn Goodman

Icahn School of Medicine, Mount Sinai, NY, United States

ASTRO Representative Dr Jeff Michalski

Carlos A. Perez Distinguished Professor and Vice Chair of Radiation Oncology at Washington

University, St. Louis, MO, United States

ESTRO Representative Professor

Matthias Guckenberger

University Hospital Zurich, Switzerland

ranzcrasm.com

Setting New Goals

Targeting Cancer Management Committee hosts the first face-to-face meeting post-COVID.

Targeting Cancer Management Committee members came together at RANZCR’s Sydney office for the first time post-COVID to discuss new ideas and set new goals for the Campaign on 4 August 2023.

Co-chaired by Dr Lucinda Morris and Dr Tuan Ha and composed of eight radiation oncologists from across Australia and New Zealand, one consumer representative, and one Indigenous representative, the Management Committee is excited to kick off the Targeting Cancer website revamp project as its first priority. The updated Targeting Cancer website is expected to be more intuitive and user friendly with culturally safe content tailored for cancer patients.

Dr Lucinda Morris said, “Targeting Cancer website is an integral and important asset of the campaign, especially in a digital world. It is due for an overhaul to catch up with the latest technology with increased accessibility so it will be able to continue to provide useful, trusted information about radiation therapy to cancer patients, their families, carers and healthcare professionals.”

Dr Morris and Dr Ha provided a reorientation of the campaign, reviewing the strategy and discussing the future direction of the campaign as well as the overall work plan.

At the meeting, the Management Committee members also learned about the critical role of social media in supporting the campaign and explored ways to effectively engage with media to help build Targeting Cancer’s profile among the general public.

There was extensive discussion about how radiation oncologists could support GP information events to educate and dispel the myths around radiation therapy as a treatment option for cancer. The Targeting Cancer campaign welcomes interested radiation oncologists to contact the Targeting Cancer team for further information to access the extensive support materials which are available.

Email: info@targetingcancer.com.au

Don’t forget to register the Targeting Cancer Fun Run at this year’s Annual Scientific Meeting in Brisbane.

www.ranzcrasm.com/targetingcancer-fun-run-2023

Dr Morris and

Ha provided a re-orientation of the campaign, reviewing the strategy and discussing the future direction.

Dr

RANZCR Volunteers in the Spotlight – Dr Carol Johnson

RANZCR relies heavily on volunteers, with more than 1,600 members currently offering their time to support the College. Each issue, we quiz key volunteers about their experiences, insights and motivations.

I have also been involved in a SIG (special interest group) in the form of GOROC as a member and one-time chair (2017–2019). This has always been a wonderful group to share in and support.

When I look back over the years (and I can’t believe the length of some of those positions!) I am reminded of meeting some very inspiring members and very grateful for the opportunity to see how professional our College is.

modelled and met dedicated and impressive College staff.

Dr Carol Johnson

Tell us a bit about your story. I qualified in Cape Town, South Africa, in 1989, and worked as a specialist there before moving to New Zealand in 1997. I was the clinical leader in Wellington from 2008–2020 and was a member of ROAC (Radiation Oncology Advisory Committee) and then ROWG (Radiation Oncology Working Group, the advisory group to the Ministry of Health) from 2006–2020. As chair of ROWG (2011–2017) I was also the ROWG member of CTAG (Cancer Treatment Advisory Group).

My first College position was as the New Zealand rep to the RO Faculty Board (now FRO Council) from 2011–2013. I was re-elected in 2015 and remained in that position until 2020. During that time we increased the number on the Council to two NZ members.

What motivates you to volunteer?

I see volunteering with the College to be a responsibility of a professional. Who better knows the current issues and who better can predict the future concerns that affect our discipline than us? We need to advocate for our service so that we can best meet the needs of our patients and the reputation and standing of radiation oncologists. Through advocacy we can advise on workforce and facility requirements. We can set standards and we can promote quality. We can lead and promote innovation. We have a responsibility to educate and support the next generation of radiation oncologists. We have a voice to speak out on behalf of patients to demand access to and provision of good care.

What benefits has volunteering had?

I have seen first-hand the breadth and professionalism of the College. I have worked with inspirational colleagues, seen effective chairmanship

What achievements are you most proud of as a volunteer? Hmmm—that is a hard one... I and two others set up the NZExec and turned it into what it is today so we could support the NZ reps on committees and get a fuller picture of the NZ concerns. I hope that I have brought the New Zealand differences to the Council discussions. I led (with a massive amount of assistance) our Horizon Summit in New Zealand in 2019 to bring our predicted workforce and facility plight to the government and decision-makers (which we had hoped would be far more impactful than it was).

What more can the College do to support volunteers? The College needs to make sure that new volunteers learn the ropes quickly when it comes to things like claims, booking travel and who is who at head office; background information relevant to the position needs to be at hand. Queries need to be addressed promptly, too. Greater assistance of the SIGs is the one area that seems to be lacking the most.

Do you have any advice on volunteering in general? Most people I know get more out of volunteering than they put in. If it is not working for you, then it is good to recognise that and withdraw. If the workload is shared around there is a greater appreciation of the machine that is the College and it’s a wonderful way to network.

We have a responsibility to educate and support the next generation of radiation oncologists.

Working to Prevent Stillbirths

A recap of the Perinatal Postmortem Imaging Workshop held in August.

Six stillbirths occur every day in Australia, with stillbirths accounting for 7.7 of every 1,000 registered Australian births in 2020. Up to 22 per cent of stillbirths are recorded as unexplained following extensive investigations.

Recognising the important role of medical imaging in 21st-century stillbirth investigation, the Australian Department of Health and Aged Care provided funding to RANZCR in the May 2021 Federal Budget as part of the National Stillbirth Action and Implementation Plan, to improve professional capacity to provide imaging-based stillbirth investigations.

The 3.5-year program of work, being carried out between 31 January 2022 and 30 June 2025, has already produced a training package including a series of six educational webinars provided by international experts in perinatal postmortem imaging, and an advanced two-day course and symposium that was held in Melbourne in August. This

meeting featured international and local experts in postmortem imaging, parent advocacy, stillbirth research and perinatal pathology. The Assistant Minister for Health and Aged Care, Ged Kearney, attended and addressed the opening session of the course. Sixty registrants from multiple disciplines including radiologists, pathologists, obstetricians and medical imaging technologists attended the course which featured a mixture of didactic lectures, interactive “how I do it” sessions and review of actual clinical cases using a proprietary DICOM viewing platform built especially for the course by Philips Healthcare.

Resources were developed for reporting, referral and technical parameters for performance of postmortem MRI in infants and were provided to meeting registrants. The project has also enabled RANZCR to contribute to the upcoming revision of the Stillbirth Centre of Research Excellence (CRE) guidelines for Care

around Stillbirth and Neonatal Death (CaSAND) and, in particular, to provide significant input into the content of the Investigations chapter of the guidelines. Finally, surveys of the knowledge, attitudes, and experience of stillbirth investigations of obstetricians and midwives, bereaved parents, radiologists and pathologists were conducted in 2022 in collaboration with the Stillbirth CRE and revealed significant knowledge gaps and consequent underutilisation of perinatal postmortem MRI following stillbirth. These surveys will be repeated in 12 months as one means of assessing the impact of the project on clinical practice and parent experience. RANZCR would like to express its gratitude to the Australian Government for enabling it to improve the availability of highquality services in this important but largely “hidden” area of clinical practice.

This meeting featured international and local experts in postmortem imaging, parent advocacy, stillbirth research and perinatal pathology.

Prof Owen Arthurs, Prof Teresa Victoria, Hon Ged Kearney (Assistant Minister for Health and Aged Care), Prof Willemijn Klein, Prof Stacy Goergen.

Giving Effective Feedback

Dr

experience impacts them. This can result in lost opportunities for learning for both the consultant and the trainee.

Below, I will outline some of the cultural and psychological barriers to effective feedback, and my top tips to mitigate them.

that opportunities for course correction are utilised prior to developing into problems, and that the process of giving and receiving feedback becomes practised, normalised and, hopefully, less emotionally challenging for everyone.

CLEAR IS KIND

Clinical radiologists are a smart and savvy bunch, yet giving negative feedback in a way that is constructive and helpful can be a challenge for many well-intentioned Directors of Training (DOTs) and Clinical Supervisors (CSs). The good news is that giving effective feedback is a skill that can be learnt and practised. I suspect our colleagues in radiation oncology have a head start on us by managing a rotating cast of junior doctors and medical students during training, providing ample opportunity for self-reflection (otherwise known as “well that conversation didn’t go to plan!”).

