Inside News September 2016 by RANZCR

Volume 12 No 4 / September 2016

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

AN EXCITING TIME IN RADIATION ONCOLOGY Dr Brigid Hickey and Dr Dion Forstner look at developments in cancer treatment

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In this edition 5 President’s Message 7 COVER STORY Cancer Treatments, Frontiers and Challenges 11 CEO Message

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Engaged Members 13 2016 Annual Scientific Meeting 14 Member Profiles Research 16 Windeyer Fellowship 17 Development of RANZCR Research Strategy 19 Think.Check. Submit Profile and Presence 21 InsideRadiology 23 Targeting Cancer 25 FCR Media and Profile Working Group Access to Quality Service 27 Coal Workers Pneumoconiosis 29 Big Win for Diagnostic Imaging 30 International Development Fund in Action

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Quality Practice 33 Management of Patients with Urgent Findings Quality Training 34 RANZCR Courses and Workshops 36 Clinical Educator’s Development Program 37 Exam and Assessment Review Update 40 CPD and Audit

Clinical Radiology 41 Message from the Dean 43 Chief Censor 45 Trainee Update Hobart, Wagga

& Radiation Oncology ry/Wodonga, 51 Message from the Dean 53 Chief Censor and, Hob &H 55 Trainee News Wagga, Ho General Interest & Hobart, Aland, 57 New Zealand Branch 59 Australian Branches 61 From the Archives donga, Wagga 63 Meetings and Events sland, Aonga, aunceston & is printed on Titan Satin. Titan is Inside News produced in an ISO 14001 accredited facility ga Wagga, ensuring all processes involved in production are of the highest environmental standards. onga, Gippsland, FSC mixed Sources Chain of Custody (CoC) certification ensures fibre is sourced from certified and well managed forests.

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

From the

Editor’s Desk We are very fortunate to have so many members contributing content to the newsletter. Thank you. It makes for a very diverse and thoughtprovoking read, as you will see in this edition. Featured on our cover this time are Drs Dion Forstner and Brigid Hickey who write about advances in radiation therapy techniques and the challenges faced in evaluating their effectiveness.

Dr Allan Wycherley The President introduces the new Interventional Radiology Committee, which will work across the spectrum of intervention-related issues and improve the flow of information in this important subspecialty. The College firmly opposes any form of bullying and harassment in the workplace and the CEO outlines the processes we have in place to counter these malicious behaviours. She reminds members of our Code of Ethics principle that “clinical radiologists and radiation oncologists have a duty to attend to the health and wellbeing of their colleagues”. Our Targeting Cancer website recently won two prestigious awards, and members of the campaign will be raising awareness of radiation therapy among thousands of GPs at upcoming education days around Australia. The International Day of Radiology on 8 November is a chance for us to celebrate the contribution of radiology to health care. The theme this year is breast imaging, and we encourage everyone to get involved. With the federal election behind us, we can concentrate our advocacy efforts on implementation of the diagnostic imaging reforms committed to by the Turnbull Government. We explain two key concepts behind the improvements we will be making to our training and assessment programs and there are plenty of opportunities for members to get involved. I hope to see many of you soon at our Annual Scientific Meeting on the Gold Coast. Allan Wycherley Editor-in-Chief editor@ranzcr.edu.au The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street Sydney NSW 2000 Ph: +61 2 9268 9777 Fax: +61 2 9268 9799 Web: www.ranzcr.edu.au Email: ranzcr@ranzcr.edu.au

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Introduction

Presidential Communique on Interventional Radiology Dr Greg Slater

Dear Colleagues

A new voice for interventional radiology As President of RANZCR, I write to inform you of developments in the professional representation of College members practising interventional radiology (IR) and interventional neuroradiology (INR) in Australia and New Zealand, and the process by which the College has determined to address emerging issues and standards in these subspecialties. Recently, the RANZCR Board of Directors and Faculty of Clinical Radiology Council resolved to establish an Interventional Radiology Committee of RANZCR as a standing committee of the Faculty of Clinical Radiology (FCR) to work across the spectrum of intervention-related issues, from interventions performed by all clinical radiologists to high level complex procedures. The establishment of this committee comes as a considered response to long-running concerns over the recognition and support accorded to interventional radiologists within the College structure, at a crucial time when these practitioners are facing challenges on several fronts. The College has been at a crossroads considering how it may best understand the concerns and interests of RANZCR members working in IR and INR. We have now chosen a course that will significantly improve representation and

the flow of information, raise the voices and profile of interventional radiologists in key forums and, just as importantly, help ensure that their decision-making is guided by the needs of patients and the best patient outcomes achievable.

Background to the decision In 2012, the College signed a formal agreement ceding its direct participation in IR matters to two affiliated societies, the Interventional Radiology Society of Australasia (IRSA) and the Australian and New Zealand Society of Neuroradiology (ANZSNR). Under the agreements, the College provided the societies with resourcing and secretariat support in exchange for their participation in a joint reference group and their advice on matters of policy and standards. It is well known today that these arrangements have not worked. The reference group failed to eventuate and for a period relations between the two societies deteriorated into what most would consider an unacceptable state of affairs. The memorandum of understanding was formally dissolved in 2014, and no alternative arrangement has come into being, frustrating the College’s efforts to represent all members equally.

of their work, including the setting of professional standards for all. Interventional radiologists face external challenges too. These challenges are due to other medical professionals seeking to displace them in the workplace, and from international debate on how IR and INR practitioners should participate in radiological associations and societies, which has fuelled uncertainty about status and identity. The conflicts and challenges now apparent here have engendered vigorous discussion, not always clear or considered, over patient access, credentialing, training, clinical evidence and relationships with other professional groups. The College has not escaped the unresolved interplay of issues within the various groups and, as you may be aware, this has generated tension within our membership. We seek today to resolve the tension as far as is practicable within the College and make sure we remain committed to an evidence-based culture focused on patient outcomes and equity in access to high-quality care.

The College has an obligation – through our accreditation by the Australian Medical Council and the Medical Council of New Zealand – to fairly represent all RANZCR members, regardless of the individual character continued over... Volume 12 No 4 I September 2016

Introduction

Role of the standing committee My view, and that of the Board and the Faculty of Clinical Radiology Council, is that the tension present in the membership over IR and INR is in part structural in nature and, insofar as it is structural, the establishment of a new standing committee dedicated to interventional radiology will go a long way to solve the problem.

deliberates and that its advice and other outputs are guided by the tenets of best practice. This means having a committee of outstanding individuals prepared to put the interests of patients above any other consideration. Further, they must be able and willing to act in accord with the FCR Council and the excellent work already undertaken by that Council.

However others may portray the decision, to my mind this is an obvious and necessary response by the College. Under its terms of reference, the Interventional Radiology Committee is charged with the responsibility inter alia to: • Identify and advise on emerging issues, procedures and technologies in interventional radiology and matters that may require advocacy with government, regulatory bodies and others • Identify issues in quality of service in IR and INR that potentially affect patient care and may require the setting of a standard or other action • Recommend professional and practice standards to support patient-centred care in IR and INR • Liaise with other RANZCR committees (such as the safety, quality and standards committee and education and training committee) to ensure issues regarding interventional radiology are addressed throughout the College • Engage with stakeholders, under the direction of the FCR Council, with the purpose of developing IR and INR policy within the College.

“We remain committed to an evidence-based culture focused on patient outcomes and equity in access to high-quality care.”

The membership structure, the Board and FCR Council have determined for the standing committee includes general radiologists who perform only Tier A (basic) interventional procedures, interventional radiologists who perform Tier A and Tier B (advanced) procedures, interventional neuroradiologists and a recently qualified Fellow. Across its membership, the committee must have an FCR Council representative and the Dean of FCR and President (as ex officio members), and ideally as a minimum:

I have long believed the College is best placed, corporately and strategically, to showcase the value of clinical radiologists, whether the practitioner is a generalist or a subspecialist. However, to do it well, the College needs a reliable flow of objective information and advice that is focused on advancing what is best for patients, not on narrow sectional interests. In this respect, the goal for IR and INR is no different to that for any other area of radiology.

• a Fellow with substantial experience in quality, safety and research; • a New Zealand Fellow or educational affiliate; • a recently qualified Fellow (within five years of receiving FRANZCR).

Membership of the committee

If you are interested in getting involved, please indicate your early interest by emailing fcr@ranzcr.edu.au and we will be in touch about the process as it develops.

To get this right, the Interventional Radiology Committee must be so constituted to ensure that a full range of views and opinions is at hand when it

Inside News

Committee members will be appointed initially for a term of one year, and the committee chair can neither be the Dean of the FCR nor a Fellow who is already the chair of another FCR or affiliated entity.

The value in taking this step I am convinced the establishment of a standing committee, as described above, is a sensible course of action to promote good clinical care, advocate for IR and INR issues and to overcome challenges confronting RANZCR members who practise IR and INR. The new committee will go a long way to remedy the shortcomings in the College’s oversight of interventional radiology practice and bring much greater certainty to our efforts to fully represent and support these members of RANZCR. The initiative taken here with interventional radiology forms part of a broader plan by the College to provide advice to the governments of Australia and New Zealand which are seeking our input on medical interventions involving new and emerging technologies. Without the RANZCR Interventional Radiology Standing Committee, the College will be unable to advocate and advise regulatory and funding bodies as comprehensively as it should into the future. This is an issue to which your Board and the Faculty Council have given much thought. I trust the conclusion we have reached and the decision we have made to address it will meet with your approval and would encourage your involvement. Yours sincerely, Dr Greg Slater, RANZCR President July 2016

Introduction

Cancer Treatments, Frontiers and Challenges This is an exciting time in the world of radiation therapy, with an evolving and expanding repertoire of new treatments and imaging techniques, technology and the development of novel systemic agents.

Dr Dion Forstner and Dr Brigid Hickey

There is a trend to both an increase in radiation treatment complexity and a reduction in the number of fractions used, in a reimbursement system where using more fractions is currently rewarded financially. Our attention must remain on delivering the highest quality patient-centred radiation therapy. The past decade or two has seen an emphasis on the implementation of more focused radiation therapy in the form of intensity modulated radiation therapy (IMRT). We have also seen changes in fractionation. There is now clear evidence that hypo-fractionation is appropriate for women with early breast cancer and emerging evidence that it may be appropriate in localised prostate cancer. Recent advances in hardware and software have also allowed the widespread expansion of stereotactic ablative body radiation therapy (SABR), which also reduces the number of fractions used to treat early lung cancer. Techniques like SABR and accelerated partial breast irradiation (APBI), which use fewer fractions, are more complex and resource intensive than conventional radiation therapy, thus requiring more machine and planning room time, despite fewer fractions being used. Expanding indications for hypofractionated, ablative and high dose radiation therapy (e.g. for brain, lung and bone metastases) place new and different demands on radiation therapy providers. In Australia and New Zealand, new treatments will only be funded by governments or insurers after appropriate health and economic assessments. There are two aspects to this form of evaluation: firstly,

ensuring the technical accuracy and reproducibility of the technique; and secondly, the efficacy, in terms of cancerrelated and toxicity outcomes. Ironically, to ensure that a new therapy is “at least as good as, or not significantly worse than” (non-inferior to) the current gold standard, requires enrolment of substantially more subjects than it does to demonstrate superiority of a new therapy. New therapies are not always expected to result in substantially different oncologic outcomes, but may provide substantial patient benefits. Examples include the use of IMRT in head and neck cancer, where one can prevent permanent, disabling xerostomia. Once the technical aspects are fully assessed, and the efficacy proven, it is necessary to test the effectiveness of the new therapy. The evaluation required is then necessarily not limited to cancer-related outcomes (local control or overall survival) and acute and late treatment related toxicity, but must encompass both micro- and macroeconomic concepts. These may include the benefits to the individual (e.g. days of life saved, time spent without

“Our attention must remain on delivering the highest quality patientcentred radiation therapy.”

Volume 12 No 4 I September 2016

Introduction

toxicity, days spent away from work), the community (e.g. keeping a trained teacher with head and neck cancer at work, because they have had larynx preservation and kept their saliva) and to the nation (an overall reduction in treatment costs). Technology is iterative, morphing (for example) from static IMRT to rotational or volume modulated arc therapy (VMAT) type of IMRT, and helical IMRT. These are all variations on the same theme, using slightly different technologies to perform the same technique, with subtle differences. To formally evaluate each version of the technology which can be used to deliver IMRT, would not be effort well spent. The rigid format currently used by governments to evaluate new techniques for reimbursement can fail to take this into account. Some new techniques may not require formal comparison with conventional radiation therapy. SABR for medically inoperable lung cancer can achieve local control rates of greater than 95 per cent at three years, with three-year survival rates of 47 per cent compared with retrospective five-year survival rates of 13–39 per cent using external beam radiation therapy. This is a development in the management of medically inoperable lung cancer analogous to parachutes or penicillin, and randomised trials in this setting can be considered redundant and unnecessary. Exciting new technologies and techniques are seductive, but it is important that they are properly evaluated. New is not always better. A recently published randomised controlled study investigating robotic prostatectomy versus radical prostatectomy reported similar functional outcomes at a 12-week followup and equality with respect to margin positivity could not be demonstrated. We must not be tempted by what we can do, but do as we should, based on

Inside News

what is best for the patient given all the available information. As a profession, radiation oncologists need to ensure they record outcomes of new treatments—not only to be aware of what the outcomes are, but so we can inform our patients. Despite being a relatively small profession, we can make a significant impact by contributing to national or international registries and becoming involved in data mining projects. We also need to embrace all the tools available to identify the tumour. In the past we used computed tomography (CT) scans and where we could, or

“Exciting new technologies and techniques are seductive, but it is important that they are properly evaluated. New is not always better.” thought it relevant, we fused other available imaging. These days, in many sites it is imperative that we use CT, magnetic resonance imaging (MRI) and nuclear medicine scans to delineate the tumour. We use the anatomical information, and importantly also the functional information. There is no doubt that MRI is going to become an increasingly important component of radiation therapy. The functional information about tumours provided by MRI is an area of much interest, there is now an MRI linear accelerator (linac) being marketed. In Australia there is a large MRI-linac research group,

and we are seeing studies using only MRI planning. We should expect that adaptive radiation therapy will become the standard of care—truly personalised treatment based on both anatomical and functional imaging performed during treatment. Radiation oncology in Australia and New Zealand can be proud of its research output. The Trans Tasman Radiation Oncology Group (TROG) has been very well served by our Fellows and as an organisation has served us proud. We should use our research experience and skills to support our colleagues in other areas such as interventional radiology. There is an exciting coming together of radiologists and radiation oncologists in the area of interventional oncology, where we expect to see ongoing development of ablative local therapies. Funding for research in radiation therapy can be difficult to source, as we lack the generous industry support enjoyed by our medical oncology colleagues. We need equipment vendors to support not only the development of their equipment, but also the research to demonstrate its clinical value. We have also seen some impressive advances in drug therapies in recent years, no more so than in the area of melanoma, where previously drugs with no more than 10 per cent response rates were being recommended. Exciting new immunotherapy therapies provide us with an opportunity, as we know the abscopal effect exists and radiation therapy combined with these modern drugs is showing interesting results. Yet this is a time of change and there is still much to learn. New developments have to be considered in the context of the economic and political environments. While we have good evidence that about one in two people who have cancer would benefit from access to radiation therapy at some stage in their illness, in Australia and New Zealand we

Introduction

“There is no doubt that MRI is going to become an increasingly important component of radiation therapy.”

do not manage to achieve this at the moment. The reasons for the shortfall are complex, and relate to a multitude of reasons, including referral practices and geography. At present we don’t often see stories on radiation therapy in the media which herald it as providing a new breakthrough in the treatment of cancer. We must continue to advocate and educate about how effective radiation therapy is. We will be challenged by many with vested interests to see their technique or technology displace radiation therapy. We must resist this by standing up in multidisciplinary team meetings and challenging treatments that don’t have the evidence base that radiation therapy has. Plus we must all support the advocacy work of the Targeting Cancer campaign to ensure referrers and patients receive adequate and balanced information. While we do not currently achieve optimum radiation therapy utilisation rates in either Australia or New Zealand, we are faced with a future increasing demand for radiation therapy services, related to an increasing incidence of cancer. This increase in incidence is also multi-factorial. We have an ageing population: the number of Australians aged 65 and over is likely to rapidly increase, from around 2.5 million in 2002 (13% of the population) to 6.2 million in 2042 (25% of the population).

This increase in age of the population is related to low fertility and increased life expectancy. As cancer is a disease of ageing (by age 85, the risk increases to one in two for men and one in three for women), this demographic shift will increase cancer incidence. Obesity is also a growing problem for both Australia and New Zealand. An estimated 62.8 per cent of Australians were obese or overweight in 2011-12. This number has increased over time, from 56.3 per cent in 1995, to 61.2 per cent in 2007-8. Obesity increases the risk for many cancers, including oesophageal, thyroid, colon, renal, endometrial, gallbladder, cervical, kidney, post-menopausal breast cancer, leukaemia and ovarian cancer. Obesity also increases the risk of dying from cancer.