However, it is easy to forget that emotional intelligence and nontechnical expertise do not necessarily develop with rank and life experience. The hierarchical nature of medicine can compound this knowledge gap in consultants, as the recipients of poorly delivered feedback (trainees) may not feel empowered to discuss how the

Data from the business world indicates that, on a global scale, Australians1 are especially fearful of providing candid feedback through fear of causing hurt or offence. Interestingly, study of Australian workplace culture has also found that a major component of how we measure success is that it is the product of a good working relationship (in contrast to cultures where success is defined by qualities of the product, such as meeting specifications or being fit for purpose). These factors can lead to avoidance when negative feedback is required.

Avoidance can manifest as a DOT delaying feedback until the time of the six-monthly DOT review (a feedback dump), by de-emphasising or euphemising negative feedback, or by a CS providing negative feedback about a trainee only to the DOT, bypassing the trainee. It’s easy for us to believe that we are maximising efficiency, or sparing the trainee’s feelings.

BITE-SIZED CHUNKS

However, the problem with the feedback dump is that the trainee can feel blindsided, which can lead to defensiveness or loss of confidence. This can impact a trainee’s ability to accept the learning points and can compound underperformance. Timely feedback means that trainees are not operating in an information vacuum,

Underplaying expectations and negative feedback can also hamper comprehension and lead to misunderstandings. It is far more helpful to be precise when explaining what the expectations are, and what actions or behaviours are required of the trainee. In the words of US psychologist and researcher Prof Brené Brown, “Clear is kind. Unclear is unkind.”

It is also easier, both for the DOT and the trainee, when expectations are clearly stated at the beginning so that feedback conversations have a reference point. Clearly, though, in a speciality with the breadth and depth of clinical radiology, this is not always possible and trainees will acquire knowledge and skills differently. This brings me to the “Curse of Knowledge”.

STAGES OF COMPETENCE AND THE CURSE OF KNOWLEDGE

Stepping out of the anxiety of causing harm is only part of the equation. Sometimes, judgement can also colour a supervisor’s perception of a trainee’s performance and this can be unintentionally communicated to the trainee, hampering the relationship and undermining otherwise potentially valuable feedback.

The Stages of Competence model was developed by Noel Burch about 50 years ago. This is a model that describes

Jennifer Chang is the Trainee Wellbeing Officer and a former Director of Training. In this column she explores issues that can impact the progression and wellbeing of trainees, based on her own experience and referencing a wide variety of sources.

“I DON’T WANT TO BREAK THEM”

Dr Jennifer Chang

the stages that we progress through when learning new skills. The stages are conscious incompetence (“I know nothing and I know it”), unconscious incompetence (“I know a little, but don’t know what I don’t yet know”), conscious competence (“I can do it, but I have to think about it”) and unconscious competence (mastery—“I can do it without thinking about it”).

The widely-known Dunning-Kruger effect overlaps considerably with the stage of unconscious incompetence (“I don’t know what I don’t know”). The ‘curse of knowledge’ is a cognitive bias which I like to think of as DunningKruger’s cousin. In its simplest form, this is the assumption that “you know what I know”. By extension, in the culture of medicine, I have also observed this to mean “if you don’t know what I know, then that’s because there is something wrong with you”.

A downside of unconscious competence is that we can forget what we didn’t always know and how we learnt it. In supporting others on their paths to mastery, I find it helpful to remember that if something seems obvious, it may only be obvious to me.

THE IMPORTANCE OF A PURE HEART

In my experience, trainees are more likely to be forgiving of bumbled feedback if they know that your intentions are pure. Stephen Covey is probably best known as the author of the book 7 Habits of Highly Effective People. However, it is his book, The Speed of Trust, which gives us the following nugget: “We judge ourselves by our intentions and others by their actions”.

Prefacing negative feedback with a short statement that notifies the trainee of your positive intent for their learning and development can set the tone of

the conversation in a way that makes your suboptimal execution easier to hear. Better yet, the literature2 gives us this gem: “I’m giving you these comments because I have very high expectations and I know that you can reach them”.

The paper referenced above also explores the importance of trust in a learning relationship, noting that “trust permits people to disambiguate feedback and to see criticism as information that can help them improve, [whereas] mistrust can lead people to view critical feedback as a sign of the evaluator’s indifference, antipathy, or bias, leading them to dismiss rather than accept it”. So, my final big tip is to connect with your trainees. They have to know that you really care, or you might just be wasting your breath.

THE ABBREVIATED VERSION (PLUS A BIT MORE)

• Don’t delay. Give that feedback today!

• Everyone’s favourite metaphorical feedback sandwich may be unnecessary. “Clear is Kind. Unclear is unkind.”

• When something seems obvious, remember that it may only be obvious to you.

• Focus on the behaviour, not the individual.

• Practise helps. If you’re a DOT and struggling particularly with giving feedback, I suggest participating in courses on feedback, coaching and difficult conversations to assist in upskilling and give opportunities to practise in a safe environment.

• Connect with your trainees. Or at a minimum, don’t reinforce some of medicine’s unhelpful behaviours (my “don’t be a jerk” rule of modern medical practice).

1. Sorry, New Zealanders. I learnt this at a workshop on Australian workplace culture, with these references from a presentation by the late Prof Daryll Hull and have been unable to find trans-Tasman data.

2. Yeager DS et al. ‘Breaking the cycle of mistrust: Wise interventions to provide critical feedback across the racial divide’, Journal of Experimental Psychology: General, Vol. 143, No. 2, 804-824.

Connect with your trainees. They have to know that you really care, or you might just be wasting your breath.

More Progress for Biomarkers: College Grants Help Fund Continuing Research

A/Prof Sweet Ping Ng shares details of her ongoing study of serum and imaging biomarkers to predict treatment response in patients with head and neck cancer.

therapy in patients with head and neck cancer.

We sat down with A/Prof Ng to learn about her ongoing research.

As members are aware, a variety of opportunities are available to support research projects and foster a culture of research at the College. RANZCR Research Grants, offered since 2005, provide financial support for Fellows, Educational Affiliates and trainees. At the College, we want to invest in the future of the radiology professions by developing researchers and supporting innovative projects.

One of our Fellows is A/Prof Sweet Ping Ng, a radiation oncologist at Austin Health, and a multiple successful RANZCR Research Grant applicant. Her most recent project has been to investigate circulating miRNA as biomarker of response during radiation

“Cancer cells release a variety of analytes, such as circulating tumour cells, cell-free DNA, and RNA, into the systemic circulation that can be detected by ‘liquid biopsy’. MicroRNAs are mature, non-coding RNAs with 21-23 nucleotides that can be involved in a multitude of biological processes. Recent studies have demonstrated the association of miR-19, miR-21, and miR-375 with poorer survival in head and neck cancer (HNC), and another six miRNAs that may discriminate high- vs low-risk oropharyngeal cancer. Currently, no validated method has been found to identify patients at risk of incomplete tumour response during treatment, thereby representing a significant unmet need.

My earlier study, which was funded by RANZCR Research Grants in 2016 and 2017, collected and stored weekly plasma samples from patients with HNC undergoing definitive radiation therapy. Weekly MRls were obtained simultaneously for this study, allowing correlation of ‘liquid biopsy’ markers with radiographic response and subsequent clinical outcomes.

This current project aims to establish the feasibility of using circulating miRNA in therapeutic monitoring during radiation therapy, early detection of poor treatment response, and improving therapeutic stratification.

Currently we have 40 patients who have completed radiation therapy with post-treatment follow-up imaging and blood sample collection. We propose to use the stored plasma samples to isolate circulating RNA and evaluate circulating miRNA via next generation sequencing to identify any change in circulating miRNA during radiation therapy that may be an early response marker.

Right now, we’re nearly finished the project—we’re awaiting formal analysis of the raw data. Successful completion of this project will provide the first in-human evidence on the utility of circulating miRNA as a promising liquid biopsy approach for serial monitoring of response during treatment. Any change in tumour genome that may

A/Prof Sweet Ping Ng

Successful completion of this project will provide the first in-human evidence on the utility of circulating miRNA as a promising liquid biopsy approach for serial monitoring of response during treatment.

alter tumour’s biology and response to therapy can be detected, allowing early therapeutic steps to be taken. This will have immediate impact in clinical practice in selecting the right patient for the right treatment and takes real steps towards precision medicine in oncology.

This RANZCR Research Grant provides an opportunity for me to pursue this exciting prospective study of serum and imaging biomarkers to predict treatment response in patients with head and neck cancer. During the course of this project, I am learning the intricacies of developing and executing a translational project, establishing collaborations, grant writing and submission, as well as laboratory skills (sample processing, workflow of NGS) and biostatistical knowledge

for analysis of circulating miRNA. I’m also gaining great experience in working with statistics, writing a critical literature review, and writing and publishing manuscripts. This project is equipping me with the research skills and knowledge to facilitate my goal of becoming a physician scientist, with a special interest in predictive biomarkers research, in an international collaborative setting.”

Find out more about Research Grants at www.ranzcr.com/ college/awards-and-prizes

This Research Grant provides an opportunity for me to pursue this exciting prospective study of serum and imaging biomarkers to predict treatment response in patients with head and neck cancer.

The education of radiation oncology (RO) trainees has come a long way in the past few decades, and together with Continuing Professional Development (CPD), is a strategic priority of RANZCR.

Since 2005, RANZCR RO trainees have been required to undertake a piece of original research. The Research Project aims to:

• Foster an interest in research

• Apply an understanding of research methodology

• Provide the opportunity for all trainees to collaborate with others to produce original research

• Expose trainees to the experience of submitting a manuscript to a peer reviewed journal

• Encourage trainees to see participation in research as an integral part of radiation oncology specialist practice

• Inspire trainees to contribute to the oncology literature in their future careers.

We all know that research informs the practice of modern, evidence-based medicine. We’re also aware of how hard it is to claw out time from a busy clinical life; along with a lack of time, access to statistical services, insufficient mentoring, and variable support from leadership may be other barriers. Many RANZCR Fellows and trainees may wonder about the extent of a research culture in their profession, given so many competing demands on their time.

More Fact than Fantasy

Prof Daniel Roos has analysed the research output of ANZ radiology oncology trainees in a study published in JMIRO.

Prof Daniel Roos, Chair of the College’s RO Research Committee, undertook a project to assess the current research output of its RO members using relevant items from the RANZCR CPD database for the 2019–21 triennium. This has been published in the Journal of Medical Imaging and Radiation Oncology (JMIRO) this year.1 In ‘Research culture in Australian and New Zealand radiation oncology: Fact or fantasy?’, Prof Roos found that the overall percentage of ROs claiming at least one research-related activity in 2019 (pre-COVID) was 71 per cent—a significant level of engagement, with the most commonly claimed research activity being a co-author of journal articles. Other common activities were conference presentations, invited lectures, leading clinical trials and peer-reviewing manuscripts for publication. Results were similar but COVID-suppressed in 2020–21. Given that claiming research activities in CPD is not mandatory, the true level of engagement is almost certainly higher.

ANZ ROs are the most productive researchers by global region, and this points to the successful promotion of research by RANZCR. 2 Roos hypothesises that “it is likely that Faculty curriculum requirements, research funding and other promotional initiatives have contributed substantively” to a healthy research culture.

In designing his project, Prof Roos could not find any comparable study of other national RO society’s research output. However, a 2020 ESTRO study

concluded there was an urgent need for more support of innovative research by European national societies. Indeed, facilitating innovative research and promoting the engagement of young scientists were not designated as high priorities for RO national societies throughout Europe. 3

‘Fact or fantasy?’ follows Foley and Roos’ 2020 survey of RANZCR RO attitudes to research, which found that, while the majority of current and recently graduated trainees perceive the current FRO research requirement as reasonable, barriers to completion were competing clinical commitments and time for research.4 For the majority of those surveyed, the likelihood of conducting future research as a result of the mandatory nature of trainee research projects increased or did not change.

In his new article, Roos writes that “whilst journal publications may be considered the ultimate measure of research productivity or achievement, they rely upon a host of other associated activities like patient recruitment, quality assurance and peer review which are captured in FRO’s CPD sub-categories and should ideally be included in any comprehensive assessment of research engagement”.

As the global demands for improved patient care and medical infrastructure in the field of RO increase, the quality and intensity of education must adapt. RANZCR continues to champion research by its members and the College’s new Research Action Plan is the embodiment of this.

1. Roos D. Research culture in Australian and New Zealand radiation oncology: Fact or fantasy? J Med Imag Radiat Oncol 2023; 67: 450–5.

2. Berger T, Noble D, Shelley L et al. 50 years of radiotherapy research: evolution, trends and lessons for the future. Radiother Oncol 2021; 165: 75–86.

3. Garibaldi C, Jornet N, Tee Tan L, Boejen A, Franco P, Bussink J, et al. National societies’ needs as assessed by the ESTRO National Society Committee survey: a European perspective. Radiother Oncol 2020; 151: 176–81.

4. Foley EF, Roos DE. Feedback survey on the Royal Australian and New Zealand College of Radiologists Faculty of Radiation Oncology trainee research requirement. J Med Imag Radiat Oncol 2020; 64: 279–86.

CPD Reminder

2023 CPD Program ends 31 December, don’t delay, start today!

A reminder to members to ensure you have entered your 2023 CPD activities by 31 December. As the College CPD program has moved to an annual cycle, it is imperative that you are regularly entering your CPD activities into the ePortfolio to ensure you remain compliant and you are ready to commence the next annual cycle at the start of the calendar year. By now, many members are likely to have completed enough activities to meet CPD requirements, so we encourage you to enter these into the ePortfolio now, to avoid the end of year rush.

The 2023 CPD requirements are as follows:

• 50 hours of CPD activities including at least 12.5 hours (25 per cent of the minimum) in educational activities; at least 25 hours (50 per cent of the minimum) in activities focused on reviewing performance and measuring outcomes, with a minimum of five hours for each

category; and the remaining 12.5 hours (25 per cent of the minimum), in any CPD category

• Professional Development Plan (PDP)

• MRI and mammography CPD hours for members participating in these programs (eight hours for MRI, four hours for mammography)

• Anaphylaxis training to be completed once every three years (Clinical Radiology members only)

• Structured annual conversation (New Zealand members, MCNZ requirement)

• CPD activities with a focus on cultural safety and health equity (New Zealand members, MCNZ requirement)

NEED ASSISTANCE?

Scan the QR code below to access the CPD section of the College website, which has has all the information regarding the program requirements,

‘how to’ guides and video recordings to assist in using the CPD ePortfolio and other information resources such as Frequently Asked Questions, CPD handbooks and templates.

Please refer to the 2023 CPD Handbooks for further details regarding the CPD program and requirements, as well as a full listing of CPD activity types and which category they correspond to.

For more information regarding the RANZCR CPD program, please contact cpd@ranzcr.edu.au or phone + 61 2 9268 9777 and select ‘CPD’ from the menu. Please note, toward the end of the year, the team experiences a high volume of calls and response times may be longer than usual.

Policy and Advocacy Report

The College unveils a new bi-annual report for members.

Advocacy is a key strategic priority of the College. We aim to be the leading voice in diagnostic imaging and cancer care and have built and maintain constructive relationships with governments in both Australia and New Zealand and the wider medical/health sectors. The work we do on behalf of members and patients often happens over many years and behind the scenes, which is why we’re excited to share a new initiative of the College—the Policy and Advocacy in Action Report.

The report will be published twice a year to better communicate all that we are doing. You can find the report on the advocacy page of the College website or scan the QR code here.

Looking ahead to the 2024 Annual Scientific Meeting.

The ANZSNR is eager to announce that plans are well underway for the 2024 Annual Scientific Meeting to be held at Ta Pae Convention Centre, Christchurch from 2-4 May 2024.

The ASM will be convened by a team of neuroradiology specialists from New Zealand, including Dr Shane Lee, Dr Tim Elliot and Dr James Caldwell, with support from Dr Ben McGuiness.

Next year we are offering an innovative three-full-day program that will include

a mix of Head and Neck, Diagnostic Neuroradiology, and Interventional Neuroradiology sessions. We look forward to welcoming international speakers in these fields to provide delegates with the latest educational opportunities and research from overseas.

Interested attendees are asked to save the date and prepare within their departments to attend. There will be tailored content for general radiologists, with an interest in

neuroradiology and RANZCR-accredited trainees are strongly encouraged to attend.

As this is the society's first time heading to the beautiful South Island of New Zealand, we look forward to welcoming you and showing you some of the local attractions as part of the networking and social program.

To register your interest or for any questions, please contact the event manager at nc@ncevents.com.au

IRSA New Website Launch

Visit

As part of IRSA’s strategy to increase awareness of interventional radiology, we are very pleased to announce that following many months of hard work, the new IRSA website is live.