If you have any feedback or comments on any of the above, please contact the College on faculty@ranzcr.edu.au Dr Dion Forstner Dean, Faculty of Radiation Oncology Dr Brigid Hickey Elected Fellow, College Board

Our challenge is to ensure that we use our resources wisely and efficiently, provide excellent quality, evidencebased therapy and advocate for patients to achieve optimal utilisation of radiation therapy delivered by leading cancer clinicians. Volume 12 No 4 I September 2016

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

KEYNOTE SPEAKERS Radiology

Radiation Oncology

Dr Russell Fritz National Orthopedic Imaging Associates, San Francisco, USA SPECIALITY: Musculoskeletal imaging

Dr Silvia Formenti New York Presbyterian Hospital New York, USA

Professor Fiona Gilbert Cambridge University Hospitals Cambridge, UK SPECIALITY: Breast Imaging and PET

Professor William Mendenhall University of Florida Florida, USA

Professor Meng Law University of Southern California Los Angeles, USA SPECIALITY: Neuroradiology

Dr Colleen Lawton Medical College of Wisconsin Wisconsin, USA

Dr Claude Sirlin University of California San Diego, USA SPECIALITY: Liver Imaging

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

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Introduction

Working towards eradicating bullying and harassment From the

Chief Executive Officer Ms Natalia Vukolova

I would like to take this opportunity to write to you about bullying and harassment in the workplace, an issue that affects all occupations and professions and one that cannot go unaddressed in a just and caring society. In 2012, a federal parliamentary inquiry into workplace bullying and harassment received over 310 submissions highlighting the complexities and absence of clarity surrounding this issue. Many were from individuals who conveyed uncertainty or lack of information about what to do and where to seek help when exposed to bullying.1 It would be foolhardy in the extreme to assume that bullying and harassment does not occur in our profession. You are no doubt aware of media reports in recent years of instances of workplace bullying or harassment in surgery and in medicine generally.

RANZCR firmly opposes any form of bullying, harassment, discrimination or behaviour that denigrates others. I cannot over-emphasise the seriousness of this issue for radiologists, radiation oncologists and trainees. The distress caused by bullying and harassing behaviour is real and significant, and it often leaves victims feeling vulnerable, anxious or professionally disempowered. Such behaviour can lead to reputational damage and is costly; the effects include loss of referrals to a practice and a tendency among patients to avoid those practices that accept or ignore the ‘disruptive radiologist’.2

The same will be true for our radiation oncology colleagues. In this regard, we would well take note of the words of Lieutenant General David Morrison, the 2016 Australian of the Year, who said in addressing the issue of unacceptable behaviour in the Army: “The standard you walk past is the standard you accept”.3 Most incidents of bullying, discrimination and harassment are matters for your individual employer. However, as the welfare of our members is of the utmost importance to the College, we are committed to working with employers and other organisations to address bullying, harassment and discrimination. I draw your attention to the existing processes we have in place to counter these divisive and malicious behaviours. In the new RANZCR Code of Ethics, the imperatives of Principle Eight represent explicitly the College’s position on these issues4: Clinical radiologists and radiation oncologists have a duty to attend to the health and wellbeing of their colleagues, including trainees, students, and also of themselves.

Understanding what the College means by ‘bullying’ and ‘harassment’ For all members, the College’s Grievance Policy applies to any incident of bullying, discrimination or harassment that occurs in the course of activities relating to the business of the College. The Grievance Policy defines bullying and harassment, as well as discusses various common forms of discrimination and the related offences of victimisation and defamation. 3.2.1 What is harassment? Harassment is defined as any behaviour that: (i) A person does not want; (ii) offends, humiliates or intimidates them; and (iii) creates a hostile environment. 3.3.1 What is bullying? While there is no statutory definition of bullying, it is generally accepted to be behaviour that intimidates, offends, degrades, insults or humiliates an individual. From a workplace health and safety perspective, workplace bullying is defined as repeated, unreasonable behaviour directed towards a person or group of persons at a workplace, which creates a risk to health and safety.5

continued over... Volume 12 No 4 I September 2016

Introduction

For trainee members of our College there are a number of additional mechanisms available to raise issues The Grievance Policy is a key instrument that all trainees should be aware of. The policy outlines a process for assessing, addressing and raising concerns. The policy has been recently updated to strengthen it further and is available from the College website. We assess trainee safety via training site accreditation, and trainee feedback is an important part of the accreditation process. An additional instrument is the Training Assessment of Training Site assessment where trainees rate and comment on their training experience.

gives us no ground for complacency and no excuse for inaction. Please take the opportunity to reflect on these issues and how each of us may work towards strengthening a culture of tolerance, equality and respect within our workplaces. Each of us can be a leader in this regard—it is where the success of our professions and the goal of highquality service delivery ultimately lies. If you wish to discuss an issue or experience directly with the College or notify us of an activity in which the College needs to improve, please let me know by emailing me on ceo@ranzcr.edu.au or by contacting one of the College Grievance Officers as listed in the Grievance Policy.

We urge you to report any and all incidents, whether experienced or observed, through the relevant channels with your employer or to the College directly.

I wish to reiterate that the College is here to support all its members, as we all have a right to train and practise our specialties in a truly professional environment.

I strongly believe that the overwhelming majority of our members conduct themselves with the utmost integrity and respect for others. But this belief

Ms Natalia Vukolova Chief Executive Officer

2017 Rogers International Fellowship in Radiology Journalism The Rogers Fellowship offered by the American Roentgen Ray Society (ARRS) provides one recipient per year with an opportunity to work closely with American Journal of Roentgenology editors and staff to learn the fundamentals of medical publishing. Radiologists practising outside the U.S. and Canada are eligible and applicants must be a member of the ARRS when the application is submitted and for the duration of the fellowship. Rogers Fellowships are announced in December of each year and the fellowships must be completed within a year. The purpose of this award is: • To stimulate bright, promising radiologists to continue with an academic career, enhance their

Inside News

credentials, and stimulate interest in good radiology journalism • To improve the quality of radiology journals by teaching the fundamentals of medical journalism, train manuscript reviewers and future editors, and provide core teachers of medical journalism in radiology departments around the country The successful candidate will be awarded a maximum of $12,000 to cover travel and other expenses. Applications for the 2017 Rogers Fellowship close on Monday 10 October 2016 and should be sent electronically to scholarships@arrs.org. Further information is available on the ARRS website at www.arrs.org/ARRSLIVE/ Rogers

References 1. Parliament of the Commonwealth of Australia. House of Representatives Standing Committee on Education and Employment. Workplace Bullying: We just want it to stop. Canberra, October 2012. http://www.aph.gov.au/ Parliamentary_Business/Committees/House_of_ Representatives_Committees?url=ee/bullying/ report.htm 2. Sidney Ulreich MD, et al., “The Disruptive Radiologist,” Journal of the American College of Radiology, 2015; 12: 800–804. http://dx.doi. org/10.1016/j.jacr.2015.02.013 3. Video message from the Chief of Army, Lieutenant General David Morrison, AO, to the Australian Army, following the announcement on 13 June 2013 of civilian police and Defence investigations into allegations of unacceptable behaviour by Army members. https://www. youtube.com/watch?v=QaqpoeVgr8U 4. Royal Australian and New Zealand College of Radiologists. Code of Ethics, ver. 1. Sydney, 15 September 2015. http://www.ranzcr.edu.au/ documents-download/document-library-9/3958ethics 5. Royal Australian and New Zealand College of Radiologists. Grievance Policy, ver. 2. Sydney, 10 December 2012. http://www.ranzcr.edu.au/ resources/professional-documents/policies

Member Engagement Survey Results Coming Soon Since our inaugural member engagement survey closed earlier this year we have been hard at work analysing the responses received from over 1,100 members. It is proving to be a powerful source of insight and ideas, and will be influential in directing future College activities and supporting your needs. A report summarising the survey results will be shared with those who took part very soon, and key findings will be published in future issues of Inside News. Stay tuned!

Engaged Members

RANZCR 2016 ASM Have you registered yet? Now is the time!

MODERN IMAGING AND RADIATION THERAPY: RANZCR 2016

APPROPRIATE, COLLABORATIVE AND TARGETED

67th ANNUAL SCIENTIFIC MEETING | GOLD COAST, AUSTRALIA | 13 – 16 OCTOBER 2016 We encourage you to book now and be part of The Royal Australian and New Zealand College of Radiologists (RANZCR) 67th Annual Scientific Meeting to be held 13 October – 16 October 2016 at the Gold Coast Convention and Exhibition Centre in Queensland, Australia. Please join us for a conference that includes an inspirational list of international speakers, who together with world-class local presenters will share their vision of modern imaging and radiation therapy.

Program Highlights The Scientific Program has been finalised and contains an excellent mix of invited keynote speakers, local speakers, proffered papers and exhibits. Radiologists attending the event will enjoy presentations by keynote speakers Dr Russell Fritz, Professor Fiona Gilbert, Professor Meng Law and Dr Claude Sirlin as well as international guest speaker Associate Professor Mahesh Thapa. Supporting and enhancing the international speaker representation will be the largest gathering of expertise from Australian and New Zealand speakers that has ever been assembled for a single meeting. Highlights of the radiation oncology program will include presentations from keynote speakers Dr Silvia Formenti, Dr Colleen Lawton and

Professor William Mendenhall. The exciting program will also feature presentations from the current ESTRO president Professor Yolande Lievens, interventional radiologist Professor Andreas Adam and a host of invited national presenters. Program sessions will focus on the management of head and neck, genitourinary and breast cancers, as well as the emerging role of immunotherapies used in combination with radiotherapy. Lecture topics have been carefully chosen to be applicable to a wide range of subspecialists and generalists alike. Presentations will be offered in a variety of formats including opportunities for audience interaction and mock multidisciplinary sessions featuring leading surgeons and pathologists. View the full Annual Scientific Meeting program online at ranzcr2016.com/ scientific-program

Workshops The highly successful BREAST Workshops are on offer again in 2016 as well as CPR Workshops and the FROLIC Lung Contouring Workshop. Places are limited; we encourage you to register early to avoid missing out! Please refer to the meeting website for full details including workshop fees at ranzcr2016. com/workshops

Social Events

industry colleagues at the numerous social functions. Keeping within the glitz and glam of the Gold Coast, the theme for the Gala Dinner is ‘A touch of bling’, with delegates encouraged to come dressed to impress! For those looking to keep fit while at the conference, the Targeting Cancer Fun Run will be held on Saturday morning in Pratten Park, Broadbeach – just a short walk away from the Convention Centre. The cost to participate is $30.00 inc. GST and the fun run is open to delegates and guests of delegates (colleagues, family, friends, etc.). You can register for the fun run when completing your conference registration. For all the latest updates and hot off the press information on the ASM, don’t forget to follow the College on Facebook, Twitter and LinkedIn using #RANZCR2016 or #RADgold or visit the meeting website ranzcr2016.com for more information. We look forward to welcoming all radiologists and radiation oncologists to the sunny Gold Coast in October! Dr Jonathan Corness Dr Sanjay Dhupelia Radiology Co-Convenors Dr Catherine Bettington Dr Jim Jackson Radiation Oncology Co-Convenors

The social program is shaping up to be an excellent opportunity to catch up with old friends and network with new

Volume 12 No 4 I September 2016

Engaged Members

Dr Jonathan Ramsay

Dr Jonathan Ramsay Associate Professor, University of Queensland; Senior Radiation Oncologist, Princess Alexandra and Mater Hospitals; Director, Radiation Oncology Centres and Icon Group; Director, Oncology Research Australia Member of the Faculty of Radiation Oncology Media and Profile Committee

Background I have spent most of my career as a radiation oncologist working in Brisbane. Prior to moving to Queensland I worked in Cambridge, UK, for four years and for two years in Boston, USA. I have experienced three different health systems and despite the limitations, I think the Australian system is the best with a high standard of public and private health care. Throughout my career I have been fortunate to see major technological and clinical improvements in our specialty. Outside of clinical work, my interests have been in radiobiology research and more recently in the development of new radiation oncology centres. Having founded Radiation Oncology Queensland (ROQ) with Michael Poulsen and Kumar Gogna, ROQ commenced operations in Toowoomba and has since been rebranded to Radiation Oncology Centres. ROC has 10 treatment centres in Queensland and New South Wales with several others in development. The majority of the centres are located in regional areas and it is pleasing to see that utilisation rates for radiation oncology have increased in these areas, which hopefully will translate into better outcomes for patients.

Why I Am Involved While geography and access to treatment is a major factor for our specialty, it is clear that we also need to be more proactive in promoting radiation therapy as a treatment option for our patients. Whether we like it or

Inside News

not, it is a competitive market among specialists actively promoting other treatments as an alternative to radiation therapy. Radiation oncologists with a few notable exceptions tend to be the more quiet types sitting at the back of the multidisciplinary meetings allowing others to do the talking. Thus despite my family’s amusement (due to my allergy to Facebook, Twitter and other forms of social media) I was pleased to be invited to join the Media and Profile Committee under the leadership of the able and not so reticent A/Prof Sandra Turner. The Targeting Cancer campaign has gone from strength to strength in promoting our specialty to patients and also crucially to general practitioners (GPs). As most of us will remember, exposure to radiation oncology as a medical student was often one visit to the department in the hospital basement. The Targeting Cancer website is expanding in the scope of information provided and is seeing an increasing number of visits. The GP education evenings have been a great initiative to demonstrate to other medical staff the care and technology available in a modern radiotherapy department. The feedback received has been excellent and in Toowoomba there was a 13 per cent increase in referrals in the six weeks after the GP oncology event, and the increase has been maintained ever since. Another initiative is to promote radiation oncology in the media. We have a lot of good stories to tell and they don’t all have to relate to proton therapy. All of

these initiatives cost money, so as well as generous support from the College we have obtained additional funding from Abbvie, Genesis, ROC, Elekta and Varian.

Encouragement to Others I would encourage all radiation oncologists to support the Targeting Cancer campaign. We will also need to look at innovative ways for funding the campaign in the future. The GP education evenings are a great way to promote your centre to the local medical community and the College provides assistance with organising the event. I understand our trainees’ number one concern relates to the lack of job opportunities and while some of this is due to the reluctance of us older radiation oncologists to retire in a timely manner, I hope it will not be due to a decline in patient referrals. We have a very effective and safe treatment for cancer and not everyone with prostate cancer needs robotic surgery!

Want to get involved in Targeting Cancer? If you would like to know how you can contribute to the Targeting Cancer campaign, please email info@targetingcancer.com.au

Engaged Members

Prof Jens J. Froelich Professor of Interventional & Neurointerventional Radiology, Royal Hobart Hospital Clinical Professor, University of Tasmania, Professor of Radiology, Phillips-University, Germany Elected Fellow on the Faculty of Radiology Council

Prof Jens J. Froelich

Background I am a general EU and US trained radiologist, currently focused on Interventional Radiology and Neuroradiology. Since 2010, I have been Professor of Interventional and Neurointerventional Radiology at the Royal Hobart Hospital in beautiful (but remote) Tasmania. Additionally I am a Clinical Professor at the University of Tasmania and Professor of Diagnostic Radiology at Philipps-University, Germany. Prior to my Australian ‘encounter’ I filled various positions as director, consultant and specialist in several German and Swiss hospitals. I have a strong interest in efficient, high-quality radiology services and enjoy personal interactive contact with patients, colleagues and referrers. I also enjoy scientific and research activities in support of our profession. Furthermore, I am involved as a state representative within the IRSA and ANZSNR councils, and a Fellow of the College, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), the German Radiology Council and the European Board of Interventional Radiology (EBIR). My involvement with the Faculty of Clinical Radiology (FCR) started recently (and somewhat surprisingly), when I was asked to represent Tasmania within our College.

Why I Am Involved Quite frankly, I was not quite sure what to expect from the FCR, as it did not seem to directly impact my

clinical, academic or scientific interests. However, I now understand that Council, together with other committees, working groups and advisory panels, represents our profession and advises the College Board in an organisational and somewhat political manner to benefit the membership.

“If we are interested in the future of our specialty, we need to acknowledge and strongly support the College as our body of representation.” While as a clinical interventional radiologist my interest in formal governance structures is somewhat limited, I believe that certain aspects of our profession could benefit from improvements. Some topics include: • Progressive fragmentation of radiology • Poor defence of the scavenging of radiology services (by other disciplines) • Acknowledgement of radiology as a clinical discipline • Verification and validation of bureaucratic burdens • Revalidation of licences

• Support and ongoing improvement of training • Transparency of College related activities • Quality, efficacy and sustainability of services • Awareness of the interests and concerns of all members to improve member engagement. Overall, I intend to contribute within the FCR to support and further enhance our profession in line with the College and its members.

Encouragement to Others Council related activities are not reimbursed and there are no associated direct personal benefits. Clinical, scientific and academic obligations may suffer from such a commitment. However, if we are not looking after our profession, external bodies will certainly handle our affairs to the detriment of our interests. Such developments have occurred in the past and there is an ongoing struggle from related consequences. If we are interested in the future of our specialty, we need to acknowledge and strongly support the College as our body of representation. All members who feel unhappy with current and potential threats to our specialty are encouraged to become involved in College related activities.

Volume 12 No 4 I September 2016

Research

Windeyer Fellowship 2014 Dr Palliyaguru describes her experience at the Mount Vernon Cancer Centre I had the honour and privilege of being awarded the Windeyer Fellowship in 2014. The fellowship is awarded to a post Phase 2 trainee to undertake a clinical/research fellowship at Mount Vernon Cancer Centre in Northwood in the United Kingdom under the supervision of Prof Peter Hoskin and Dr Andreas Makris.

of intra-uterine catheters for cervical brachytherapy (including insertion of interstitial needles) and insertion and planning of vaginal brachytherapy. Subsequent contouring and planning was done using MRI guidance. I gained a lot of experience with MRI contouring both in prostate and cervical brachytherapy.

Mount Vernon offers treatment to a large catchment area of approximately two million people. The fellowship has the potential to advance your interest in many subspecialties including brachytherapy, gynaecology, breast, prostate, CNS and lymphoma. There is also the opportunity to gain experience in CyberKnife.

My other clinical involvement included the administration of radium 125 for metastatic prostate patients, attendance at gynae and CyberKnife multidisciplinary team meetings, and attendance at brachytherapy chart rounds.

My clinic days were mainly Mondays and Fridays. Clinics can be very busy, however, they were well staffed with a combination of research fellows, international fellows and a registrar. My initial concerns about prescription of chemotherapy soon dissipated with constant supervision from supervisors and support from colleagues. Clinics operate in a central hub setting where complex cases are discussed and there is plenty of opportunity to learn, not only from the patients you review, but also from a wide variety of patients in the clinic. I gained a good understanding of systemic treatments, complications and the management of these complications. My objective was to further my experience in brachytherapy. This was achieved by attending theatre sessions twice a week, and being involved in planning and approving plans for the patients undergoing prostate, cervical and vaginal brachytherapy. I had a lot of hands-on time in theatre with insertion of prostate interstitial needles using ultrasound guidance. I also had plenty of opportunities to assist with insertion

Inside News

of the best years of my training. The staff at Mount Vernon were also very helpful and friendly and made this year a fantastic experience. I would strongly encourage all trainees to consider applying for this fellowship as it has been an invaluable experience for me. Dr Manoja Palliyaguru

Visiting the radiology department (Paul Strickland Scanner Centre) was also a good learning experience with the radiologists always keen to teach. Whole body diffusion MRI is utilised in many breast cancer patients in assessment of treatment response to systemic treatments. Patient MRIs were often reviewed with the radiologist thus improving my skills of MRI interpretation. Initial assessments of me as a fellow were carried out by both supervisors with regards to competency of patient management with case discussions. With progression through the year, contouring and plan approvals were carried out under supervision. The icing on the cake, of course was the opportunity to complete a fellowship in a European city with ample opportunity to attend ESTRO courses and travel around Europe. My girls did enjoy immensely their trip to Disneyland. Finally, I would like to thank the College for giving me the opportunity to gain this vast and beneficial experience. I cannot thank Prof Hoskin and Dr Makris enough, not only for their guidance and supervision, but for making this year one

Windeyer Fellowship If you would like more details on the Windeyer Fellowship, visit the College website at www.ranzcr. edu.au/members/awards-a-prizes/ research-awards-a-grant or contact gaps@ranzcr.edu.au

Research

Development of RANZCR Research Strategy Priorities identified at recent forum Research is a strategic priority of the College and is one of the seven collegewide strategic pillars: Clinical Radiology and Radiation Oncology are recognised as professions characterised by a research ethic, and Australia and New Zealand become more research competitive internationally. This priority addresses the risk that insufficient and low quality research adversely affects the perceived role of radiology in patient care and radiation oncology in cancer care. If the College fails to demonstrate research leadership, then reliance on overseas research and the perception that College members are more ‘technicians not clinicians’ will grow. Despite research being a priority, it has been the least supported of the priorities. The College position is that developing a research strategy would be an initial step towards increasing resources for the research priority as it would outline key research areas for targeting. A research strategy forum was held on 26 July at the College office in Sydney. Invitations were sent out to members who represented a crosssection of the College membership. In total 23 participants attended. These included seven members from clinical radiology, 11 members from radiation oncology and four RANZCR Staff. The members represented various College committees, including four Board members and the College President. The mix was to provide a balance of ideas from across the College membership. The forum was facilitated by Philip Pogson from The Leading Partnership. The objective of the forum was to gain member input into the development of a College-wide Research Strategy. Some

of the discussions points raised were: • Research is an integral component of clinical activity and a culture of research needs to be embedded from training. There are challenges in measuring research output, especially in clinical practice. • The current College grants are small and should be considered as seed funds for bigger projects, which the College can later support with bigger grants or source funding from elsewhere. • Clinical radiology needs more support. It is a very technical discipline. The research component of training may not contribute much to change the research culture in clinical radiology unless a different approach is taken. Private radiology practices are difficult to engage in research. • Early career and mid-career researchers in Australia and New Zealand may need different strategies to address the challenges.

We need to forge links with other national international research bodies, and organisations to promote research projects and secure funding for research for collaboration on College membership. • Providing a governance framework and administrative support for the implementation of the research strategy and measurement of performance against set objectives for the research plan. • Effective internal and external communication will be a key ingredient to the success of the strategy. The next steps are work on the strategy before circulating it to members for comment. Then it will be presented to the two Faculty Councils and finally the Board.

Preliminary priorities identified include: • P romoting and facilitating basic and applied research across the career cycle of professions in order to provide evidence for best practice, decision-making and policy formulation. Promotion should start with embedding research in the training curriculum of both clinical radiology and radiation oncology as a way of providing lifelong competence and stimulating interest in research. The College will consider including research training as part of the accreditation process. • Enhancing partnership and collaboration internally across the two Faculties and with external organisations to ensure that the College does not work in isolation from other organisations, institutions or the community.

If you have any questions about the RANZCR Research Strategy, please contact Prof Patricia Desmond or Dr Keen-Hun Tai c/o Chilandu Mukuka, Manager, Research Co-ordination on Chilandu.Mukuka@ranzcr.edu.au

Volume 12 No 4 I September 2016

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It takes a special radiologist to calmly, meticulously and swiftly put the pieces together while the clock is ticking. Is this you? Everlight Radiology is a leading teleradiology provider – an expert in after-hours and urgent reporting, specialising in emergency radiology. Daily and nightly for the past decade, we’ve been providing valuable and vital support to hospitals and emergency departments across Australia and New Zealand. Each month we report on more than 40,000 cases and service the largest urgent caseload volume of any radiology provider in the region. We’re looking for more high-calibre FRANZCR radiologists, with special interests and experience in emergency radiology, to join our growing team. Now over 100 strong, our team of radiologists are based in Australia, Canada, New Zealand, South Africa, the United Kingdom, the United States and other global locations. Are you looking for a new challenge that makes a real difference? If you care about quality reporting and patient outcomes as much as we do, we’d love to hear from you. Contact us today: careers@everlightradiology.com.au

everlightradiology.com.au/careers

Broad scope of varied and interesting cases Focus on reporting without unnecessary interruptions Leading technology and quality assurance systems Ongoing CPD learning and knowledge sharing Access to an international network of peers Opportunities to report from all over the world

Research

Think. Check. Submit. Pitfalls and Perils of Open Source Publishing

There has been much discussion recently in academic publishing circles about publishing articles under ‘Open Access’ or ‘OA’ terms. So what is OA, and how can you as an author stay informed about your options? Firstly, there are two forms of OA publication: gold and green.

The OA movement represents a significant change to the traditional journal subscription model but, within a complex, shifting landscape, it is also opening up opportunities for new relationships between publishers and authors and new ways to add value for researchers, funders, and libraries.

In gold OA, articles are made freely available by the publisher immediately upon publication (typically under a liberal licence, such as Creative Commons Attribution – CC-BY), in return for payment of an Article Publication Charge (APC) that is usually covered by the author’s funding source. The author retains copyright of their gold OA article and it may appear in a completely OA journal or in a hybrid journal mixing both OA and subscription content, such as the Journal of Medical Imaging and Radiation Oncology (JMIRO).

The publication of OA content begins with you, the researcher. As the OA publishing landscape continues to evolve, valuable resources for helping you learn about the process have never been more important. Cue Think. Check. Submit.—a new cross-industry initiative designed to support researchers on the road to publication.

The appeal to authors of immediate, free access to their work in a prestigious journal is compelling and payment of APCs is not necessarily an obstacle, particularly in better-funded disciplines, such as health and life sciences. In green OA, the author’s accepted manuscript (the peer-reviewed, but otherwise not-yet-finalised version of an article) is deposited in an institutional repository or a subject archive, such as PubMed Central and made freely available, typically following an embargo (usually between six to 36 months) after the article’s formal publication in an academic journal. Again, this is typically under a creative commons licence. Many journals, including JMIRO, have recognised that authors need the flexibility of a green OA option in order to comply with funder mandates and have adjusted their self-archiving policies to make it easier for authors to do so.

“The mission of Think. Check. Submit. is to help researchers identify highquality journals which would be appropriate for submitting their research.” As the output of scholarly content grows, so does the risk of deception and malpractice. Think. Check. Submit. seeks to combat both issues. According to a recent Scientific Technical Medical (STM) Report, the number of academic journals grows by 3.5 per cent each year—nearly 1,000 journals were launched in 2014 alone and new ones are launched daily. Since March 2014, the Directory of Open Access Journals (DOAJ) has processed 6,000 applications, of which 2,700 have been rejected, 1,800 are in progress and 1,500 have been accepted. That makes choosing the best journal for your work a difficult task, especially for those less experienced with the process. Now,

Are you submittin g research to a tru your sted journal? Publish

ing your research resu lts is key to advanc your discipline – and ing your career – but with so many journals in you r field, how can you be sure that you’re choosing a rep utable, trustworthy journal?

Tips to confirm a jour nal’s credentials and decide if it will help you reach the right audience with your rese arch, and make an impact on your career.

Take control of your career at thinkchecksubmi t.org

Poster from thinkchecksubmit.org under Creative Commons Attribution 4.0 licence

more than ever, it is essential that you have the right tools and services to help you make informed decisions. The mission of Think. Check. Submit. is to help researchers identify high-quality journals which would be appropriate for submitting their research. Think. Check. Submit. is an easy-to-use online checklist built on indicators that allow you to thoroughly investigate individual journals, ensuring that whichever publication you choose is the right fit for you and your work. The campaign is led by representatives from various organisations, including ALPSP, DOAJ, ISSN and SPARC (see boxed text over for details).

continued over... Volume 12 No 4 I September 2016

Research

Beyond Think. Check. Submit., authors can turn to freely available resources such as the new Directory of Open Access Scholarly Resources (ROAD) and Quality Open Access Market (QOAM). Developed through partnerships between scholarly organisations and the International ISSN Centre, ROAD offers descriptions of over 12,000 open access journals, conference proceedings, academic repositories and more. Like Think. Check. Submit., QOAM, a service based on academic crowd sourcing, also helps authors in the market for the ideal journal for their work. College members can be confident that JMIRO will continue to support authors in making the correct choices when submitting and publishing their work, as well as ensuring that the journal continues to cater for funding mandates that require gold or green OA publication.

Associated organisations and resources

International Standard Serial Number (ISSN) – www.issn.org/

Association of Learner & Professional Society Publishers (ALPSP) – www.alpsp.org/

PubMed Central - www.ncbi.nlm.nih. gov/pmc/

Creative Commons – https:// creativecommons.org/

Quality Open Access Market (QOAM) – www.qoam.eu/

Directory of Open Access Journals (DOAJ) – https://doaj.org/

Scholarly Publishing and Academic Resources Coalition (SPARC) – http://sparcopen.org/

Directory of Open Access Scholarly Resources (ROAD) – http://road.issn. org/

Scientific Technical Medical Report – www.stm-assoc.org/2015_02_20_ STM_Report_2015.pdf

International Association of Scientific, Technical and Medical Publishers (STM) – www.stm-assoc.org

Think.Check.Submit. – http://thinkchecksubmit.org/

The College thanks Simon Goudie of Wiley for his contribution to this edition.

For more information, visit http:// thinkchecksubmit.org Simon Goudie Senior Journal Publishing Manager, Wiley

International Breast Cancer Conference 25-29 October 2016 Precision medicine in Breast Cancer imaging, diagnosis and treatment The Westmead Breast Cancer Institute and BreastSurgANZ are co-hosting the 8th Leura Breast Cancer Conference 25th to 29th October 2016. This multidisciplinary breast cancer conference will be hosted at the Fairmont Hotel in Sydney’s iconic Blue Mountains. The theme “Bringing Precision Medicine into the Clinic” will cover all aspects of breast cancer from screening and diagnosis to management of breast cancer and features keynote speaker A/Professor Sophia Zackrisson, Senior Consultant Radiologist at Skåne University Hospital in Malmö, Sweden and Head of Section of Oncologic Imaging.

Inside News

A number of interactive speciality workshops are planned, including: • FALCON Breast Contouring Workshop, featuring expert ESTRO teacher A/Prof Birgitte Offersen • Ultrasound Guided Biopsy Workshop • Tomosynthesis Workshop 24 points RANZCR CPD points can be claimed for attendance at the Leura International Breast Cancer Conference

Profile and Presence

InsideRadiology Enters a New Phase A new look and expanded role planned for this popular resource

InsideRadiology provides consumers and health professionals with up-to-date information on diagnostic imaging and interventional radiology relevant to the Australian and New Zealand healthcare environments. Over the last financial year, the InsideRadiology team has:

Promoting InsideRadiology in your professional networks. Supplementing your hospital or practice resources using links to InsideRadiology.

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Recommending any topics that could be considered for inclusion.

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Following feedback from the Profile of a Clinical Radiologist Project, the scope of the website will be expanded to facilitate more advocacy for the role and value of the clinical radiologist. It will also host additional College resources that are relevant to the general public. The aim is for InsideRadiology to become a consumer resource for information about clinical radiology, similar to the role that the Targeting Cancer website plays for radiation oncology.

The first stage of the plan was to increase InsideRadiology’s presence in New Zealand. Local Faculty of Clinical Radiology Council Member, Dr Kate O’Connor, gave up her weekend to help raise the profile of InsideRadiology and the College at the recent Royal New Zealand College of General Practitioners’ annual conference. InsideRadiology was a welcome addition to the exhibition hall where it was promoted as a useful resource for clinical radiology information for both referrers and their patients.

Get involved with InsideRadiology:

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InsideRadiology is transitioning from its status as a public resource funded by the Australian Department of Health to a fully integrated trans-Tasman Collegeowned resource. As part of this process, the website is being redesigned to align it with other College resources.

InsideRadiology is looking to the future with a five-year plan to update information items, develop new content as required and renew promotional activities in the general practitioner space.

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• Amended the three information items on contrast agents to bring them up to date with the College’s recently revised contrast media guidelines • Reviewed and condensed the Cardiac MRI information items into a single comprehensive item • Developed a new information item covering the emerging breast imaging technique of breast tomosynthesis.

Volunteering to assist with

content.

For more information about InsideRadiology visit insideradiology. com.au or insideradiology.co.nz or contact Prof Graham Buirski c/o Dr Phil Munro, Manager Quality and Standards at the College on quality@ ranzcr.edu.au or +61 2 9268 9741.

Volume 12 No 4 I September 2016

What’s in Issue 5? Medical Imaging Article Review Article Imaging in multiple sclerosis: A new spin on lesions Corresponding author: Dr Fadi El-Merhi, Diagnostic Radiology Department, American University of Beirut Medical Center, Beirut, Lebanon This article evaluates the most relevant state-of-the-art magnetic resonance (MR) techniques that are clinically available to investigate multiple sclerosis (MS). The presence of hypo- and hyperintense lesions on T1- and T2-weighted magnetic resonance imaging (MRI) sequences in white matter (WM) is a common finding that is occasionally a diagnostic challenge for the radiologist. The technical requirements and how they may help to understand, classify or follow-up these pathologies are briefly summarized. The gold standard for MS diagnosis is pathological correlation. Yet due to limited availability of biopsy and autopsy material, there is a high demand for imaging as a diagnostic as well as prognostic indicator. With the progress in MRI during the last decade, MRI now plays a leading role in the diagnosis and follow-up of MS. A number of correlative pathological and MR studies have helped to define pathological substrates of MS in focal lesions and normal appearing white matter (NAWM). Vascular spaces mimicking MS lesions have been minimized by the enhanced differentiation of WM and grey (GM) matter parenchyma. The aim of this article is to enhance the current understanding of histopathology and radiological characteristics of MS lesions in space and time.

Medical Imaging Article Pictorial Essay Radiological diagnosis of spinal arachnoid cysts: A pictorial essay Corresponding author: Dra Carolina Ospina Moreno, Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain Spinal arachnoid cysts (AC) are intraspinal extramedullary loculated cerebral spinal fluid collections. They are relatively uncommon lesions. Spinal AC often cause symptoms such as pain, weakness and radiculopathy. In this pictorial essay we demonstrate the main radiological features of spinal AC, as well as symptoms and complications associated with them. We also describe the main differential diagnoses.