The new website is re-branded, with new imaging, a modernised colour palette and an innovative look and feel. Structurally, the new website features a redesigned landing page with new sections for patients and doctors to visit and access information about IR and the many common procedures we offer.

The Doctor Finder function is the call to action for patients and doctors who visit the website. Members are encouraged

to ensure their profile is up-to-date so that potential patients and GPs can contact you.

We are eager to continue to work with our online marketing team of experts to increase content for patients and doctors, as part of search-engine optimisation plans that will ensure that the IRSA website is the number-one searched platform for patients seeking information on a variety of conditions that can be safely and effectively treated by an interventional radiologist.

To become involved or learn more about IRSA’s plans, please contact secretariat@irsa.com.au

Annual Scientific Meeting (ASM)

2024 SAVE THE DATE

We are pleased to be welcoming delegates to the new Ta Pae Convention Centre in Christchurch for our 2024 ASM from Monday 05 to Wednesday 07 August.

IRSA is yet again planning an excellent 3-day scientific program, welcoming a faculty of international and local speakers who are leaders in the field of interventional radiology. We look forward to delegates connecting via the social events scheduled to showcase this beautiful region on the South Island of New Zealand. IRSA

A New Platform for IR and INR

Introducing a dedicated stream for interventional radiology and interventional neuroradiology at this year’s RANZCR ASM.

This year’s RANZCR ASM will see an exciting addition to the format—it is the first year the College will have a dedicated stream for interventional radiology and interventional neuroradiology content running the length of the scientific program. This is a fantastic development that complements the strategic direction of the College and its commitment to defining, advancing and embedding interventional radiology and interventional neuroradiology as clinical radiology specialties across Australia and New Zealand.

The IR and INR stream leads are A/Prof Nick Brown, interventional radiologist and chair of RANZCR’s Interventional Radiology Commitee, and Dr Grace Aw, interventional neuroradiologist at the Royal Brisbane and Women’s Hospital. The program will present a wide range of inspiring content that will provide something for everyone. Running in parallel to the clinical radiology and radiation oncology streams, the IR and INR programs will offer delegates sessions that cover the latest in scientific content across a range

of current and ‘new horizon’ practice areas, technological advances, advocacy, health economics and the immense value that these specialties contribute to the health system and to improving patient care. Combined sessions with AMSIG, ARGANZ, IRSA and ANZSNR will provide an opportunity to present new collaborations between diagnostic, interventional radiology and interventional neuroradiology. Alongside this content, delegates will have the opportunity to hear about the work the College is undertaking

to advance interventional radiology and interventional neuroradiology, including seeking specialty recognition and the development of two dedicated, contemporary and local training programs for interventional radiology and interventional neuroradiology. This session will focus on how this work will unfold in the future.

Fellows, radiology registrars, junior doctors and medical students are invited to attend a breakfast session for an IR and INR careers forum on Saturday 21 October from 7.00–8.30 am. This forum will be an opportunity to learn about what a day as an interventional radiologist and interventional neuroradiologist looks like and what training pathways are available.

RANZCR is proud to announce that Dr Matthew Mauro, RSNA President, will be presenting the keynote address during the opening session on ‘The Birth of a Specialty: Interventional Radiology in America’. We are pleased to also have international speaker Prof Andreas (Andy) Adam, of King’s College London, join us at the RANZCR ASM. Prof Adam has been involved in many key projects that have transformed interventional

radiology, including leading the successful application for subspecialty recognition for interventional radiology in the UK. This year, Prof Adam will present on interventional oncology, the fourth pillar of cancer care, alongside Prof Lizbeth Kenny, and will be part of a panel discussion with RANZCR, IRSA and ANZSNR after his presentation on ‘A Faculty of Interventional Radiology:

Dreamtime or Primetime?’—mark this one in your diaries.

Clearly, a lot of great content and opportunities to learn more about what is happening in the world of IR and INR will feature in the program. For more information on the RANZCR ASM and to register, visit www.ranzcrasm.com

Cardiac CT Training 2023

We go beyond simply meeting training requirements:

l Maximum allowable course based live and library cases for ANZ credentialing.

l 40.75 RANZCR CPD hours for Masters.

23.75 RANZCR CPD hours for Recertification.

l Officially sponsored and endorsed by GE Healthcare for more than 10 years.

l Live scanning at second highest global recruiting site in SCOT-HEART study.

2023 COURSE DATES:

5 Day Level A Courses: 9th - 13th November

3 Day Recertification Course: 11th - 13th November

WATCH THIS SPACE: www.aicct.com.au

For Face to Face and online courses: info@aicct.com.au

It is with considerable interest that I recently read two studies1 2 which examine healthcare supply-chain issues, particularly relating to the shortage of iodinated contrast media (contrast) in Australia in 2022.

The ‘great contrast shortage’ exposed the vulnerabilities in procurement, the reliability of heathcare markets and created significant challenges for each of us as we grappled with the consequences.

Both papers discuss lessons learned and opportunities to improve current procurement practices, asserting that much of what occurred could have been prevented, had medical professionals been involved. Apparently, contrast had been incorrectly considered to be a mere commodity, and the vital importance of these products to patient care was not always understood. 2

As we experienced first-hand, the unexpected and critical shortage of contrast forced us to conserve resources, prioritise indications, triage patients based on risk, explore alternate imaging strategies, and prepare for similar events recurring in the future.

While the quick and decisive actions of the College were pivotal in mitigating the effects of the shortage on members, practices and patients, we were nonetheless on the back foot.

Reflections on Leadership and Learning

Australia turned out to be particularly vulnerable, due to the absence of in-country buffer stocks, the limited availability of MRI units, and the relative paucity of new generation CT scanners offering dual energy or spectral imaging.

One study2 contends that “the tender evaluation committee must be heavily weighted towards the end-users of the product in the organisation (e.g., radiologists, cardiologists, medical

imaging technologists, nurses) since they have the know-how and assume full responsibility in case of adverse effects and complications”.

It is clear from these studies that procurement and supply decisions would benefit from a clinical and patient-focused perspective, and it will be interesting to see the extent to which radiologists can exert influence in this space in future.

Dr Rajiv Rattan, Dean of the Faculty of Clinical Radiology

A

NEW ZEALAND ASM

I recently attended the New Zealand ASM alongside the entire RANZCR Board. The ASM, held in Queenstown, served as a platform for radiologists, researchers and experts to convene, exchange insights and celebrate advancements within our field. The ASM also presented a great opportunity to meet our colleagues in person and discuss pertinent issues specific to the New Zealand context. The ASM sessions showcased great topics from bi-national and international presenters.

One standout session during the event centred on achieving equity in healthcare. Radiology, like many fields in medicine, has been increasingly recognising the importance of diversity, inclusivity and equity of access.

Talks on AI and spectral imaging garnered much interest.

Behind the scenes, the ASM’s success was greatly attributable to the dedication of Dr Gabes Lau, chair of the NZ Branch, the ASM organising committee and the many RANZCR staff involved who contributed to a great atmosphere. Thank you to all involved for an excellent ASM in picturesque (though cold) Queenstown!

1. Kisby G, Seow JH, van Schie G, Phatouros CC, Lam K-V, Muir T et al. The great contrast shortage of 2022: Lessons learnt in Australia. J Med Imaging Radiat Oncol. 2023 Aug;67(5):475–481.

2. Parizel PM, Mallio CA. How to prevent a repetition of the ‘not so global’ contrast media shortage of 2022?. J Med Imaging Radiat Oncol. 2023;67:471–474.

Dr Barry Soans

REGIONAL RURAL TRAINING

RANZCR is currently piloting a new Regional & Rural Training Pathway (RRTP) program designed to attract, train and retain clinical radiology and radiation oncology clinicians in regional and rural areas of Australia. This is the first step in creating a sustainable training pathway to support the growth of regional Australian clinical radiologists and radiation oncologists in the workforce.

The College received a very positive response to the recent EOI process, where eligible trainee applicants and training sites were invited to apply. It is very encouraging to see the commitment of doctors-in-training to contribute to their regional and rural communities. Successful applicants (trainees) will be awarded a scholarship that covers all RANZCR training and examination fees for the duration of their training. The College is now working with training networks to match applicants to fill the five dedicated training positions.

AMC VISIT

I would like to thank everyone involved in the College AMC follow up assessment and acknowledge the efforts made in providing the highly detailed information that was required in response to recommendations made in our full re-accreditation assessment in 2019.