Radiation Oncology Article Original Article Economic evaluation of single-fraction versus multiple-fraction palliative radiotherapy for painful bone metastases in breast, lung and prostate cancer Corresponding author: Dr Nisha Nair, Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand Introduction: Single- and multiple-fraction external beam radiotherapy (SFX-EBRT and MFX-EBRT) are palliative treatment options for localized metastatic bone pain. MFX is the preferred choice in many developed countries. Evidence shows little difference in how effectively SFX and MFX reduce pain. However, SFX is associated with higher retreatment and (in one meta-analysis) pathological fracture rates. MFX is, however, more time-consuming and expensive. We estimated the cost-effectiveness of SFX versus MFX for metastatic bone pain in breast, prostate and lung cancer in New Zealand. Methods: We constructed a Markov microsimulation model to estimate health gain (in quality-adjusted life-years or QALYs), health system costs (in real 2011 NZ dollars) and cost-effectiveness. The model was populated using effect estimates from randomized controlled trials and other studies, and New Zealand cancer and cost data. Disability weights from the 2010 Global Burden of Disease study were used in estimating QALYs. Results: Across all three cancers, QALY gains were similar for SFX compared to MFX, and per patient costs were less for SFX than MFX, with a difference of NZ$1469 (95% uncertainty interval $1112 to $1886) for lung cancer, $1316 ($810 to $1854) for prostate cancer and $1344 ($855 to $1846) for breast cancer. Accordingly, from a costeffectiveness perspective, SFX was the preferable treatment option. Various sensitivity analyses did not overturn the clear preference for SFX. Conclusion: For all three cancers, SFX was clearly more cost-effective than MFX. This adds to the case for desisting from offering MFX to patients with metastatic bone pain, from a cost-effectiveness angle.

Radiation Oncology Article Guidelines Australia and New Zealand Faculty of Radiation Oncology Lung Interest Cooperative: 2015 consensus guidelines for the use of advanced technologies in the radiation therapy treatment of locally advanced non-small cell lung cancer Corresponding author: Dr Patrick M Dwyer, Northern New South Wales Cancer Institute, Lismore, NSW Definitive radiation therapy (RT), generally combined with chemotherapy, is the standard of care for patients with unresectable locally advanced (stage II-III) non-small cell lung cancer (LA-NSCLC). With the advent of newer technologies, RT for LA-NSCLC has changed significantly in recent years. Some of these advances include PET/CT in treatment planning, 4DCT simulation, 3D/4D cone beam CT image guidance and IMRT/VMAT. Many of these techniques were used in the most recent RTOG randomised controlled trial of chemo-RT for Stage III NSCLC, which reported a median overall survival of 28.7 months in patients randomised to the standard therapy arm, much higher than previously documented.[1] Currently, many radiation oncology departments in Australia and New Zealand are in the process of implementing these techniques. In 2015, the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) conducted a patterns-of-practice survey amongst radiation oncologists to investigate the range of radiation therapy management of lung cancer in Australia and New Zealand and to define the gaps in optimal patient care. Results of this survey are published in this issue of the journal. There was appreciable variation in methods of simulation, planning and image verification techniques noted from the survey. With this in mind, the FROLIC executive committee identified the need to develop guidelines for the use of advanced RT technologies in the treatment of LA-NSCLC. In August 2015, the inaugural FROLIC workshop was conducted with the aims of sharing knowledge and experience regarding the optimal use of the advanced techniques in LA-NSCLC with a view to developing consensus guidelines. We felt there is a need to develop local guidelines relevant to the Australian and New Zealand context for the implementation of new technologies. These guidelines may assist in departments accelerating their implementation and reduce variations in practice. They will help to ensure high quality utilisation of these technologies and best practice radiation therapy for patients with LA-NSCLC.

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!

Profile and Presence

Targeting Cancer Website Wins Prestigious Global Award We are very excited that the Targeting Cancer website has won the Best in Class award in the Interactive Media Awards (IMA) for Healthcare category. The Best in Class award is the highest honour bestowed by the IMA. It is awarded to a healthcare related digital platform displaying the very best in planning, execution and overall professionalism. In order to win this award, our site had to successfully pass the comprehensive judging process, achieving outstanding marks in the judging criteria - an achievement only a fraction of sites in the IMA competition earn each year. The site received an overall score of 491 out of 500 in the category of ‘Healthcare’. The scores covered five areas of Design (97), Content (100), Feature Functionality (99), Usability (98) and Standards Compliance (97). In addition, the Targeting Cancer website was recently named a Gold Winner in the prestigious Sydney Design Awards in the Digital EdTech category. Thank you to everyone who has contributed to the design and content of the website.

For more information about these events visit http://www.healthed.com. au/seminars/

GP Oncology Education Evenings Oncology Education Evenings provide GPs with the opportunity to learn about the role of radiation therapy for their patients. So far in 2016, 14 GP evenings have been held in Australia and New Zealand, with hundreds of GPs and other health professionals attending and providing positive feedback. We would like to thank our members and the team from those sites for organising these events. There are several GP evenings planned for later this year. If you are interested in hosting a GP Oncology Education Evening, please contact us on faculty@ranzcr.edu.au and we will provide all the materials to assist you.

How YOU can get involved We are always looking for patient and good news stories about radiation therapy, patient resources/photos that will help raise the profile of our profession and of radiation therapy as a treatment option. Please email us at faculty@ranzcr.edu.au if you would like to contribute to the campaign, or contact A/Prof Sandra Turner sandra.turner1@optusnet.com.au if you have any questions or ideas about suitable stories. Like Targeting Cancer on Facebook, or follow @targetingcancer on Twitter, and help us spread the word. Please help us make Targeting Cancer THE brand to promote our fantastic treatment!

continued over...

HealthEd Seminars A/Prof Sandra Turner has secured a speaking opportunity to update general practitioners (GPs) on modern radiation therapy for prostate cancer and the role of the GPs in ensuring men hear all the treatment options. Cancer Institute NSW has agreed to sponsor Targeting Cancer’s participation in those events. There are five CPD-approved General Practice Education Days run by HealthEd, the biggest GP education provider in Australia. Dr Peter Gorayski and A/Prof Jeremy Millar will be assisting with this program which attracts thousands of GPs each year.

Some of the City2Surf Targeting Cancer team

Volume 12 No 4 I September 2016

Profile and Presence

City2Surf We would like to thank all those who participated in the City2Surf fun run as part of the Targeting Cancer team. It was a great day for all. This year the Targeting Cancer team had the privilege of 72 year old Michael Bendeich’s participation in the team (see picture over). Michael is a veteran runner in the City2Surf, having run the event 42 times. Michael joined the Targeting Cancer team to help promote awareness of radiation therapy as an effective, sophisticated and well tolerated option for curative prostate cancer treatment.

Michael Bendeich joins City2Surf Targeting Cancer team

To read more about Michael visit www.targetingcancer.com.au/2016/08/ michael-runs-his-meaning-of-lifecity2surf/

Targeting Cancer Fun Run at College 2016 ASM – Please Register The Targeting Cancer Fun Run/Walk is on again this year at the College’s Annual Scientific Meeting (ASM), with generous support from GenesisCare and prizes donated by QLD Xray. Please join us on Saturday 15 October at Pratten Park, Broadbeach at 6.00am. Registrations are open to all delegates and guests of delegates (family, friends, colleagues) http://www.ranzcr2016.com/ registration/ This is an event not to be missed, with exciting surprises and prizes in store. T-shirts and caps will be provided. If you have already registered for the ASM and would like to register for the Targeting Cancer Fun Run/Walk, please contact ranzcr@wsm.com.au. We look forward to running/walking with you on the Gold Coast, before an exciting day of scientific presentations and workshops!

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Inside News

Profile and Presence

Faculty of Clinical Radiology Media and Profile Working Group The Faculty of Clinical Radiology established the Media and Profile Working Group in 2015 with the aim of raising the profile of clinical radiology among patients, consumers, other healthcare professionals and governments in Australia and New Zealand. Chaired by A/Prof Rajeev Jyoti, the working group’s target is to increase awareness about the specialty of clinical radiology by working towards the following three main objectives:

Based on the findings from the research, Hill+Knowlton has provided the Media and Profile Working Group with a number of key recommendations for improving communication with referral groups and consumers, to raise the profile and shape perceptions about the specialty’s role in the medical community as well as ideas on how to encourage clinical radiologists to take ownership of their own profile in their local patient and referrer communities.

• To manage the Profile of the Clinical Radiologist Project, expanding it as appropriate • To develop and manage the International Day of Radiology campaign, expanding it as appropriate • To facilitate media and other opportunities to raise the profile and awareness of clinical radiology.

The Media and Profile Working Group has begun its work on these recommendations by identifying areas for collaboration with other established College bodies, such as the Faculty of Radiation Oncology’s Media and Profile Committee and the Safety Quality and Standards Committee which oversees InsideRadiology and Choosing Wisely. The intention is to leverage established resources within the College to support these goals in conjunction with College policy and advocacy staff.

Profile of the Clinical Radiologist Project The President introduced this project in the June edition of Inside News. Commissioned by the Faculty of Clinical Radiology in 2015 and conducted by Hill+Knowlton Strategies, the report on the Profile of the Clinical Radiologist involved research into the perceptions held by consumers and referrers and the level of awareness and understanding of the role of clinical radiologists among these groups. The research also tested the hypothesis that clinical radiologists are undervalued. Overall findings indicated significantly more positive views of radiologists from these groups, compared to the perception that clinical radiologists held of themselves. For example, over 90 per cent of referrers (mainly GPs and surgeons) perceived radiologists positively as fellow clinicians, rating them as ‘excellent’ or ‘adequate’ and acknowledging their respect for the specialist advice in contribution to patient care.

The working group is seeking input from members, with any stories of innovation or of special interest for potential media use, particularly those which illustrate the role and value of clinical radiologists in the healthcare system. For further information, contact Ms Neena Mairata, Senior Advocacy Officer via neena.mairata@ranzcr.edu.au

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

The theme for 2016 is breast imaging. College policy and advocacy staff have been working in partnership with the Australian Diagnostic Imaging Association (ADIA) and the Peak Imaging Coalition (PIC) to arrange a parliamentary event during the week of IDoR, with a view to delivering a ‘call to action’ for the government to address the issues of barriers to access for patients and the lack of funding for breast imaging. To celebrate IDoR 2016, the College will play an active role in encouraging radiologists and practices in Australia and New Zealand to promote their work. The College, in collaboration with the PIC, will produce promotional and educational material on the role of the clinical radiologist and other members of the radiology team, as well as information on a patient’s breast imaging journey, for radiology practices to distribute to referrers and members of the public in their practices. The College encourages all members to get involved in IDoR 2016. If you would like to receive a promotional pack containing IDoR resources, please contact Sharon Connolly, Projects Officer for the Faculty of Clinical Radiology via fcr@ranzcr.edu.au Expressions of Interest are still open for membership to the Faculty of Clinical Radiology Media and Profile Working Group, as the group is seeking to achieve representation from as many areas of Australia and New Zealand as possible.

If you have any questions or comments about this article, please contact Neena Mairata, Senior Advocacy Officer, Faculty of Clinical Radiology on fcr@ranzcr.edu.au

Volume 12 No 4 I September 2016

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Access to Quality Services

Coal Workers Pneumoconiosis

Over the past year the College has been working with the Queensland Government in response to the re-emergence of coal workers pneumoconiosis (CWP), also known as black lung.

multiple causes and there are a number of gaps in the system that manages the welfare of miners. This includes dust levels in the mines, medical testing, record keeping and coordination of examination results.

In 2015 a number of suspected CWP cases were identified in Queensland, even though the disease was thought to have been eradicated. The College has been active in the media and worked closely with the Queensland Government and other stakeholders to resolve the situation.

Reforms by the Queensland Government

Over the summer period, the College created a CWP Register of clinical radiologists who are experienced in screening for pneumoconiosis. This was published early in March 2016. We have also shared the CWP Register with key stakeholders involved in coal mining. The register is updated regularly to assist patients in accessing the services they need. Alongside this, the Faculty of Clinical Radiology has received a range of queries regarding the CWP Register from stakeholders, all of which were resolved in a timely manner. We would like to give special thanks to the Fellows who have provided advice and support in the development of the CWP Register and those who volunteered to join the register.

Reviews There have been two inquiries completed on this issue, one by the Federal Parliament’s Senate Select Committee on Health and the other from the Monash University Review of Respiratory Component of the Coal Mine Workers’ Health Scheme. The College has monitored both and sought to participate in any way we could. The two inquiries have rightly identified that the re-emergence of CWP is due to

The Queensland Government has now determined that chest X-rays of coal mine workers will be double read through a new screening program which was launched in July 2016. At this stage the proposal is that the readings will be conducted by an Australian radiologist from the CWP Register and subsequently a US-based National Institute for Occupational Safety and Health (NIOSH) accredited reader. It is the view of the College that no evidence has been provided to indicate shortcomings in the interpretation by Australian radiologists and the evidence does not support sending X-rays to overseas doctors who are not registered to provide healthcare in Australia. The College is seeking an opportunity to review available evidence to clarify what went wrong. In the meantime, we see merit in double reading of X-rays for CWP as often happens in screening programs. This should however be managed sustainably within the Australian healthcare system through double reading by two independent clinical radiologists from our CWP Register. The College will remain active in this space as more information becomes available and continue to engage with stakeholders. We need to ensure that the re-emergence of CWP is handled appropriately and sustainably within the Australian health system in the best interests of miners.

If you have any questions or comments about this article, please contact Dr Greg Slater, c/o Mark Nevin, Senior Executive Officer, Faculty of Clinical Radiology on fcr@ranzcr.edu.au

Volume 12 No 4 I September 2016

Access to Quality Services

Big Win for Diagnostic Imaging Determined advocacy results in pre-election commitment by the Coalition In the lead up to the recent election the Turnbull Government made a major election commitment to diagnostic imaging (DI). This announcement is a great policy win for the College, the Australian Diagnostic Imaging Association (ADIA) and other key stakeholders who have worked together to bring this about. It follows months of work to persuade the Minister for Health and subsequently the Prime Minister’s Office to revise the changes to the bulk billing incentive into a wider package of DI reforms. (Cessation of the bulk billing incentive for DI for non-concession card holders had been announced in the 2015 Mid-Year Economic and Fiscal Outlook.) The main points of the government’s commitment are: • Commitment to implement the Quality Framework • Bulk billing incentive will cease from 1 Jan 2017 (instead of 1 Jul 2016) for all non-concession card holders and people over 16 years • Investment of $50 million into the sector, allocation will be determined where the rebate is low compared to the cost of providing the service • MBS Taskforce Review will continue without change • No change to Diagnostic Imaging Services Table, excluding MBS Taskforce Review, for next three years without consultation and agreement from the sector • DI indexation will resume when GP indexation resumes, currently scheduled for 2020. Now that the results of the election are confirmed we will realign our advocacy efforts to press for implementation of the Quality Framework reforms. This will occur in several stages, the first of which will cover:

1. Patient access to Medicare-funded imaging services provided in a comprehensive practice where a specialist radiologist is on site to attend the patient during normal working hours. 2. Patient access to Medicare-funded CT services in radiologist supervised comprehensive practices which also offer ultrasound and X-ray as a minimum. The current rural and remote exemptions will continue without change for the time being. This reform will enable patients to benefit from consistent professional supervision and clinical input from clinical radiologists as required to ensure that patients receive the most appropriate diagnostic imaging for their clinical circumstances, thereby reducing inappropriate imaging and waste in the system. This is a significant step towards true recognition of the role and value of the clinical radiologist in healthcare services. The second stage of the Quality Framework reform will focus on ultrasound and rural and remote service provision, these include: 3. Patient access to radiologist supervised diagnostic mammography and MSK ultrasound is improved. 4. Remote reporting will meet quality protocols to preserve the clinical chain of responsibility across all service components and rural patients will have real time access to supervising radiologists. 5. All comprehensive diagnostic ultrasound services will be performed by qualified practitioners. The College will continue to update members on key developments as implementation of the Quality Framework progresses.

If you would like further information about this, please contact Prof John Slavotinek c/o Melissa Doyle, Manager of Policy via Melissa.doyle@ranzcr.edu.au

Volume 12 No 4 I September 2016

Access to Quality Services

College’s International Development Fund in Action The purpose of the RANZCR Annual International Development Fund is to provide small grants for overseas development work undertaken by College members or College groups that will improve patient care and raise the standard of practice in both disciplines. As reported in Inside News in September 2015, two grants were awarded last year to a total value of $30,956. One of the grants assisted in funding a visit to Sydney by Dr Kaung Myat Shwe, a mid-career radiation oncologist from Myanmar. The other grant enabled the running of contrast-enhanced ultrasound workshops in Sri Lanka. Grant applications close in March each year. For further information visit the College website: www.ranzcr.edu.au/members/ international

Visit by Dr Kaung Myat Shwe from Myanmar According to a nationwide census in 2014, Myanmar has a total population of

Dr Kuang Myat Shwe

51.4 million and GLOBOCAN estimated that there were 63,600 new cancer cases in 2012. As there is no population based cancer registry system in Myanmar there is no data for incidence and mortality of the whole country so far. But according to the hospital based cancer registry of Nay Pyi Taw General Hospital, the most common cancers in males are lung, oral cavity, liver, stomach and colorectal. In females, the most common cancers are breast, cervix, lung, ovary and stomach. Currently we have eight radiotherapy centres for the whole country including four public, two private and two military centres. In Myanmar, there have been changes recently in every sector of the country such as politics, economics and health care, including radiotherapy. Major refurbishments of radiotherapy equipment include installation of new linear accelerators, CT simulators, immobilisation devices, dosimetry tools and HDR Brachytherapy systems. Therefore, we need more knowledge and best practice of radiotherapy treatment techniques for the treatment facilities we have, and in this transition period, we need help from developed

countries like Australia where we can learn new radiotherapy techniques. It was my great pleasure and I was very fortunate to have six weeks training in Australia including one week at the Australian Brachytherapy Conference and another week at the Cancer Institute, NSW. This visit is part of an ongoing engagement of the University of Sydney’s medical school with Myanmar and was possible with the financial support from The Royal Australian and New Zealand College of Radiologists. During the first week of my visit in Australia, I attended the annual Australian Brachytherapy Group (ABG) scientific meeting in Perth. The topics discussed in this meeting were about advanced brachytherapy techniques and I had the chance to expand and update my knowledge of brachytherapy practices, research and technology. I also met and had discussions with other international speakers and it was a very good chance for me to share knowledge and exchange information. Then I visited the Cancer Institute, NSW, which operates the NSW statewide cancer control activities. It has more than 100 staff working systematically for cancer screening and prevention, cancer services and information and cancer research. It was great for me to visit there because I had a chance to study the activities of cancer registration in NSW. As we are planning to have a population based cancer registry in the Nay Pyi Taw region, the visit was very fruitful for me. I made a presentation there about ‘Cancer Registration in Myanmar’ and we shared our own experiences and exchanged information about cancer data and will develop further collaboration between the cancer institutions of the two countries. The visits to Royal North Shore Hospital/ Northern Sydney Cancer Centre, Prince

Inside News

Access to Quality Services

of Wales Hospital, Royal Prince Alfred Hospital and Liverpool Hospital were also very good experiences for me. The radiation oncologists, physicists, radiotherapy technologists and all the staff were very welcoming and were very keen to share their experiences and practices with me. There was emphasis on IMRT techniques and therefore I had the chance to study contouring, planning and treatment verification procedures of various cancers by IMRT and SBRT techniques. I also attended multidisciplinary team meetings of all different cancer sites and it was very useful for me to hear and know the opinions of different professionals for each cancer treatment. We plan to try to develop this type of multidisciplinary

meeting in our hospitals. I also learned contouring and planning of 3D brachytherapy treatments and it is very useful for me because we are about to start 3D brachytherapy treatment at my centre.

CEUS Workshops in Sri Lanka

safe, and relatively cheap alternative to CT and MRI in many clinical scenarios, potentially often obviating the need to transfer patients to a major centre. CEUS has widespread acceptance around the world. However, its uptake in Australia and other ‘developed’ countries has been limited by the easy availability of CT and MRI.

Marilyn Zelesco examining a volunteer patient

In March 2016, in receipt of a grant from the College’s International Development Fund, our team of two radiologists (Dr Padmini Hewavitharana and myself) and two senior ultrasonographers (Elvie Haluszkiewicz and Marilyn Zelesco) travelled to Sri Lanka to run workshops on contrast-enhanced ultrasonography (CEUS). The aim was to introduce CEUS to Sri Lankan radiologists and to encourage and facilitate the dissemination of CEUS in Sri Lanka.

Background Most low-middle income countries, such as Sri Lanka, cannot afford CT and MRI machines and services, other than in major centres, but many peripheral health facilities do have ultrasound machines. CEUS provides an excellent,

This visit encouraged and reinforced my enthusiasm to develop a standard cancer registry system in Myanmar and the best practices of radiotherapy treatment for my patients. I would like to acknowledge Prof Graeme Morgan for this opportunity to study in Australia and to meet with various professionals of cancer care. Without his advice and constant attention to many details during my visit, I would not have enjoyed it so much. I also want to

CEUS can be performed on conventional US machines with dedicated software and some additional training of sonographers and imaging specialists. It has application in the examinations of many solid organs, especially the abdomen and vascular structures, and can be used at the bedside or in an emergency department if required. The enhancement patterns of lesions can be studied during multiple vascular phases in real time, with higher temporal resolution than is possible with other imaging modalities. US contrast can be given in the presence of renal impairment without the need for laboratory tests prior to administration. And of course there is no ionising radiation.

The Workshops Workshops were held in Colombo, Galle and Kandy and comprised of lectures and live demonstrations on volunteer patients, with a variety of liver and renal lesions. The workshops were held under the aegis and imprimatur of the Sri Lankan College of Radiologists, without which the project would not have been possible. Representatives from

extend my appreciation to A/Prof Kirsty Foster and Senice So from the University of Sydney, Craig Opie and Edward Noh from Royal North Shore Hospital, Prof Michael Jackson from Prince of Wales Hospital, the conference committee of the ABG meeting, Dr Mo Mo Tin from Royal Prince Alfred Hospital and Dr Myo Min from Liverpool Hospital for your warm reception and gracious hospitality during my visit. Dr Kaung Myat Shwe Consultant Clinical Oncologist Radiotherapy Department, Nay Pyi Taw General Hospital (1000 Bedded) Nay Pyi Taw, Myanmar

the Sri Lankan college undertook the recruitment of registrants and patients. Apart from some technical hitches, including power outages, all went reasonably smoothly. In total, about 30 patients with a variety of lesions were examined ‘live’. GE Medical was generous in supporting our team by transporting us between venues, providing US machines and the contrast (Sonazoid; kindly paid for by RANZCR). About 130 radiologists and radiologists-in-training attended the workshops. Audience reaction and verbal feedback have been very positive.

Conclusions As a result of these workshops, our belief is strengthened that CEUS provides a potentially extremely important, cheap and easily disseminated significant part of the solution to the problem of advanced imaging in developing countries. Clin Prof Richard Mendelson Emeritus Consultant Radiologist, Royal Perth Hospital Clinical Professor, University of Western Australia Adjunct Professor, Notre Dame University, Western Australia

Acknowledgements We wish to express our gratitude to the College, the Sri Lankan College of Radiologists, GE Medical and to Dr Sumudu Palihawadana for her untiring help in preparing for the workshops.

Volume 12 No 4 I September 2016

Quality Practice

Appropriate Use of Medical Imaging Forum Saturday 15 October at the Annual Scientific Meeting on the Gold Coast ‘Appropriateness’ is a hot topic in relation to medical imaging. In essence, it is about providing the right test or procedure to the right person at the right time in a safe, efficient, and cost-effective manner. It is about the patient, and sometimes the community in general, receiving a net health benefit from the procedure. Join the multidisciplinary local and international speakers as they share their experiences, including: • Mr Timothy Benson, Faculty of Clinical Radiology Council Consumer Representative • A/Prof Taryn Bessen, Consultant Radiologist, Royal Adelaide Hospital • Dr John Bonning, Emergency Department Clinical Director, Waikato Hospital, New Zealand • Dr James Brink, Chair, American College of Radiology Board of Chancellors

• Prof Stacy Goergen, Director of Research, Monash Health • Dr Megan Keaney, Principal Medical Adviser, Medicare Reviews Unit, Department of Health • Dr Robyn Lindner, Client Relations Manager, Heath Technologies NPS Medicinewise • Dr Kim McAnulty, Consultant Radiologist, Waikato Hospital, New Zealand • Dr Nicola Strickland, President, The Royal College of Radiologists Get involved in the discussions on Saturday15 October (8.30am – 12.30pm) at the 2016 Annual Scientific Meeting on the Gold Coast. Attendance is free of charge. Enrol when you register for the ASM www.ranzcr2016.com/registration

• Prof Paul Glasziou, Faculty of Health Sciences and Medicine, Bond University

RANZCR Standards of Practice for Diagnostic and Interventional Radiology Update

The Faculty of Clinical Radiology is pleased to announce the release of Version 10.1 of the Standards of Practice for Diagnostic and Interventional Radiology. To view the Standards, please visit http://www.ranzcr.edu.au/ quality-a-safety/radiology/standards-ofpractice

Release of Version 10.1

The Standards provide members with a quality management framework in which to establish and maintain continuous quality improvement in their practices and mitigate risk.

This document sets out for members the standards of practice the College has set for radiologists and radiology practices to support the delivery of safe, high-quality diagnostic imaging and interventional radiology services in both private and public hospital settings.

The Standards also provide a reference point for the College to influence the development of the Diagnostic Imaging Accreditation Scheme (DIAS).

Inside News

Version 10.1 of the RANZCR Standards provides amendments to Standard 13.2.1 Diagnostic Mammography Equipment to remove the word ‘monochrome’ so as to not exclude the use of colour monitors in mammography and to reflect recent evidence demonstrating colour mammography monitors meet the technical and diagnostic requirements for mammography reporting. Feedback and suggestions for improvements are welcome and can be directed to Daisy Garling, Senior Projects Officer, Quality and Standards via daisy.garling@ranzcr.edu.au

Quality Practice

Case Study: Management of Patients with Urgent and Significant Findings A recent death investigated by a State Coroner highlights the importance of adhering to RANZCR Standard 5.5.3. Scenario Frank is working as a busy clincal radiologist in a private practice setting on Friday. He notices that a patient, Mr Smith, who had a CT of his chest earlier that day for increasing shortness of breath over the past week, has bilateral lobar pulmonary emboli. Frank immediately tries to contact Mr Smith’s GP, only to find that the practice is closed as she is on leave. Frank also tries to contact Mr Smith who does not answer his phone. He reports the study immediately and continues to try to contact Mr Smith for the rest of the afternoon without success. With the practice due to close shortly at 5pm, what should Frank do next?

Discussion Most clinical radiologists are aware of their duty to communicate urgent findings regarding a patient’s scan to their referrer. What may be unclear or unknown to clinical radiologists is their duty in circumstances where a referrer is uncontactable or in situations where the referrer and the patient are both uncontactable. In accordance with The Royal Australian and New Zealand College of Radiologists (RANZCR) Standards of Practice for Diagnostic and Interventional Radiology Version 10.1, it is clear that Frank has a duty of care to ensure that Mr Smith receives timely and appropriate treatment for his condition that, if left untreated, may result in serious harm or even death. In addition,

it is evident that Frank, in the absence of Mr Smith’s referring GP, is the best positioned person to co-ordinate the next step of that care. In situations where a patient is uncontactable and requires immediate medical attention, medical practitioners should contact the ambulance or police service, or another suitable authority or service to perform a welfare check and ensure that the patient receives appropriate medical treatment. The importance of this was highlighted in a South Australian Coronial Inquest relating to the death of a 69-year-old woman in 2010. In that case, a CT scan revealed a pontine haemorrhage that was identified correctly by the reporting radiologist. The finding was immediately communicated to the referring GP who was then unable to contact the patient over the next six days, by which time she was found deceased by her daughter. Importantly, the patient had been seen alive up to five days after her scan. The Coroner deemed that the unsuccessful phone calls made to the patient by the GP practice were not sufficient and that the GP should have put in place a plan to ensure that the patient was contacted. This failure to contact the patient to initiate urgent medical treatment was considered likely to have contributed significantly to the patient’s death. The Coroner recommended that in such circumstances medical practitioners contact an ambulance or police service to conduct a welfare check.

every year on the time between the performance of the study and the issuing of the report.

Indicators 1. The practice has a documented policy for report turnaround times which sets out expected turnaround times for defined urgent and nonurgent findings. 2. The practice maintains records of regular reviews of reporting turnaround times in accordance with this policy, and implements and records corrective action should there be any indications that the designated reporting times are not being met. 3. If there are urgent and significant unexpected findings, there is a protocol which ensures that: a) the reporting radiologist uses all reasonable endeavours to communicate directly with the referrer or an appropriate representative who will be providing clinical follow-up; b) a record of actual or attempted direct communication is maintained by the practice; and c) the reporting radiologist coordinates appropriate care for the patient if they are unable to communicate such findings to the referring clinician. Dr Ronny Low Chair, CT Reference Group

Relevant RANZCR Standard 5.5.3 Communication of Imaging Findings and Reports The practice shall ensure that reports are made available in a clinically appropriate, timely manner and shall carry out regular reviews at least once

If you have any questions or comments, please contact Daisy Garling, Senior Projects Officer, Quality and Standards at daisy. garling@ranzcr.edu.au

Volume 12 No 4 I September 2016

Quality Training

ESTRO Evidence Based Radiation Oncology Course

Have you registered yet?

Sydney, 19-22 November, 2016

This clinical refresher course will be jointly hosted by the European Society for Radiotherapy and Oncology (ESTRO) School, the premier organisation for radiation oncology education in Europe, and the RANZCR Faculty of Radiation Oncology.

There is still time to register to attend the Evidence Based Radiation Oncology Course from 19–22 November at the ParkRoyal Hotel, Darling Harbour, Sydney, Australia.

The course will explore the evidence basis behind the indications for radiotherapy, and the radiation therapy techniques for commonly occurring malignancies. Illustrative cases will be integrated into each sub-site session and will form the basis of discussion. In addition, this year will be the first year in the course history to include the subsites, skin and central nervous system.

Inside News

Keynote speakers include Dr Chris Cottrill (London), Prof Johannes Kaanders (Netherlands) and Dr Li Tee Tan (Cambridge). The program will also feature a number of high-profile local faculty. The program is available to view via the website www.ebro2016sydney. com Delegates will have the opportunity to network with the international speakers at the course dinner on Monday 21 November at L’Aqua, Dockside, Darling Harbour. Dinner is included in the registration fee. Numbers are strictly limited, so register now to secure your place via the website www.ebro2016sydney.com We look forward to welcoming you to Sydney in November. Dr Penny Mackenzie Convenor

Quality Training

RANZCR/ACR Educational Courses “Absolutely fantastic, very clinically relevant and effective learning” Inaugural RANZCR/ACR Educational Courses are met with rave reviews. In early July, the College in partnership with the American College of Radiology (ACR) hosted some inaugural educational courses on High Resolution CT of the Chest (HRCT) and Emergency Radiology at the Amora Jamison Hotel, Sydney, Australia. These intensive, hands-on three-day courses were delivered on individual workstations that emulate a clinical environment. An active, customised learning experience was provided via the ACR Case Engine and an expansive repository of cases/ data sets. Both courses had case-bycase feedback provided by renowned course directors from the US. Registrations were advertised to radiology members in mid-January, with a large number of registrations received within the first 48 hours. The launch of the RANZCR/ACR education offering was met with such unprecedented demand that a second HRCT Course was offered to the members to run concurrently with the Emergency Radiology course. The HRCT course was led by course directors Jeffrey Kanne, MD, FCCP, and Gerald F. Abbott, MD, FACR, and is designed to provide practising radiologists with the skills and understanding necessary to interpret high resolution CT of the chest in diffuse infiltrative lung diseases. Developed in conjunction with the American Society of Emergency Radiology, the Emergency Radiology course is designed to provide the practising radiologist an intensive hands-on experience in imaging interpretation of traumatic and nontraumatic emergencies. This course was led by Jorge Soto, MD and O. Clark West, MD, FACR.

The feedback received by the course participants was overwhelmingly positive. “Exceptional course; superbly organised” “Excellent moderators and cases. Learned a lot.” “It has been one of the best (courses) I have ever attended.” 100% of the participants indicated they would register to attend another course in the future and would recommend a colleague to attend a RANZCR/ ACR Education Centre Course. The College would like to thank EIZO and Fujifilm Australia for assisting in the delivery of these courses to its members. EIZO provided the Radiforce RX850 Diagnostic monitors and ColorEdge CG277 monitors for the participants to use review the cases, while Fujifilm Australia provide the technical and application training assistance via application specialist support to ensure course participants got the most out of hands-on interpretation of related cases using Synapse PACS.

Additionally, the College would like to extend a heartfelt thank you to the ACR Education Centre teaching faculty and its operations team, Mr Vinay Sandhir and Ms Kerri Waldren for their time, effort and investment in ensuring the success of these inaugural courses for our College members. If you missed out on attending one of these exceptional courses in 2016, the good news is there will be an opportunity for you to attend next year. Based on the positive feedback for this year’s offerings, the College in conjunction with ACR is currently investigating the prospect of hosting several courses during August 2017. While the modalities and Faculty are yet to be finalised, potential course topics that may be on offer include Neuroradiology, MSK, Body and Pelvic MR and additional HRCT.