The AMC was impressed with how the College is progressing against these recommendations, acknowledging RANZCR’s significant improvements in

CHIEF

CENSOR IN CLINICAL RADIOLOGY

FCR Updates

Progress on the new regional and rural workforce training pathway; the AMC followup assessment; successful delivery of Phase 2 examinations; and planning for the ASM.

implementing the new training program, digitising examinations and ensuring our training program is more trainee focused. Our emphasis on becoming more inclusive, constantly evaluating our progress and the training experience was also acknowledged by the AMC. We look forward to sharing the results of the scheduled follow-up AMC visit in a future edition.

ACCREDITATION STANDARDS

The review and update of our Accreditation Standards is well underway. Accreditation ensures there are structures and systems in place to support and deliver the specialist Clinical Radiology Training Program, positioning trainee wellbeing and safety as integral to these standards.

Please take the time to review and provide your feedback on the draft standards which will soon be distributed for consultation.

TRAINEE WELLBEING

I am pleased to announce the appointment of two new Trainee Liaison Officers (TLOs), one each for Australia (Lisa Grayson) and New Zealand (Jenna Howell). They will provide practical and confidential support throughout your training and will help you address issues and concerns should they arise.

PHASE 2 EXAMINATIONS

The first delivery of the capstone assessment of the new training program, the OSCER, was held in June 2023.

The new OSCER format was a significant change for trainees, examiners and College staff. It was also a huge logistical exercise requiring meticulous planning and much effort from all involved, with 182 candidates sitting a total of 884 OSCER stations over the three days.

OSCER panel leads were tasked with creating structured cases for their station, incorporating new question formats blueprinted to targeted domains and learning outcomes, and aligned to a formal marking rubric. All examiners attended station rehearsal workshops prior to the exam to ensure consistency of question delivery and timing.

It is pleasing to receive very positive feedback about the new format from examiners, who noted that this improves fairness for candidates, all of whom have a similar exam experience regarding question format and mark allocations.

Candidates were similarly positive in their feedback about the new OSCER format, with results indicating a higher pass rate for individual stations and for overall performances of both trainees and IMGs, many of whom progressed to fellowship.

RANZCR ASM

The ASM is fast approaching, and I am particularly looking forward to engaging with trainees and meeting the junior doctors considering a career in radiology. I also look forward to engaging with the DoTs at the preceding Dot workshop. The academic program this year is particularly strong and the social events are always a highlight. See you all there.

The Faculty of Clinical Radiology Professional Practice Committee (PPC) has completed its third meeting for the year and the work it’s prioritising is moving forward with high productivity. A few items worthy of an update are:

RANZCR CODE OF ETHICS

In May of this year the FCR PPC, in partnership with the Faculty of Radiation Oncology PPC, commenced the task of reviewing the RANZCR Code of Ethics. To ensure recency and relevance of the information, a modernised code was drafted to include references to ethical principles in artificial intelligence in medicine, prioritising consent and, communication with patients. I am pleased to announce that the updated code was submitted to Council for consideration at its 24 August meeting and it was approved. I thank all

OF PROFESSIONAL PRACTICE

New Code of Ethics Approved

committee members of both faculty PPCs for their insight and contributions to this important document.

CT CORONARY ANGIOGRAPHY (CTCA) TRAINING GUIDELINES REVIEW

Another exciting announcement of a piece of work approved by Council is the review of the CTCA training guidelines which first commenced in 2022, with agreement from the CTCA Parent Bodies. It has been ongoing this year and was a substantial and specialised piece of work which demanded high collaboration on approaching bestpractice rationale for the training pathways. The PPC oversaw this project as it slowly came to fruition and we’re enthusiastic to see the training guidelines be put into action by the CTCA Conjoint Committee.

PROFESSIONAL PRACTICE AND THE ASM

The 2023 ASM theme of “Beyond” aims to extend our experience beyond the limitations of the image or technical constraints for each of our specialties. Collaborations with our fellow clinicians are becoming increasingly important in the face of advancing medical knowledge and technology, and for ensuring best patient outcome in the era of personalised medicine. Be sure to visit the ASM website for program and registration details. I look forward to seeing you there.

If you have any questions or comments regarding the work of the FCR Professional Practice Committee, please feel free to reach out by emailing the College team at: professionalpractice@ranzcr.edu.au

07 3667 7260

info@oxlade.com.au

www.oxlade.com.au

Prof Dinesh Varma

FCR CHIEF

AI-Driven Contouring Software Integrated with Varian’s Treatment Planning Services

Varian’s Advanced Oncology Solutions (AOS) can now offer the Siemens Healthineers AI-Rad Companion Organs RT solution as part of its treatment planning services, allowing Varian experts to provide client cancer centres with remote dosimetry and radiotherapy treatment planning.

“Varian’s combination with Siemens Healthineers continues to pay off, as we have successfully integrated the use of AI-Rad Companion Organs RT with Varian’s Eclipse™ treatment planning software," said Mika Miettinen, Vice President, Technology Enabled Solutions at Varian. “By incorporating this artificial intelligence tool into our treatment planning workflow, we are able to further enhance operational and clinical efficiency for our customers. It reduces the amount of time we need for organs-at-risk contouring, to produce complex, sophisticated treatment plans that narrowly focus the radiation dose on the targeted tumor and minimise the impact on surrounding healthy tissues.”

AI-Rad Companion Organs RT is an artificial intelligence (AI)-based solution from Siemens Healthineers that provides radiation oncology clinicians with automatic contouring of organs at risk, an otherwise extremely timeconsuming process that also creates variability in radiation therapy treatment planning when done manually. By leveraging artificial intelligence, AI-Rad Companion Organs RT was designed to produce high-quality contours of organs at risk—the areas of anatomy that require protection during treatment— while reducing the amount of time needed to produce those organs-at-risk contours.

Christus Health, a Texas-based health system, and American Oncology Institute™ (AOI), a leading cancer care provider operating a chain of cancer hospitals across India, are the

first clinical networks to benefit from the integration of AI-Rad Companion Organs RT with Eclipse, which are hosted in the cloud so that clinicians at the client sites can easily share data and collaborate with Varian’s remote dosimetry service providers.

The Simulation/Planning Process

At Christus and AOI cancer centres, a patient’s CT simulation images are sent directly to the cloud-hosted Eclipse software. The Varian dosimetrist then transfers the images to the cloudhosted AI-Rad Companion Organs RT, which automatically creates the needed organs-at-risk contours. When the contouring process is complete, the images are automatically transferred back to Eclipse. The Varian dosimetrist reviews and/or edits the contours and uses them to generate high-quality treatment plans that are transferred back to the client site for use during patient treatment.

According to Rajesh Gutti, Regional Director of Physics for AOS, the addition of the AI-Rad Companion Organs RT solution to the cloud-based dosimetry services from AOS is designed to allow Varian dosimetrists to save time on contouring with the goal of achieving consistent results when contouring organs at risk. “We are in the process of gathering data on the time savings and consistency in contouring results achieved with the implementation of AI-Rad Companion Organs RTsolution into the clinical workflow,” he said. “We look forward to sharing more about the efficiency gains when we have accumulated more data.”

AOI Pilot Project: AI-Rad Companion Organs RT Confers Quality and Productivity Gains in Organs-at-Risk Contouring

In Hyderabad, an AOI clinical team conducted a pilot program to evaluate

the benefits of integrating AI-Rad Companion Organs RT, with its AIpowered algorithms, for high-quality contouring of organs at risk (OAR), with Eclipse-based TPaaS. According to Sushil Beriwal, MD, Vice President, MultiDisciplinary Oncology, Medical Affairs, 11 radiation oncologists across seven AOI institutions evaluated 1,400 AI-Rad Companion Organs RT-generated contours encompassing 33 organs. The AI-Rad Companion Organs RT solution performed extremely well, with over 95 per cent of the AI-generated contours being accepted by treating physicians with minor or no edits. The pilot project confirmed what others have reported: that use of AI-Rad Companion saves time in the organs-at-risk contouring process while enabling standardisation across their network.

The results by Siemens Healthineers’ customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g. hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.

To view the complete article including a full list of references, please refer to AI-Driven Contouring Software Integrated with Varian’s Treatment Planning Services | Varian

A version of this article previously appeared in Centerline April 2023

Further information can be obtained at www.varian.com

Please direct all enquiries to Varian Medical Systems Australiasia on 1800 657 036 or customerservice-anz@varian.com

Clinical Radiology Trainee Matters

changes can take a longer period of time to go through the system. RANZCR has a robust committee structure where members, through their representatives, can raise issues which are then thoroughly discussed before implementation. In my time as CRTC Chair I’ve come to be more familiar with this structure and appreciate the various checks and balances that are in place before changes are made.