More courses coming in 2017. To register your interest to receive more information, please contact the Conferences and Events Team at events@ranzcr.edu.au

Volume 12 No 4 I September 2016

Quality Training

Clinical Educator’s Development Program For those of you who have worked alongside A/Prof David Lisle, you will agree that he has been a significant contributor to the betterment of radiology training in Australia and New Zealand. Queensland trainees in particular have benefited greatly from his educational discourse, shared generously over many years. I have been one such benefactor of his dedication to teaching, and am lucky enough to consider him my mentor. Last year at the College Annual Scientific Meeting in Adelaide, David was formally recognised for his contributions and was awarded the inaugural Clinical Radiology Educational Service Award. As part of the award, David was asked to nominate a junior radiologist to participate in the Clinical Educator’s Development Program (CEDP) in Los Angeles, which is a prestigious, international one-day educator’s course held before the American Roentgen Ray Society (ARRS) meeting. Despite his initial shock at not being considered a ‘young’ radiologist himself, David nominated me to attend. I was a little taken aback and, quite frankly, truly honoured to be asked, so I graciously accepted. It has been three and a half years since I completed the formal component of my training and thanks to great teachers like David, I have developed a keen passion for teaching. I am a full-time public radiologist, sole Director of Training of the College’s largest hub, as well as being actively involved in several educational endeavours including Managing Director of Radiopaedia.org, College co-lead anatomy examiner and soon-to-be Part II examiner. Seated in a 747 flight to Los Angeles in April, I reflected on what type of educator I am and what type of educator I want to be. I have striven to be a competent teacher and leader, but am

Inside News

I truly? Always wanting to improve my skills, the promise of an expert-lead program in teaching was thrilling. The annual CEDP is a highly interactive, focused program with a faculty that includes some of USA’s most experienced and respected radiology professors including Prof Petra Lewis (bit.ly/PetraLewis) and A/Prof Jonathon Swanson. The theme was ‘brain-friendly teaching’, which aims to increase learner retention through teaching as effectively as possible. Radiologist educators from all over the world were presented with skills sessions on oral presentation, MCQ item writing, classroom flipping, task managers and lecture video-recording. A common element throughout the course was the integration of technology into teaching delivery, leading to increased engagement with students and a more rewarding and successful educational experience. By incorporating these principles into my teaching sessions, I aim to increase active learning by using Radiopaedia.org case playlists and online polling. I was also able to attend the ARRS meeting, which was a great learning and revision course on a variety of radiology subjects. It is well suited to the general radiologist aiming to brush up on specific topics. Attending the conference with my good friend, Frank Gaillard, Founder and Editor-in-Chief of Radiopaedia.org was an added bonus. I am sincerely grateful to both David Lisle and the College for nominating and supporting my attendance. I hope the skills I learnt at the CEDP will benefit my trainees and the College in the future. Dr Craig Hacking Clinical Radiologist

Quality Training

Constructive Alignment and Programmatic Assessment in Registrar Training The recommendations for improvement handed down by Prof David Prideaux in his 2015 review of the College’s assessment programs centred on two key concepts: constructive alignment and programmatic assessment. Constructive alignment is about clearly articulating the learning objectives and student learning outcomes of the training program and ensuring that they are aligned with the curriculum content, the teaching strategies and the assessment tasks. It’s about ensuring a balance between theory and practice and having a well-defined framework of assessments and examinations to evaluate the learning outcomes. The College’s training program curriculums conform to good curriculum design, and while the radiation oncology curriculum is organised according to learning outcomes and includes statements of overall learning outcomes, the clinical radiology curriculum requires some additional work. The clinical radiology curriculum contains statements of educational principles, details on assessments, key conditions and experiential requirements. There are syllabus statements for the medical expert roles of the program, however improving the documentation on learning outcomes will assist with clearer models for assessment. Over the coming months statements on overall learning outcomes for the nonmedical expert roles will be developed. These statements will not only guide the overall assessment program but will also identify to any trainee or clinical supervisor what the expected learning outcomes of that syllabus are. Once the learning objectives have been identified, the way in which they are assessed can be developed. The tool for assessment needs to be appropriate and be able to capture the information

required to determine if the expected outcomes have been reached. A formal examination is one such tool. However often an examination may not be the best performing tool or may not be the only assessment tool used to build a comprehensive picture of performance.

“Programmatic assessment is about having a holistic view of performance across multiple events.” This is where programmatic assessment is introduced. Programmatic assessment is about having a holistic view of performance across multiple events. It recognises that competency develops over time, so assessment information is gathered in a progressive way, and all available data is used to measure the achievement of learning outcomes. The College’s curriculums are supported by well recognised assessments and examinations tools and on face value there are alignments with the curriculum statements. However in both training programs, each assessment and examination is a unique event with no relationship between each activity. As an example there is no clear relationship between the work-based assessments and examinations. Over the coming months the assessments and examinations of each training program will be reviewed. The exact purpose of an assessment and examinations will be documented and related back to the overall outcomes of the curriculum. The overall framework of assessments will also be reviewed so that a trainee’s performance is not evaluated using

one assessment tool but by evaluating performance across a number of assessment tools. This will allow for the strengths and weaknesses of a trainee to be captured across multiple instruments and provide more comprehensive information about trainee progress. The move to programmatic assessment may mean that work-based assessment tools change in the future. This could also assist with addressing workload issues by identifying areas of overlap and redundancy to allow for assessments that provide sufficient information to evaluate a trainee’s progress through the training program. It will also provide opportunities to have more targeted and focused feedback to trainees about performance. Two steering committees have been established to oversee the review and development of constructive alignment and programmatic assessment. A/Profs Margot Lehman and Sandra Turner, Dr Matthew Seel, Prof David Prideaux and the Head of Specialty Training will lead radiation oncology. A/Prof Dinesh Varma, Drs Meredith Thomas, Barry Soans, Alexandria Taylor and Graeme Anderson, Prof David Prideaux and the Head of Specialty Training will lead clinical radiology. This review will require the knowledge and collaboration of many members. To support the development of the programmatic assessment over the next 12 months, a number of working groups will be established. Members are encouraged to be a part of these developments.

If you are interested in being involved please contact A/Prof Varma or Lehman c/o Mr Adam Rayment, Manager Special Projects, at adam.rayment@ranzcr. edu.au or phone +61 2 9268 9706.

Volume 12 No 4 I September 2016

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Learn more at varian.com/velocity 38

Inside News

Quality Training

Fair and Equitable Pathway to Fellowship Changes to eligibility requirements for New Zealand international medical graduates The College Board discussed the New Zealand vocational scope of practice pathway to FRANZCR at its March 2016 meeting and determined that in order to be eligible to apply for Fellowship of the College, all clinical radiology applicants are to meet the same requirements. This was deemed to be a fair and equitable decision. Therefore, the vocational scope of practice pathway for Fellowship of the College was closed by the Board in March. Any new international medical graduates (IMGs) arriving in New Zealand will be required to successfully complete all components of the Part 2 examination in order to be eligible to apply for Fellowship. A phasing in process has been established for those IMGs currently working in New Zealand on a provisional

Faculty of Radiation Oncology Phase 1 Foundation and Exam Preparation Course

or vocational scope of practice, who may currently be eligible, or are in the process of meeting the criteria for the New Zealand vocational scope of practice pathway. The criteria for eligibility* through the pathway is as follows: • Minimum of two years in a Vocational Scope of Practice in New Zealand • At least seven years as a consultant in total (counting the years prior to entering the pathway and/or after achieving vocational scope of practice) • Completion of a multi-source feedback – facilitated by the College. Eligible New Zealand IMGs can register intent to complete the pathway described above, by: • Submitting a letter requesting to be added to the pathway register; AND

• Submitting a copy of an updated curriculum vitae. Please forward submissions to img@ ranzcr.edu.au by 31 December 2016. All eligible New Zealand IMGs have been notified of this change via electronic and hard copy communication. *Conditions apply

Any questions? If you did not receive notification, have any questions or would like more information please contact Dr Martin Marshall c/o Wendy Frazer, Senior Education Officer, IMG on 61 2 9268 9724 or wendy.frazer@ranzcr. edu.au or at img@ranzcr.edu.au

The Phase 1 Foundation and Exam Preparation Course was held between 16 and 19 June at Rydges World Square in Sydney, NSW. The annual course is designed for Phase 1 trainees who are aiming to sit the Phase 1 exams. This year, 49 trainees attended the four-day event.

Course co-convenors Drs Claire Hardie and Marcus Dreosti would like to thank sponsors AbbVie, Ferring Pharmaceuticals and Ipsen for their generous support, and also extend their thanks to the facilitators, speakers and College staff for their time in order to run the program.

The program provided trainees with didactic lectures in the main topic areas to supplement their knowledge in the four basic sciences. It also provided specific guidance on exam preparation and techniques including a mock exam on the Sunday.

The Phase 1 Foundation and Exam Course will be held once again in June 2017. Trainees aiming to sit their Phase 1 exams are strongly encouraged to attend the course to assist in preparing for their upcoming exams. Details will be available via the College website or by emailing the conferences and events team at events@ranzcr.edu.au

It wasn’t all work and no play over the three days, with the trainees, facilitators and sponsors coming together in an informal setting on the Saturday night to network over drinks and canapes at the Cidery Bar and Kitchen.

Volume 12 No 4 I September 2016

Quality Training

Continuing Professional Development and Audit Did you know… The Post Fellowship Education and CPD Committees have worked together to develop CPD programs that align clinical radiology and radiation oncology in structure, requirements and points. To be CPD compliant, radiology and radiation oncology CPD participants are required to: • Complete a minimum of 30 CPD points per year • Complete a minimum of 180 CPD points per triennium • Complete CPD activities across a minimum of 3 categories Compliance with CPD is mandated by the College, and is a requirement for specialist registration with the Medical Board of Australia and the Medical Council of New Zealand. For more information, refer to the 2016-2018 CPD handbooks via http://www.ranzcr.edu.au/cpd/overview

RANZCR CPD Audit Each year the College undertakes a random audit of 7% of members participating in the CPD program. This is an opportunity for our members to ensure that they are compliant with the RANZCR CPD program and are fulfilling their medical registration requirements. The audit provides members an opportunity to review and understand the appropriate evidence that they need to provide when they claim CPD points. The RANZCR CPD Audit commences in May every year and only the previous year of CPD activities is audited. For more information on the RANZCR CPD Audit, refer to: http://www.ranzcr.edu.au/cpd/ overview/audit

ANNUAL CPD SUBMISSIONS ARE DUE ON 31 JANUARY

The Australian Health Practitioner Regulation Agency (AHPRA) requires all registered medical practitioners in Australia to participate in CPD that is relevant to their scope of practice. From 1 October 2016, the Medical Board of Australia will enforce revised CPD and recency of practice registration standards. For further information refer to: http://www. medicalboard.gov.au/Registration-Standards.aspx CPD participants registered to practise in Australia should also note that AHPRA has commenced randomly auditing medical practitioners. It is advised that members retain evidence of their CPD activities for the duration of the triennium and an additional two years. For more information on AHPRA’s audit, go to: http:// www.medicalboard.gov.au/Registration/Audit.aspx

The Medical Council of New Zealand (MCNZ) requires all New Zealand Fellows, Educational Affiliates and CPD participants to meet the requirements of the CPD program which includes: • A minimum of one Audit per year • A minimum of 10 hours of Peer Review activity per year • A minimum of 20 hours of Educational Activities per year Members registered to practise in New Zealand should also note that MCNZ conducts an annual random audit of 15% of medical practitioners each year. For more information on MCNZ requirements: https://www.mcnz.org.nz/maintain-registration/ recertification-and-professional-development/

Contact us: If you have any questions about your CPD activities, feel free to contact us via email: cpd@ranzcr.edu.au or phone +61 2 9268 9777

Inside News

Clinical Radiology

A Message

from the Dean

Prof John Slavotinek

Medicare Reforms in Australia Last month I attended the Diagnostic Imaging Advisory Committee meeting in Canberra. Following the reelection of the Turnbull Government, as promised during pre-election campaigning, the government will progress implementation of the Quality Framework measures. Further consultation will follow on the recommended path to implementation which has been substantially influenced by RANZCR and ADIA. The agreement by government to re-instate indexation of diagnostic imaging rebates when the rebate freeze for general practitioners ends is also most welcome and represents a major achievement due to joint advocacy by RANZCR and ADIA. We will continue to share key developments with members as they arise.

Telehealth Standards in New Zealand The Medical Council of New Zealand (MCNZ) has recently published its revised Telehealth Standards which govern telehealth both within and beyond New Zealand’s borders. The Faculty responded to outline the provision of telehealth within the clinical radiology setting and provided key principles which should be adopted to safeguard patients. We continued to engage with the MCNZ, partner medical colleges and the NZ Medical Association right up to publication of the revised standards. Several of the Faculty’s recommended changes have been included, however we are still

working through the implications of the new standards, particularly in relation to how the registration requirements will work. The new Telehealth Standards are available on the MCNZ’s website and I encourage all Fellows to have a look www.mcnz.org.nz

Choosing Wisely I would like to report back to members that as one of the founding members, RANZCR is provided with an opportunity to comment on draft Choosing Wisely recommendations from other colleges and societies. We recently worked closely and productively with The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) on one of their recommendations which relates to diagnostic imaging and the place of point of care ultrasound in obstetric care. The final recommendation aligns with RANZCR’s view on the distinction between referred ultrasound and point of care. I am grateful to Prof Stacy Goergen, Chair of the Safety, Quality and Standards Committee for her assistance during this engagement with RANZCOG.

Education Modules on Appropriate Imaging I had the pleasure of contributing to the successful launch of education modules and a phone app to support appropriate referrals for diagnostic imaging at the Royal Adelaide Hospital last month. The education modules are targeted to medical students and junior referring doctors and the phone app

assists referring doctors at the point of care. At this time it is anticipated that the educational modules will be incorporated into the curriculum of medical schools at Adelaide and Flinders Universities. I am grateful to Prof Stacy Goergen and A/Prof Taryn Bessen for leading the successful presentation. This activity is part of a joint initiative between RANZCR and Choosing Wisely and follows on from other such activity interstate. This process also illustrates how the work of the College and its Fellows can help to shape appropriate and judicious use of medical imaging in the future. I would encourage Fellows with an interest to seek to do likewise in their Branches. If you would like to know more about this, please contact jessica.brown@ranzcr. edu.au.

Upcoming Annual Scientific Meeting I am very much looking forward to the upcoming Annual Scientific Meeting (ASM) at the Gold Coast. The ASM Committee and convenors have put together an exciting program of speakers with national and international leaders in both clinical radiology and radiation oncology. I am particularly looking forward to the Appropriate Imaging Forum which will showcase the work to date of the College in this critical area of medical practice. The forum will bring together policymakers, regulators, public health academics, consumers and clinicians to discuss ways we can work together by using medical imaging appropriately to improve the health of our community. Volume 12 No 4 I September 2016

Clinical Radiology

This year’s Faculty of Clinical Radiology Forum will consider the often controversial realm of role extension for allied health professionals within the clinical radiology team. Guest speakers have been invited to give their perspectives of the advantages and disadvantages of role extension. I hope to see you there.

New Screening Program for Coal Workers Pneumoconiosis As noted on page 27 in this edition, coal workers pneumoconiosis (CWP) is still a major political issue for the Queensland Branch and the College. You will have seen a number of media releases from the College on this issue during 2016. In July, the Queensland Government implemented a new screening process with double reading, which we support as good practice in healthcare screening, much like BreastScreen. Regrettably, the Queensland Government has also insisted that the second reading be done by a B-reader in the United States of America. The College has made a number of representations stating that we do not feel that unregistered practitioners should be allowed to practise medicine in Australia. We will continue to advance the view that CWP be dealt with sustainably within our own healthcare system.

Faculty of Clinical Radiology Council on this rapidly advancing area of practice. A series of new bodies have been established to develop College policies in the following areas: • Safety, Quality and Standards Committee • Acute Stroke Working Group • Teleradiology Standards Working Group • Written Report Guidelines Working Group Expressions of interest are placed on the College website for vacancies on these and other bodies (www.ranzcr.edu. au/members/get-involved). We need your expertise, skills and perspectives to ensure that we develop the right policies that align with best practice and establish a firm foundation for the future. In due course, policies developed by these bodies will be shared with the membership for input. If you cannot spare the time to get involved in Faculty bodies directly, you can still provide your advice through these member consultations. Please feel free to contact the Faculty at any time on fcr@ranzcr. edu.au

New Bodies within Faculty of Clinical Radiology The Faculty is continuing to evolve its governance structures to ensure that we align with our key strategic priorities and remain responsive to external developments. As the President notes in his piece in this issue, an Interventional Radiology Committee has been established to provide advice to the

Inside News

If you have any questions or comments about this article, please contact Mark Nevin, Senior Executive Officer, the Faculty of Clinical Radiology on fcr@ranzcr.edu.au

Clinical Radiology

Chief Censor in Clinical Radiology

A/Prof Dinesh Varma

The second half of the year has commenced with much activity.

Examination and Assessment Review The Examination and Assessment Review task force leading the ACER/ Prideaux review met in May to determine the workplan for the proposed recommended improvements. Four work areas have been identified: governance; examinations; programmatic assessment and infrastructure and resources. Steering committees for clinical radiology and radiation oncology have been created to support programmatic assessment and governance. Dr Meredith Thomas, Dr Barry Soans, Dr Alexandria Taylor, Dr Graeme Anderson, Prof David Prideaux, the Chief Censor and the Head of Specialty Training form the clinical radiology steering committee. Further information about the review can be found on page 37.

Examinations As I write this article, the 2016 Series 2 examinations are all being actively prepared. In November our Vivas will be held in Melbourne for the first time, at the Novotel St Kilda. The move to Melbourne starts a new journey for our Viva examinations as we prepare to transition to the National Testing Centre (NTC), a purpose-built examination centre in Melbourne, from Series 1 in 2017. I look forward to sharing more details with you in the next edition of Inside News.

The Clinical Radiology Examination Reference Panel (CRERP) recently increased its membership to support the additional activities and developments of our future examinations. Dr Barry Soans has been appointed Chair, and will lead the current and new members, Dr Ben Wilson, Prof Michael Ditchfield, Dr Gabriel Lau, Dr Jim Koukounaras and Dr Robert Loneragan on this important journey.

Applied Imaging Technology Examination Reference Panel Recently I met with our lead Applied Imaging Technology (AIT) examiners Prof John Heggie and Dr Kieran Maher to discuss the structure and support for the AIT examination team moving forward. For those of you who are not aware, Prof Heggie has been a College examiner for a significant period of time, including a long tenure as the AIT chief examiner. The College is indebted to Prof Heggie for his knowledge, passion and guidance in preparing and setting our AIT examinations. This work is only possible with the support he receives from Dr Kieran Maher and the extended AIT exam team. On behalf of the College I would like to offer a sincere thanks to Prof Heggie as he prepares to retire from our examinations team and for continuing to offer guidance as we transition. I am pleased that Dr Kieran Maher has agreed to continue to support our examinations into the future, Kieran is a great asset to the College and our examinations.

As part of our governance review, the AIT examination group will be recognised more formally (and supported) within the College structure and renamed the AIT Examination Reference Panel (AITERP). Prof Heggie and Dr Maher have provided advice on the appropriate structure of the panel and the criteria for membership as an AIT examiner. Henceforth, the panel membership will consist of 12 AIT examiners, including up to two radiologists (desirably). Expressions of interest have been circulated through the Australasian College of Physical Scientists & Engineers in Medicine and the College.

New Zealand Registrar Centralised Recruitment The New Zealand centralised recruitment process was held 3-4 July 2016. I, along with Sandra McDonald, Manager Training and Accreditation from the College, was fortunate to attend. Talking with directors and supervisors of training, it was welcoming to hear that many of the issues being faced are exactly the same in both countries, albeit with some local flavour. I say welcoming because the current planning and work underway should make a significant difference to both jurisdictions. I would like to sincerely thank the New Zealand Branch directors and supervisors of training and Branch Education Officer (BEO) Dr Lisa Sweetman, for their warm hospitality along with Mr Alexander Brunt, Manager, New Zealand, as well as the New Zealand office staff for the support provided.

Volume 12 No 4 I September 2016

Clinical Radiology

Director of Training (DoT) Workshops

sites when more details regarding Deeds of Variation of contracts are known.

It was a great pleasure to be back in New Zealand at the New Zealand DoT Workshop on 4 August. While I provided a training program update, I am sure the highlight for those in attendance was the presentation from Dr Rawiri Jansen, President of Te ORA Mãori Medical Practitioners Association. Dr Jansen spoke about cultural issues, including raising awareness of Mãori health issues and supporting Mãori trainees in medical training. This was followed by a very informative session from Ms Wendy Beverley from Claro Health Sector Law who explained the legalities and responsibilities of the role of DoTs in New Zealand. I also found this very beneficial, given the different legislative and legal frameworks to that of Australia. I look forward to making the New Zealand DoT workshop a regular event on the College calendar.

The details of the new Integrated Rural Training Pipeline (IRTP) posts are yet to be released. The College is expected to be advised in the coming weeks. Information will be passed on once it’s available. If you have any questions regarding STP please contact Shane Bryan, Senior Project Officer, Specialty Training Unit at shane.bryan@ranzcr.edu.au

As part of the College’s commitment to continually improve the training program, there is a final DoT workshop being held in October 2016. Prof Prideaux will present at this event which will focus on actively reviewing the future training assessments. This workshop will be held at the College’s Annual Scientific Meeting on Wednesday 12 October 2016 at the Gold Coast Convention Centre. Please submit your RSVP to radtaa@ ranzcr.edu.au

STP Funding Extension Approved for 2017 The Australian Minister for Health, Hon Sussan Ley MP, recently approved the extension of the Specialist Training Program (STP), including the Tasmanian Project and Emergency Medicine Program for 2017. The training posts and funding arrangements for 2016 will apply for 2017. The College will contact STP

Inside News

STP Private Infrastructure and Clinical Supervision Funding Many STP sites are eligible for Private Infrastructure and Clinical Supervision (PICS) funding, which will become available shortly. PICS is facilitated through The Royal Australasian College of Medical Administrators (RACMA) and is a key component of STP and aims to expand and enhance training in the private sector. Funding is available to support clinical supervision and infrastructure with funds of up to $30K per annum, pro rata for clinical supervision and $10K pro rata once every three years for private infrastructure based on each private sector full-time equivalent STP training post. For further information on how to apply, visit the RACMA website http://tinyurl.com/ STPPICS

Updated Consideration of Special Circumstances Policy All trainees and international medical graduates need to be aware that this policy has been updated and is now available on the College website at www. ranzcr.edu.au/resources/professionaldocuments/policies I have really enjoyed meeting so many members that are involved in training, listening to the challenges, suggestions and innovations for the future, which

have all been insightful. Your support and willingness to contribute has been fantastic. I look forward to sharing more of our progress in the next edition of Inside News.

If you would like any further information or would like to comment on any of the above, please contact Pamela Taylor, Head of Specialty Training on radtaa@ranzcr.edu.au

Clinical Radiology

Radiology Trainees Update

The College Annual Scientific Meeting (ASM) is fast approaching and following on from the excellent session in Adelaide last year, the Trainee Learning Day looks to be another exciting opportunity for trainees to expand their knowledge and get helpful tips and tricks on navigating the Part 2 exams and research components of the curriculum. Kicking off the Friday will be the Branch of Origin session where young researchers from each Branch will give a short presentation on their research topic to be judged by a panel of experts. To the victor goes the spoils of a free trip to the RSNA meeting in Chicago to represent the College and present their winning project at the biggest medical conference in the world.

The Trainee Learning Day proper will follow with sessions on viva exam techniques and a host of subspecialty topics. There will be a new session on the written report examination with a team of examiners providing critique on a selection of exam answers. Questions will be uploaded to Radiopaedia in the lead up to the ASM and trainees will have the opportunity to write their own practice answers to these questions. There will also be a session on late-night emergency reporting as well as a session on identifying and delivering a research project by the Director of Radiology at the University of Cambridge (see box below).

Consultants Reception held at Clifford’s Grill and Lounge at the Watermark Hotel on Friday evening. To facilitate interdisciplinary dialogue, the evening will be a combined radiology and radiation oncology reception, providing opportunities to network with other trainees and young Fellows from Australia and New Zealand. See you in the Gold Coast! Dr Jules Catt Chair, Radiology Trainees Committee

Perhaps the most significant and important part of the ASM schedule will be the Trainee and Junior

Clinical Radiology Research Forum Friday 14 October at the Annual Scientific Meeting Thinking about your Project 2 proposal or RANZCR Research Grant application? Thinking about how to publish your manuscript and looking for some advice? Returning after its inaugural launch in 2014, the Clinical Radiology Research Forum, presented by the RANZCR Clinical Radiology Research Committee, aims to support trainees embarking on Project 2 or applying for grants and publishing their manuscripts by providing information on the successful planning, implementation and delivery of research. Take advantage of this unique opportunity and learn from our leading radiology researchers and previous grant recipients, including international guest speaker, Prof Fiona Gilbert from University of Cambridge who is an active researcher and Head of the Department of Radiology; and Prof David Ball, recent Editor of JMIRO.

The sessions will outline how to identify and deliver on a research project, publication requirements and how to get your manuscript across the line. The current Clinical Radiology Curriculum consists of Projects 1 and 2. The projects will soon be replaced by only one ‘advanced’ project, subject to approval by the Curriculum Assessment Committee and Clinical Radiology Education and Training Committee. Trainees will be given clarity on this ‘advanced’ project—what it is, its requirements and assessments at the forum. The event will also be of value to Directors of Training.

Volume 12 No 4 I September 2016

Clinical Radiology

ADIA Update United Stand

For many years, radiologists have complained about our inability as a craft group to gain government support. For many years the problem was the same; our tendency to splinter into special interest groups which are not politically relevant. Finally, this has changed. In the recent federal election, Australians made it clear that they value bulk billing. They want free health care, in and out of hospital, which is in stark contrast to what many diagnostic imaging patients experience—low rates of bulk billing and higher and higher gaps. For the first time, diagnostic imaging— under the “scans and tests” headline— became politically relevant because bulk billing was believed to be at risk. Australian Labor Party 12 April ∙

Mr Turnbull’s cuts to Medicare are set to push up costs for vital services and have a devastating impact on women’s health. Labor will always stand to protect Medicare.

PAP SMEARS

BLOOD TESTS

ULTRASOUND

MAMMOGRAMS

X-RAYS

AUSTRALIAN WOMEN CAN’T AFFORD MALCOLM TURNBULL’S $650 MILLION CUTS TO TESTS AND SCANS SHARE IF YOU THINK THIS IS UNFAIR

Comment

ADIA seized the opportunity to create political headway and make meaningful progress on issues important to the sector. After many meetings with the Health Minister Sussan Ley and her office, the Prime Minister’s office and other senior ministers, our arguments in support of evidence-based policy were recognised.

Inside News

Dr Wriedt We achieved an agreement with the Turnbull Government which ensures that indexation of diagnostic imaging rebates will resume when the current GP rebate indexation freeze concludes. It will also see the introduction of a long-awaited Quality Framework, which is pivotal to recognising the role of the radiologist as a medical specialist. The details of the agreement, announced on 5 June, were published by the Government, ADIA and RANZCR and are available on ADIA’s website. Of course, this outcome was only possible due to the years, not months, of collaboration, engagement and trust between RANZCR and ADIA. In particular, we would like to thank the RANZCR President, Dr Greg Slater, Dean of the Faculty of Clinical Radiology, Prof John Slavotinek, as well as the College management team including Mark Nevin and Andrew Paine led by Natalia Vukolova as CEO. When challenged, all stakeholders stood unanimously behind the Quality Framework and the need for indexation when the freeze was lifted on GPs. We were united in our indignation when Labor leader Bill Shorten referred to medical specialists and didn’t include radiologists. United, we will continue to defend radiologists as medical specialists

with a vital role to play in the nation’s health—a position supported by newly reappointed Health Minister, Sussan Ley: “Advancing technology in many areas of the health system creates a much more efficient and automated service, leading to decreased costs. However this is not the case for most diagnostic imaging services which need specialist doctors to supervise the examination and analyse the results, not machines.” Minister Ley played a crucial role in the government’s commitment on diagnostic imaging policy, and we are looking forward to working with her to implement what was agreed. As a craft group and a health care sector, this commitment by the government provides us with a sound base from which to continue our joint push for policies and funding which support access to quality radiology services for all Australians. This is great news for radiologists and our patients. Dr Christian Wriedt ADIA President

Clinical Radiology

Interventional Radiology 2016 – Where do we stand? A/Prof Lourens Bester shares his views on the current state of play Background Interventional radiology (IR) is a subspecialty of radiology that utilises minimally-invasive image-guided procedures to diagnose and treat diseases in nearly every organ system. Interventional oncology (IO) is a subspecialty of interventional radiology that deals with the diagnosis and treatment of cancer and cancer-related problems using targeted minimally invasive procedures. The field of endovascular surgery arose from interventional radiological techniques to treat disease that is endovascular and has become an alternative to vascular surgery for some conditions such as abdominal aortic aneurysm and peripheral artery disease. Interventional cardiologists have now also entered the field of interventional radiology performing endovascular procedures on the pelvic, renal and carotid arteries (Drive-by renal stenting). It is now well recognised that interventional radiologists have almost completely lost control of the endovascular management of peripheral vascular diseases to vascular surgery, and carotid stenting to cardiology. This has lead them to concentrate and direct their practices towards interventional oncology. This was helped along by private hospital angiography facilities wanting to fill their available lists and offering vascular surgery the opportunity to have angiographic facilities without having to pay a facility fee. The same opportunities were available but were not taken up by interventional radiologists, with the exception of a small number of lone practitioners. In the meantime, vascular surgeons have decided to enter the arena of interventional oncology and are now readying themselves to be trained in IO.

At present neither IR nor IO is recognised by the Australian Health Practitioner Regulation Agency (AHPRA) as a subspecialty whereas vascular surgery is.

The Problem It is quite possible that interventional radiologists will lose intervention completely as they do not control the referral base and do not act as consultants. Many just do what is requested on the referral without actively getting involved with the patient. In a nutshell, interventional radiology is not recognised by AHPRA as a subspecialty; interventional radiologists cannot refer to themselves; they do not have recognition in the hospitals they operate in; and there is no recognised interventional radiology subspecialty credentialing.

CoPET and EBIR At present the Conjoint Committee in Peripheral Endovascular Therapy (CoPET) recognition of training is a very easy way of getting credentialed as it is widely recognised by hospital administrators as a form of accreditation. It is often used by hospital administrators to counter a complaint from interventional radiologists that the vascular surgery operator is performing suboptimally, with the statement that he or she is CoPET accredited. The European Board of Interventional Radiology (EBIR) qualification is the future and interventional radiologists should be encouraged to sit this exam. I believe that new Fellows should complete their training by sitting the EBIR. At present only a small number are allowed to sit the exam and this needs to be addressed by increasing the places available. Also there should be a formal notification from the College and the Interventional Radiology Society of Australasia (IRSA)

to all stakeholders that EBIR is now the superior accreditation process replacing CoPET. I believe if we do not make this widely known, EBIR will just be another qualification, and its impact will be minimised and its importance marginalised.

Solving the Problem This is not going to be easy but the following are a few of my ideas. Firstly, interventional radiologists need to become consultants who manage their own patients. They should have inpatient admitting rights and clinical privileges should be obtained. To put interventional radiologists on an equal footing with surgeons and interventional cardiologists, self-referral should be allowed, and finally, the EBIR accreditation should be mandated. I also believe that the College and IRSA need to enter into discussions to change the training curriculum. All interventional radiologists need to get actively involved in preserving a subspecialty that rightfully belongs to us. I recommend that we discuss our approach to these issues in the recently formed Interventional Radiology Standing Committee of the College. A/Prof Lourens Bester Head of Clinical Radiology, School of Medicine, Sydney

If you have any comments about this article on interventional radiology, please contact A/Prof Bester directly on Lourens.Bester@nd.edu.au

Volume 12 No 4 I September 2016

Clinical Radiology

Interventional Radiology Society of Australasia IRSA Queenstown 2016 The Interventional Radiology Society of Australasia (IRSA) recently held its Annual Scientific Meeting and AGM in Queenstown, New Zealand, which was preceded by the second EBIR examination held in the southern hemisphere. A highly successful meeting was convened by Prof Tim Buckenham and Dr Gabes Lau. An impressive array of international and local speakers delivered presentations on some of the most important and pressing issues in interventional radiology today. The meeting was strongly supported by members and the trade, resulting in 176 attendees—an all-time record for the winter meeting. The meeting also received extremely positive feedback from attendees, vendors and College members including College President Dr Greg Slater and CEO Natalia Vukolova.

EBIR Examination The European Board of Interventional Radiology (EBIR) examination was a great success, with 16 registered candidates sitting for the examination, and demand to sit the examination growing. Pamela Taylor, Head of Specialty Training at the College, accompanied the President and CEO to the examination as guest observers. All were extremely impressed by the conduct, organisation and invigilation of the EBIR examination and plan to use some of what they have learned to improve the College examination process. Tripartite partner, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), was also very pleased with our administration of the EBIR, and IRSA now has 10 EBIR examiners actively contributing exam questions and participating in the conduct of the EBIR here and in Europe. Chief Examiner

Inside News

of the EBIR Australia/New Zealand, Dr Gerard Goh, is to be commended for a highly professional and smoothrunning operation. Most importantly, the examination process received high praise from the candidates themselves. Candidates of all levels of experience stated that they found the journey in preparing for the examination enriched and refreshed their knowledge of interventional radiology (IR) to their benefit. IRSA feels that the EBIR is of critical importance to all who wish to pursue a career in IR. It is the key credential for IR and an essential point of difference for all those who wish to be identified as career interventional radiologists.

IRSA Gold Medal IRSA is proud to announce the 2016 gold medallist, Dr Kevin Bell. Kevin has been an outstanding contributor

Dr Bell receiving his gold medal from Dr Vrazas

to the field and IRSA, having served seven years as the President. His tireless efforts on College and IRSA committees, advising MSAC and the Health Insurance Commission and the teaching of registrars and Fellows will be sorely missed. Congratulations on your outstanding service Kevin!

RANZCR Interventional Radiology Standing Committee RANZCR President Dr Greg Slater recently wrote to all College members outlining the vision for the creation of a new Interventional Radiology Standing Committee, aiming to form a body that is representative of all IRs within the College. It is anticipated that the terms of reference will be available soon. Interested members are strongly encouraged to email their expressions of interest to: fcr@ranzcr.edu.au

Clinical Radiology

Education and Training Two levels of IRSA sponsored workshops have been conducted this year so far, to high acclaim by all who attended. The first, COOK Vista Workshops for IR Fellows was held at the Alfred Hospital, Melbourne, in February 2016, convened by Dr Gerard Goh. The three-course series included essentials of peripheral vascular disease, embolization and IVC filters. The annual registrars workshop at Liverpool Hospital, Sydney, was held in May 2016, convened by Dr Glen Schlaphoff. This workshop involved lectures, hands-on simulator sessions, and interactions with a variety of medical devices. Both workshops received overwhelmingly positive feedback, were highly oversubscribed and a testament to the passion and excellence that experienced IRs bring to the education of aspiring young IRs. Both teams are to be congratulated.