The year has gone by in a blink of an eye and it’s hard to fathom that we’re already in the latter part of 2023. From a Clinical Radiology Trainee Committee (CRTC) perspective we’ve managed to achieve some wins that improve a trainee’s experience. There are many more advocacy points that we are still working on, and it reminds me that even though a year feels like a long time when put in perspective it goes by fairly quickly and sometimes large

The Medical Training Survey (MTS) is a survey that is run by Ahpra every year and delivered to doctors-intraining (DiT) when they complete registration. The 2022 MTS survey results are available and recently we sent a report to all trainees to highlight how RANZCR trainees compared to other DiTs in Australia. RANZCR trainees marked their training program either equivalent to or higher than their colleagues in overall satisfaction, recommending their current training site as well as satisfaction with supervision and education. RANZCR trainees felt the College needed to improve: communication, timeliness of examination feedback, flexibility in training, access to psychological support services, ability to raise wellbeing concerns and ability to raise concerns about bullying and harassment.

The College has acknowledged these

results and has plans in place to improve how we score on these metrics in future surveys. One thing the College has done to improve communication and address concerns about access to support services and the ability to raise concerns is to have two Trainee Liaison Officers (TLO) in place, one for Australia, Lisa Grayson, and one for New Zealand, Jenna Howell. They can address trainee concerns confidentially and are available both in hours and after hours. Their contact details are as follows:

Hours

Monday – Friday 9 am–3.30 pm (AEST and NZST)

Tuesday evening 6–8 pm (AEST & NZST)

Lisa Grayson: +61 437 893 913

Jenna Howell: +64 2 7434 8515

Email: tlo@ranzcr.edu.au

I encourage all trainees who have issues they want to discuss to reach out to our TLOs, who can provide invaluable support and can also point you in the right direction of further support services.

As always, please feel free to reach out to CRTC at clinicalradtc@gmail.com and also feel free to contact me at sanjay. hettige@gmail.com or 0405 472 499.

Dr Sanjay Hettige

I encourage all trainees who have issues they want to discuss to reach out to our TLOs, who can provide invaluable support and can also point you in the right direction of further support services.

Gerry Adams, Dean of the Faculty of Radiation Oncology

While we often speak of the role that the College plays in advocating to government on behalf of members, the biennial Facility Survey is of particular importance in enabling the College to provide critical longitudinal data about radiation therapy in Australia and NZ.

The Faculty of Radiation Oncology (FRO) has been conducting Facility Surveys every second year since 2011, providing evidence-based insights into the resources available at radiation therapy facilities — equipment, workforce, and treatment activities at each site.

These data are not always easy to gather from other sources and the value to RANZCR and its members cannot be overestimated. Each survey reflects the realities of radiation therapy in both countries, enabling detailed comparisons and authoritative analysis that underpins and informs our advocacy efforts.

Survey questions, designed and reviewed by the FRO Economics and Workforce Committee (EWC), have been consistent to enable comparison of data over time, while allowing slight adjustments to each survey to ensure continued relevance.

The data is highly influential and forwardlooking, enabling the College to leverage its influence and pave the way for ongoing workforce and funding reviews, including the MBS review where this data proved critical to our advocacy efforts on behalf of members.

The clear trends from this data have helped to inform decisions made around the new proposed MBS scheduling for Australia, which we anticipate will

Biennial Facility Survey

provide a framework for reimbursement that promotes evidence-based quality radiation therapy that is economically sustainable. Along with other data, results from this survey have helped highlight the current plight in New Zealand and support our ongoing advocacy around critical workforce shortages.

TRENDS

The 2021 survey highlighted the increasing complexity of the services we deliver, acknowledging that there have been significant changes in practice over the 10 years since the survey began.

This has been driven by a variety of factors, including the introduction of new and complex techniques such as IMRT, VMAT and stereotactic treatments; an absolute increase in cancer cases due to Australia’s growing and ageing population over time; and some improvement in access to radiation therapy closer to home for cancer patients who live outside major cities. While some may have concerns that changing the payment structure for radiation therapy could incentivise overuse of complex techniques, the patterns of practice shown by our data paints the opposite picture. The newer techniques clearly come before rule changes, and this allows us to make the argument that changes to the payment structure now are essential to ensure the safe and sustainable delivery of radiation therapy for the benefit of patients in the changing landscape of today. There are new technologies coming constantly, and ongoing robust data collection

today will help shape the arguments of the future. Collecting this information is only possible with the work of our membership and we thank you for your support in this area.

The 2021 survey report also highlighted a different picture for brachytherapy. We all know the benefits of brachytherapy but the drop off in its use is in stark contrast to the growth in external beam radiation therapy (EBRT). As a result of these findings the EWC has commissioned a working group on brachytherapy to look at the implications of these findings and whether they can (or should) be mitigated.

CLEAR BENEFITS

The detailed data, workforce and practice trends revealed by these surveys over the past 10 years provide an invaluable evidence base for the College, members, facilities and government, and play a vital role in ensuring that quality radiation therapy services are appropriately resourced, accessible and sustainable. The survey is also an opportunity to focus on inequalities and gaps in healthcare provision. While there are limitations to what we can measure, the College will endeavour to capture some data around patient and staffing levels in facilities for Aboriginal and Torres Strait Islander and Māori and Pasifika peoples.

Given that the Facility Survey offers critical insights into radiation therapy and influences its future, the College asks members to strongly encourage their workplace to complete the 2023 survey.

This invaluable survey data informs future workforce and funding.

The upcoming College ASM promises to be an excellent event—providing a great opportunity to connect with each other and be inspired by guest speakers.

The theme of this year’s ASM is "Beyond", something that is particularly meaningful for our speciality. We are not only reaching beyond in terms of our achievements in technology and research, but are always aiming to go above and beyond for our patients, colleagues and trainees.

With Dr Angela Allen and Dr Tuan Ha as radiation oncology co-convenors, we can be assured that this ASM will go beyond in terms of academic excellence and entertainment.

The College is very fortunate to have Li Cunxin AO as the Nisbet Orator, whose presentation, along with the Varian prize session which celebrates our talented trainees, will be a highlight.

AMC VISIT

My sincere thanks to everyone involved in the AMC’s follow-up assessment of the College, relating to recommendations from the full re-accreditation assessment in 2019.

Over the past five years we have made significant progress against each of the 30 AMC recommendations, with key milestones including the implementation of a new training program, digitising examinations, and ensuring our training program is more trainee focused.

In Focus

I look forward to sharing the results of the expected AMC follow-up visit in a future edition.

EXAMINATION REPORTS

The College is committed to producing an examination report which sets out more detailed information on the performance of the examinations after each Phase 1 and Phase 2 Examination Series.

It is RANZCR’s intention to provide more open and transparent information about the final outcomes of the examinations, and we welcome feedback on the content and structure of these reports to better respond to your learning needs and improve these documents as a source of useful information for both trainees and Fellows.

If you have any questions or require any further information on the reports, please contact Julia Snedic at roexams@ranzcr.edu.au

TRAINEE LIAISON OFFICERS (TLOs)

I am delighted to report that the College has appointed two new TLOs. Jenna Howell works with our New Zealand trainees and Lisa Grayson works with our Australia and Singapore trainees.

In their short time in these roles, the TLOs have revised the Trainee Wellbeing Page which will continue to be regularly

updated. Both TLOs also offer an afterhours session where trainees can get in touch for a confidential conversation out of work hours if required. They can be contacted at tlo@ranzcr.edu.au.

REGIONAL & RURAL TRAINING PATHWAY PILOT

The College secured funding to pilot the new Regional & Rural Training Pathway (RRTP) program, aimed at attracting, training and retaining clinical radiology and radiation oncology clinicians in regional and rural areas of Australia.

The RRTP is initially establishing five training positions across Australia as a first step in RANZCR’s efforts to address the maldistribution of clinical radiologists and radiation oncologists in regional and rural Australia.

The EOI applications closed in July, and the College received a very positive response from interested training sites and trainee applicants. RANZCR is now working with training networks to match applicants to fill the positions, which will enable selected trainees to train within a rural or regional location instead of relocating to a metropolitan area.

PLEASE GET IN TOUCH

I am very happy to be contacted at any time by anyone who needs support or wishes ask questions, give feedback or volunteer. My email is lisa.sullivan@act. gov.au. See you at the ASM!

It is my pleasure to provide you with an update on recent and upcoming events, training programs and TLOs.

Dr Lisa Sullivan

CHIEF CENSOR IN RADIATION ONCOLOGY

Radiation Oncology Trainee Matters

with one’s job. There are three key components of this syndrome. These are

1. emotional exhaustion (leading to easily becoming irritable or downhearted);

2. replacement of usual empathy with cynicism, negativity and feeling emotionally numb (depersonalisation); and 3. a reduced sense of professional effectiveness and accomplishment. Burnout was described by Maslach et al. in the Maslach Burnout Inventory Manual in 1996.

While this topic has rightly received more attention in recent years, it remains relevant to bring up ‘burnout’ again as we head into the second half of the training year. Leading up to my recent annual leave, I recall being aware and guilty of experiencing compassion fatigue while in clinic one day. During my time away, this made me reflect on the slippery slope to burnout in our jobs and careers.

Burnout is a recognised syndrome and is a measure of chronic distress associated

A US study last year found that 50 per cent of medical practitioners are burned out. Junior doctors had a significantly higher rate of burnout than their seniors. In fact, more local data would suggest that almost half of Australian junior doctors may be suffering from burnout. There have been numerous research studies looking into the effects of burnout. Unsurprisingly, burnout has been found to be associated with increased levels of job dissatisfaction, regrets about career choice, thoughts of quitting one’s job and significantly lower productivity levels. Beyond the associated higher frequency of medical errors, lapses in professionalism and impeded learning, burnout can also have severe personal consequences that can lead to relationship breakdowns, problematic alcohol use and even suicidal ideation.

Our jobs are very demanding, especially

from an emotional perspective, and advanced training is a particularly challenging time for our specialists in training. Prolonged and repeated periods of stress without adequate opportunities to replenish inevitably lead to burnout. The AMA Victoria has recommended measures for both recovery and prevention of burnout. These include self-awareness, selfcompassion, rest and fuel, physical, mental and spiritual health, revisiting values, relationships with family and friends, maintaining broad interests outside of medicine, professional development and personal growth, teamwork and support from colleagues and lastly, compassionate practice.

Burnout is important because it can harm our doctors and impair patient care. It remains a complex problem and as with all complex issues, the solutions are not going to be easy. Part of the solution resides in the structure of medicine and how the culture influences burnout. While systems are more challenging to change, on a more practical level we may be able to optimise the individual factors that contribute to burnout and improve support systems.

Let us normalise taking time to fill our own cups, prioritising our hobbies and social relationships outside of work and putting our well-being first.

Data suggests almost half of Australian junior doctors may be suffering from burnout. Here, Dr Tracy Lim highlights the symptoms of burnout and the importance of prioritising mental wellbeing.

Dr Tracy Lim

FRO Chief of Professional Practice

MENTORING PROGRAM

The FRO Mentoring Program Working Group have continued to meet regularly to prepare the next steps of launching a new pilot program by quarter four of 2023. On 25 August FRO council approved the new program framework which reflects an updated focus on mentors addressing specific goals identified by the mentees such as career establishment and progression, career tailoring to specific interests, support for working in specific departments, work/life balance, and pursuing a family during training. The working group are applying the finishing touches to the program and the PPC look forward to seeing this fantastic initiative go live by the end of this year.

CPD

There is a wonderful feeling to be had once you know you have completed the CPD requirements for the year. I expect you have all done more than enough to meet the annual requirement but have not entered your data and evidence. As you all did it last year I trust you will not require assistance - remember if you all leave it to the end of the year there will be limited staff to assist you.

If you have any questions or comments regarding the work of the FRO Professional Practice Committee, please feel free to reach out by emailing the College team at: professionalpractice@ranzcr.edu.au

Carol Johnson

Greetings, colleagues. In July, the FRO Professional Practice Committee (FRO PPC) held its third meeting for the year with a full work program. Bringing you up to date:

RANZCR CODE OF ETHICS

Earlier this year the FRO PPC commenced the task of reviewing the RANZCR Code of Ethics in partnership with the Faculty of Clinical Radiology Professional Practice Committee (FCR PPC). As the code was originally created eight years ago in 2015, we made it a priority to include modern topics such as references to ethical principles in artificial intelligence in medicine which is at the forefront of our profession in these times. We also addressed consent and communication with patients.

The PPC are happy to announce that the updated code was approved by Council at its 24 August meeting.

Congratulations to both faculty PPCs for their contributions to this important piece of work.

NZ BRANCH ASM

Thank you to the organisers for including a session on Cultural Safety. Certainly food for thought. For those New Zealanders who attended, capturing your attendance would meet your CPD requirement. There will be another opportunity for Cultural Safety at…

…THE RANZCR ANNUAL SCIENTIFIC MEETING –BEYOND

The 2023 ASM will be held on 19–21 October at the Brisbane Convention & Exhibition Centre. The conference is fast approaching, have you registered yet? We have a program full of diverse and interesting sessions to attend. Last year’s CPD session was a great success so I’m looking forward to this year’s session which is on Friday 20 Oct at 8.30 am. The session will cover an overview of the College CPD program, CPD Home, ePortfolio, and focusing on specific elements including PDPs and newly developed resources. I hope to see you there!

Dr

The new program framework reflects an updated focus on mentors addressing specific goals identified by the mentees such as career progression, work/life balance, and pursuing a family during training.

Quality Corner

Quality Improvement Committee member A/Prof Charles Lin weighs in on the implications of artificial intelligence in radiation oncology.

The advent of artificial intelligence (AI) has taken the technology world by storm and arguably initiated the next phase of industrial revolution. The specialty of radiation oncology is also being impacted by AI with its potential to assist at multiple steps along the way of a patient’s cancer journey. The application of AI can change the way we operate as a multidisciplinary radiation therapy team involving radiation oncologists, radiation therapists and physicists.

AI can aid in the decision making and treatment outcome prediction at the time of diagnosis. Following that, auto-segmentation of contours (both target volumes and organs at risk) can be performed by AI for perusal by the radiation oncologists. Once the contours are finalised, AI can also aid in the planning process with a short turnaround to produce a treatment plan with acceptable dosimetry metrices. Quality assurance can also be performed by AI prior to starting treatment. Moreover, adaptive planning can be assisted by AI during radiation therapy when there are significant changes in patient and/or tumour contours.

Cautions should be utilised when implementing AI in clinical practice as the technology is still evolving and clearly require ongoing validation. The Royal Australian and New Zealand College of Radiologists, in conjunction with Australasian College of Physical Scientists and Engineers in Medicine, Australian Society of Medical Imaging and Radiation Therapy, and Cancer

Nurses Society of Australia have endorsed a Radiation Oncology Artificial Intelligence (ROAI) self-audit tool on the AI practice standards in radiation oncology. The tool set out a minimal standard in the governance, professional standards, information management, algorithm development, algorithm deployment, and audit on the use of AI in radiation oncology clinical practice. It is an exciting time to embrace and collaborate with AI, but it is prudent that we exercise caution by continuing to reflect our practice based on the recommended ROAI audit tool. Quality care to our patients with AI can only be safely improved by real human intelligence.

Quality assurance can also be performed by AI prior to starting treatment.

New Zealand Branch News

staff who assisted with the planning and organising.

The programme and speakers were excellent, offering a wide range of clinical topics for generalists. It was also good to see the running theme of equity and access to care across the radiology and radiation oncology programmes. Rouse Fellow, A/Prof Mei Ling Yap presented on improving global access to radiation therapy. Dr Sharyn MacDonald presented on gender equity in radiology—one has to like a presentation that quotes the Barbie movie. The combined session on Saturday afternoon asked members to spend some time self-reflecting on their biases and behaviours and how they may impact care for Māori in Aotearoa New Zealand.

Congratulations as well to the following registrars:

Dr Hardie was recognised for her contributions to teaching and education, leadership and advocacy, as well as her ongoing research.

Dr MacDonald was recognised for her leadership and advocacy around datadriven decision-making and workforce, as well as her research.

REGIONAL TRAINING FOR RADIOLOGY

The National Radiology Action Group is seeking support from the College to increase the amount of regional training across Aotearoa. Training in smaller centres has the advantage of training the radiologists NZ needs as well as building training capacity. This is an important initiative and one I hope we can see implemented.

RADIATION ONCOLOGY IN NEW ZEALAND

Kia Ora Koutou. From time to time, I make obscure sporting references at the start of this article. Not this time. It’s fair to say hosting the FIFA World Cup has been an excellent experience for NZ and Australia. More than two billion people worldwide have been watching the games. I hope this inspires more people to follow the beautiful game. And well done to the Tillies for getting so far.

NZ ASM 2023

The recent Queenstown NZ ASM was a success—I enjoyed seeing so many members there. Thanks once again to the College Board for attending as well.

Many thanks to Leigh Harvey, Nanda Krak, Glenn Coltman and Lukasz Klobukowski who convened. Thanks also to the Outshine Team and College

• Dr Hugh McHugh, winner of the Obex Medical Registrar Research Award

• Dr Kyle Grabowski, winner of the NZRET Poster Prize

• Dr Kathrine Tse, winner of the FRONNZ Prize

I’m certain many members are looking forward to the 2024 NZ ASM which will be held in Queenstown 2–4 August.

NZRET PIKIMAIRAWEA AWARD

2023 is the second year of the NZRET Pikimairawea Award, which will be awarded each year at the NZ ASM. I would encourage Fellows to start thinking of who you might want to nominate next year. This year’s winners were Dr Claire Hardie (radiation oncology) and Dr Sharyn MacDonald (clinical radiology).

The College has withdrawn accreditation from Dunedin Hospital for radiation oncology training, which is now down to two SMOs. The trainees will be able to complete their current training year in Dunedin, moving to other sites in 2024 to complete training. It is a disappointing outcome after many years of advocacy regarding this fragile workforce. The College must continue with its advocacy efforts to prevent further collapse of radiation oncology services in New Zealand.

As always, please email nzbranch@ranzcr.org.nz should you have any concerns or issues you wish to draw to my attention.

Dr Gabes Lau

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Stories from the Rare Books Collection

A look at the pioneering work of William Ironside Bruce.

The fallout from his untimely passing lead to the establishment of the British X-Ray and Radium Protection Committee.

The book itself provides numerous insights into early radiology and radiography.

William Bruce created an encyclopedia of radiograms of healthy bones of the body at different ages of development. Essentially it was an atlas of healthy people at various ages (ages 5, 15 and 25) that radiographers and radiologists could use to compare their radiograms against.

The book also provides a visual and written description of the position to place the patient in as well as the apparatus to use and where to place it.

The outstanding work and passion of William Bruce continues to contribute to the understanding of radiography and radiology, as well as the safety of medical personnel.

The Trainor Owen Collection boasts a sizable collection of rare books. One of our oldest books in the collection was published in 1907. It is a first-edition copy titled A System of Radiography, with an Atlas of the Normal by W. Ironside Bruce.

William Ironside Bruce (1876–1921) was a radiologist from Scotland. In the early 1900s, during his service as a civil surgeon in the South African Field Force, he took much interest in the new emerging technology of X-rays, then used for the diagnosis of war injuries. Upon his return to the UK, he took up an assistant role to Dr Davidson at Charing Cross Hospital in 1905. He remained in service at Charing Cross Hospital until his passing and is noted for building up an efficient radiology department.

William Bruce soon became a highly regarded radiologist, becoming President of the Section of Radiology in the Royal Society of Medicine, and contributed to the creation of the Radiological Diploma given by the University of Cambridge.

During his early years as a radiologist, it was the custom to have the X-ray tube below the couch on which the patient was lying, to identify the area to be radiographed using a fluorescent screen, and then replace the screen with a photographic plate for the exposure. The tube was unshielded and irradiated the lower half of the radiologist’s body. This practice had probably contributed to his early death in 1921 at the age of 42 from radiation-induced leukaemia.

If you have any queries or wish to donate to the Trainor Owen Collection, please contact the College Archivist.

Natasha Ramrakha archives@ranzcr.edu.au

Methods: A traditional protocol is an arterial phase chest followed by venous phase abdomen and pelvis A venous CAP (vCAP) protocol is a single acquisition 60 s after contrast injection, with optional arterial phase upper abdomen based on the primary tumour Consecutive eligible patients were assessed, using each patient's prior study as a comparator Attenuation for various structures, lesion conspicuity and dose were compared Subset analysis of dual-energy (DE) CT scans in the vCAP protocol performed for lesion conspicuity on 50keV virtual monoenergetic (VME) images

Results: One hundred and eleven patients were assessed with both protocols Forty-six patients had their vCAP scans using DECT The vCAP protocol had no significant difference in the attenuation of abdominal structures, with reduced attenuation of mediastinal structures. There was a significant improvement in the visibility of pleural lesions (p <0 001), a trend for improved mediastinal nodes assessment, and no significant difference for abdominal lesions. A significant increase in liver lesion conspicuity on 50keV VME reconstructions was noted for both readers (p <0.001). There were significant dose reductions with the vCAP protocol

Conclusion: A single-pass vCAP protocol offered an improved thoracic assessment with no loss of abdominal diagnostic confidence and significant dose reductions compared to traditional protocol Improved liver lesion conspicuity on 50keV VME images across a range of cancers is promising

What’s in JMIRO –Volume 67, Issue 5

ISSUE HIGHLIGHTS INCLUDE:

How to prevent the contrast shortage of 2022. Doi:10.1111/1754-9485.13533

Insertion of button-guided gastrostomy catheters. Doi:10.1111/1754-9485.13501

IMRT & ADT for octogenarians with prostate cancer. Doi:10.1111/1754-9485.13542

Brain metastases; patterns of care and outcomes. Doi:10.1111/1754-9485.13545

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!

Cardiac CT Training 2023

We go beyond simply meeting training requirements:

l Participants eligible to claim 40.75 RANZCR CPD hours for the Masters and 23.75 RANZCR CPD hours for the Recertification course.

l Maximum allowable course based live and library cases for ANZ credentialing.

l Clinician led teaching by high volume operators.

l State of the art low dose, High Definition imaging.

l Unrivalled venue and catering.

2023 COURSE DATES:

5 Day Level A Course 9th - 13th November

3 Day Recertification Course 11th - 13th November

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

The College’s Member Rewards Program

See

Australia

THE ACCOMMODATION BROKERS

They say “memories last forever” and some of the best memories for us all are holiday memories.

Our partner The Accommodation Brokers has been delivering holiday discounts to our members for more than three years and the ongoing feedback has been very positive.

“I am a RANZCR member and have used The Accommodation Brokers on six occasions, I just submit the best price I can find, and The Accommodation Brokers have always been able to secure a better deal,” says a College member from South Australia.

To discover your travel discounts, visit The Accommodation Brokers website, www.theaccommodationbrokers.com. au and register to become a member or email your request to bookings@ theaccommodationbrokers.com.au

• An initial meeting with a Partner or Director free of charge;

• A minimum 40 per cent discount on KPMG standard rates for the engagement period with all College members;

• Access to a dedicated national KPMG Enterprise team to support your members, across all service areas. This offer is available to the following services provided by KPMG Enterprise Australia, New Zealand and Asia: Audit and Assurance; Tax, Transactions, and Accounting; Advisory; Accelerating Business Growth.

To access the offer, please complete the online form. You will then be connected with the appropriate KPMG Enterprise contact.

bit.ly/ContactKPMG

3 years/60,000kms, and is based on BMW Condition Based Servicing or Service Interval Indicator, as appropriate. Normal wear and tear items and other exclusions apply. Servicing must be conducted by an authorised BMW dealer. Consult your preferred BMW dealer for further terms and conditions.

To find out more:

Online: Visit www.bmw.com.au/corporate or www.mini.com.au/corporate Phone: Call 1800 635 750

Email: Write to corporate@bmw.com.au

When you’re ready to make a purchase, you will require an authorisation letter from the College to access the corporate benefits. Email the College to request this letter.

BMW

BMW Corporate offers Australian College members and their spouses the following benefits:

KPMG

KPMG Enterprise is a specialist division of KPMG Australia, dedicated to advising the emerging, private and midmarket. KPMG works with established and emerging entrepreneurs, family business, private clients, not-for-profit and fast-growing companies to build successful organisations.

College members can access the following benefits:

• A free Service inclusive for three years or 60,000kms*

• Benefits extended to your spouse or de-facto partner

• Reduced dealer delivery of $1,850 excluding taxes

• Access to a dedicated Corporate Sales Manager This offer currently excludes electric cars.

*Complimentary basic scheduled servicing, including Vehicle Check, is valid from date of first registration for whichever comes first of

PETALS FLOWERS

Petals Network is one of Australia and New Zealand’s premier flower delivery services, proudly connecting customers with the world’s best local florists for almost 30 years.

All of Petals’ flower arrangements are artistically arranged and hand-delivered using only the freshest flowers available through its network of talented local florists.

College members receive 20 per cent off the value of flowers purchased. This discount applies to the flower value only. An additional delivery fee will apply.

Please register your details (bit.ly/PetalsRegister) to access the online catalogue and discount.