IRSA and The Australasian College Of Phlebology At the recent ASM of the Australasian College of Phlebology (ACP), IRSA members, Drs John Vrazas and Sanjay Nadkarni, were invited guest speakers. The IRSA President, Dr John Vrazas was awarded an Honorary Fellow of The Australasian College of Phlebology by the ACP Board, opening a new era of co-operation and collaboration with this growing group of proceduralists in venous diseases.

IRSA AND APSCVIR IRSA is pleased that at the recent APCCVIR, the newly formed Asian Pacific Society of Cardiovascular and Interventional Radiology was formally ratified as a legal entity, APSCVIR. IRSA

is the member organisation for Australia and New Zealand. Drs John Vrazas and Stephen Merrilees will be representing Australasia on the APSCVIR Executive Council. We are also proud to announce Dr Andrew Holden’s nomination as the incoming President of APSCVIR, and wish Andrew the best of luck in the upcoming elections. IRSA and APSCVIR will be holding the inaugural APSCVIR AGM and Scientific Congress in Auckland, New Zealand 8-11March 2018. The theme for the meeting is “Advances, Problems, Solutions” and the scientific program will provide an excellent update on the latest developments in interventional radiology. This congress will replace the annual IRSA winter meeting in 2018, which will return in 2020. All IRSA members are invited to attend what promises to be a landmark conference in the Southern Hemisphere. Please visit www.apscvir2018.com for more details.

education for diagnostic and interventional radiologists of all levels. Further details will be available on the IRSA website.

General Business Dr Goh was appointed Secretary of IRSA by the Executive, filling a casual vacancy for the position left following the resignation of Dr Merrilees last year. IRSA would also like to congratulate Dr Richard Waugh OAM, on his Australia Day honour, awarded for his service to radiology as an interventional radiologist and educator. Dr John Vrazas IRSA President

IRSA 2017 ASM/AGM/ Stroke Course and EBIR The 2017 IRSA Annual Scientific Meeting will be held in Port Douglas, Queensland, 11-13 July 2017. The meeting will be preceded by the EBIR examination to be held on 10-11 July 2017. IRSA is proud to announce an inaugural stroke course planned for 14-15 July 2017, convened by Drs John Vrazas and Marcus Mykytowycz and to be hosted by Dr David Sacks and Dr Jeff Carpenter of the Society of Interventional Radiology (USA). A comprehensive course is planned, encompassing the essential clinical, diagnostic, imaging and interventional aspects of stroke therapy in the era of mechanical clot retrieval. David and Jeff are renowned experts in the field of INR stroke management and this course promises to provide preeminent

Volume 12 No 4 I September 2016

ONE PICTURE BRINGS EVERYTHING INTO FOCUS

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Radiation Oncology

A Message

from the Dean

Dr Dion Forstner

I feel privileged to have been elected to serve the Faculty of Radiation Oncology as the Dean for another two-year term from January 2017 to December 2018. I appreciate the confidence and trust from the College Board and Faculty Council, and would like to take this opportunity to thank all Council members, College staff, and my wonderful colleagues at Liverpool Hospital for their hard work and support during my current term. We have made a great deal of progress in the last two years towards achieving the strategic priorities of the Faculty, in particular in the area of advocacy and government engagement. We have established a sound and collaborative relationship with the Department of Health which is extremely helpful during this critical time when both the Medicare Benefits Schedule (MBS) and the Radiation Oncology Health Program Grants (ROHPG) are being reviewed. While we celebrate our achievements, we also acknowledge various issues and challenges ahead, e.g. ongoing work around the MBS/ROHPG reviews, ongoing workforce issues, progressing the radiation oncology practice standards, how to best support the Faculty standing committees and special interest groups and ultimately strengthening the voice of radiation oncology within the health sector both in Australia and New Zealand. The Faculty Council and I are committed to addressing these issues, continuously improving the radiation oncology sector and ensuring that we identify new challenges and opportunities early.

We welcome suggestions and ideas from all radiation oncology members, and I encourage all of you to get involved in College activities, which is guaranteed to be a rewarding experience.

Profile and Presence of Radiation Oncology The Targeting Cancer campaign continues to make progress in various areas, including GP education, media/ social media presence, website development, etc. It is very exciting that the Targeting Cancer website recently won the Best in Class Award in the healthcare category of the Interactive Media Awards, as well as a gold medal in the 2016 Sydney Design Awards. Please see the article on page 23 for more details. I congratulate the Targeting Cancer team on this outstanding achievement and encourage all members to participate in Targeting Cancer activities. Please contact faculty@ranzcr.edu.au if you are interested in getting involved, to help raise the profile of our profession, and ultimately increase the utilisation rate of radiation therapy.

Funding of Radiation Therapy The review of the radiation oncology items within the MBS is well underway. The first activity of the Oncology Clinical Committee (OCC) was to look at obsolete items within the schedule. The Faculty’s MBS Review Working Group consulted with heads of departments on the list of items identified as potentially

obsolete and provided advice to the nominees on the OCC: Dr Liz Kenny, Prof Michael Barton and A/Prof Chris Milross. The radiation oncology section of the MBS is outdated and does not reflect the way we currently deliver treatment to our patients. Through our working group, the Faculty is providing advice to the OCC nominees on various options for redesigning the schedule to better suit contemporary practice. We continue to seek opportunities to nominate Fellows to other committees of the MBS Review that intersect with our specialty. Prof Gill Duchesne has been nominated to the Nuclear Medicine Working Group which has been formed under the Diagnostic Imaging Clinical Committee.

Updated Faculty Guidelines for Informed Consent with Informed Financial Consent In 2010, the Faculty published Guidelines for Informed Consent, which represent the Faculty’s view on the pivotal matter of patient consent to receive radiation treatment. The Faculty Council believes it is important for patients to understand the costs associated with radiation oncology services, and full disclosure of financial/ cost information should be provided in writing to patients before they sign the informed consent form. The Faculty Council recently approved updates to the guidelines for informed consent, which now include a section on

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Radiation Oncology

informed financial consent. The updated document will soon be available on the College website.

to further strengthen our training program over the next 18 months.

Training and Research for Radiation Oncology

The Faculty Council is very mindful of the various challenges in the education and training area, and is committed to providing its full support to the Radiation Oncology Education and Training Committee (ROETC), as well as to the Chief Censor and Specialty Training Unit staff in the implementation of these recommendations.

I am very grateful that A/Prof Margot Lehman has nominated for the role of Chief Censor in radiation oncology for the 2017-2019 term. This would allow much-needed continuity for the implementation of key recommendations

I am grateful to the long-standing members of ROETC who have completed their time after many years of enormous commitment: Dr Melissa James, Dr Rahul Mukherjee and Dr Apsara Windsor.

I encourage all radiation oncology practices to include financial/cost information in their informed consent form for patients to sign before the treatment commences.

The Faculty remains committed to fostering a culture of research in radiation oncology. A Research Planning Forum was held on 26 July, with the aim of developing a College-wide research strategy. For further information on this initiative, please refer to the article on page 17 in this edition.

If you have any feedback or comments on any of the above, please email Sonja Cronjé, Senior Executive Officer, Faculty of Radiation Oncology on faculty@ranzcr.edu.au.

FROLIC Update The Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) special interest group met face-to-face at the College Annual Scientific Meeting in 2015 and TROG ASM in 2016. The group has conducted a Patterns of Care Survey on Radiation Therapy Practice in Lung Cancer which has been published in the Journal of Medical Imaging and Radiation Oncology (JMIRO). FROLIC also held a successful interdisciplinary workshop in 2015 on Advanced Technologies in the Radiation Therapy Treatment of Locally Advanced NonSmall Cell Lung Cancer. As a result of this workshop, consensus guidelines have been recently published in JMIRO. The FROLIC Executive is pleased to announce the inclusion of a lung contouring workshop at the 2016 College Annual Scientific Meeting (ASM). Participants in the workshop will be asked to contour two lung cancer cases—a locally advanced lung cancer case and a SABR lung case—prior to the ASM. During the workshop, participants will have the opportunity to compare their contours with those of the experts in the field to validate and/or improve their contouring skills. Radiation oncologists, Dr Shankar Siva and Dr Pat Dwyer will be joined by dual trained

Inside News

radiologist/nuclear medicine physician Dr Peter Jackson, to provide evidencebased recommendations on target volume delineation and tips on Organs at Risk (OAR) contouring.

The fun run will be held on Saturday 15 October and is open to all delegates. For further details and to register visit www.ranzcr2016.com/social-networkingprogram

The lung contouring workshop will be held on Saturday 15 October, from 8.30-10am.For more information visit www.ranzcr2016.com/workshops Participant numbers are strictly limited.

Resources

The FROLIC Executive will also be organising an educational workshop in 2017, titled ‘Targeted treatment for advanced lung cancer’. Topics will include stereotactic radiotherapy and immunotherapy in the setting of advanced lung cancer. Further details will be available in future editions of Inside News. Members are also working on establishing a SABR registry, which will include SABR treatment of lung cancers and pulmonary oligometastases. The next face-to-face meeting will be on Friday 14 October 7.00-7.55 am in Room 9 of the Gold Coast Convention and Exhibition Centre at the College ASM. I would like to encourage all FROLIC members to participate in the Targeting Cancer Fun Run to show off our superior fitness as a special interest group.

Patterns of Care Survey on Radiation Therapy Practice in Lung Cancer http://onlinelibrary.wiley. com/doi/10.1111/1754-9485.12475/full Consensus guidelines http://onlinelibrary.wiley. com/doi/10.1111/1754-9485.12501/full

For further information on FROLIC visit http://www.ranzcr.edu.au/ organisation/special-interestgroups/frolic

Radiation Oncology

Chief Censor in Radiation Oncology

A/Prof Margot Lehman

In May and June, the Phase 1 and Phase 2 courses were held in Sydney. A combination of lectures, practical demonstrations and participation in mock examinations assisted trainees to gain knowledge of what is expected of them and what the exam experience will be like. During the Phase 2 course, valuable insights and practical methods of dealing with stress and performance were provided by clinical psychologist Dr Susan Johnson, and trained actor Dr Paul Heinrich. During the Phase 1 course, Dr Robin Cassumbhoy, one our radiology colleagues, provided a “masterclass” in cross-sectional anatomy. The organisation of these courses is a major commitment and I would like to extend my thanks to Dr Apsara Windsor and Dr Alex Tan for organising the Phase 2 course, and Dr Marcus Dreosti and Dr Claire Hardie for organising the Phase 1 course. I would also like to thank the Phase 2 examiners who made themselves available to assist with the mock examination on a Saturday morning and all the Fellows who assisted with the teaching during the Phase 1 course. Both courses are of very high quality and much appreciated by the trainees and all Fellows involved in College educational activities.

Director of Training Workshop The Director of Training workshop held in May covered a variety of topics. Dr Yaw Chin provided an overview of programmatic assessment of

competency-based workplace learning, a major trend in medical education and one of the key recommendations of the Australian Council for Educational Research (ACER)/Professor Prideaux report. Representatives from one the major medical defence organisations provided a practical and interactive session on ways to support trainees who are experiencing difficulties. A panel discussion followed, regarding the unique challenges faced by those involved in regional practice.

Exam and Assessment Review A Task Force chaired by Dr Greg Slater and comprising the Chief Executive Officer, Head of Specialty Training and both Chief Censors met by teleconference to set key priorities and strategic direction for the implementation of the ACER/Prideaux Review. Subsequently a meeting of the Radiation Oncology Steering Group comprising A/Prof Sandra Turner, Dr Matthew Seel, Dr Yaw Chin, Pamela Taylor and Adam Rayment from the College’s Specialty Training Unit, and me met with Prof David Prideaux to begin laying the foundations for how this work will proceed in radiation oncology. I look forward to providing further updates as progress continues. As I write this, preparations for the Phase 1 and Phase 2 Series 2 examinations are well advanced. I would like to thank all the Fellows and specialist reviewers for their involvement in this robust process. I also wish all trainees the best of luck as they approach these examinations.

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

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Radiation Oncology

TROG Update

Vale Dr Nicola Bruce Grants Workshop Learn from an expert how to secure grants and funding for your research projects. You are invited to a one-day Grants Workshop hosted by TROG, on Wednesday 9 November from 9.30 am – 3.30 pm at the Woolcock Institute, Sydney. The workshop will be presented by Keith Whelan, ‘The Grants Guy’. Registration is $299 per person, which includes lunch. All funds raised from the event will support TROG Cancer Research. Places are limited so book now at trog.com.au/Events

The theme for our 2017 meeting will be ‘Radiation Oncology: Precise Treatment, Quality Research’. Dr Giuseppe Sasso and Laura Ciurlionis will co-convene the event and Prof Andre Dekker, medical physicist at MAASTRO Clinic in the Netherlands has been confirmed as an international speaker. Registrations are now open. Visit TROG2017.com for more information and to take advantage of early bird rates. We look forward to seeing you in Auckland next March.

Race4TROG Fundraiser Dr Nicola Bruce

It was with great sadness that we learnt of the passing of Dr Nicola Bruce on 25 May 2016. Nicola was diagnosed with breast cancer many years ago, but unfortunately in recent years she had to deal with a diagnosis of lymphoma. A passionate advocate for cancer patients, Nicola has been an integral part of the Trans Tasman Radiation Oncology Group (TROG) for several years in her role of Consumer Expert on the TROG Consumer Advisory Panel. She also served on the TROG Scientific Committee as an Independent Consumer Representative. Nicola was a specialist qualitative researcher who worked across many areas of health and was also a committee member of Cancer Action Victoria. Nicola will be remembered for her kind and gentle nature and her dedication to improving the lives of those affected by cancer—she will be greatly missed.

Inside News

Join us for a fun day at the Newcastle races on Saturday 29 October from 12 pm at the Newcastle Jockey Club. Dress up in your derby day best and enjoy a two-course luncheon in a private marquee along with Tamburlaine organic wine tasting. Tickets are $100pp or $950 for a table of 10. Get a group of friends or colleagues together and book online at trog.com.au/Events

TROG 2017 ASM It is with pleasure that we invite you to our 29th Annual Scientific Meeting to be held from 6-9 March 2017 at the ANZ Viaduct Events Centre in Auckland, New Zealand. The event will provide a unique opportunity for all health professionals with an interest in radiation oncology to collectively discuss and influence the direction of current and future cancer clinical trials. Our 2017 meeting will feature subspecialty group sessions, as well our full-day, interactive research workshops and opportunities to relax and network at our social afternoon, welcome function and gala dinner.

Joan Torony CEO, TROG

Radiation Oncology

Radiation Oncology Trainees Committee Update Examination Series

Courses and Conferences

ROTC 2017 Election

A collective sigh of relief can be heard among the trainees with the completion of all examination series for 2016. The Phase 1 examination was held on 9 September and the second sitting of the Phase 2 examination series took place from July through to early September. Congratulations to the trainees who were successful in these sittings and best of luck to those who are studying for upcoming examinations next year— all your hard work and effort will be rewarded!

The 2016 College Annual Scientific Meeting (ASM) will be held on the Gold Coast on the 13-16 October. In addition to the jam-packed scientific program, the Trainee Learning Day will provide a focused series of talks, covering both clinical content as well as other trainee related topics such as fellowship opportunities. The trainee forum, held at the conclusion of the day, will provide an opportunity to share any thoughts, feedback or concerns amongst the trainee body as well as with College staff. A short survey by the ROTC will be emailed to all trainees prior to the trainee forum to enable you to identify any issues you wish to discuss. The ASM social calendar will ensure that we both ‘work hard and play hard’ on the Gold Coast. This year the inaugural trainee and junior consultant reception will be held in addition to the annual social events. Lastly, don’t forget to pack your sneakers and sign up for the Targeting Cancer Fun Run.

The nomination and voting process for the 2017 ROTC took place in August and September. Hopefully all trainees participated in electing their incoming ROTC members who will continue championing our concerns. I look forward to meeting the new committee for 2017.

Trainee Feedback Maintaining the high standard of the Faculty of Radiation Oncology (FRO) training program is an ongoing priority for the College. There are numerous ways in which the College evaluates the quality of our training and many of these methods rely heavily on trainee feedback. One important tool is the Trainee Assessment of Training Site or ‘TATS’, which we are required to complete every six months at a minimum. The TATS form is currently under review to ensure that it is an accurate and valid tool. In addition to this, our training sites are regularly reviewed to ensure they meet accreditation standards. As trainees, we can capitalise on these opportunities to provide constructive feedback to the College by participating in these activities as honestly and accurately as possible. The TATS forms are anonymous and collated over a period of time, such that any information provided is de-identified. The Radiation Oncology Trainees Committee (ROTC) is working together with the College to optimise this feedback process and in particular, will be aiming to optimise the utility of the TATS forms.

Dr Gina Hesselberg Chair, Radiation Oncology Trainees Committee

There are a number of other fantastic meetings coming up over the next few months. Hopefully you can attend one or more of these: • The Australasian Melanoma Conference 2016. 28-29 October, Sydney • Clinical Oncology Society of Australia, Trainee’s Weekend “Everything you need to know about breast cancer”. 12-13 November 2016, Gold Coast • The ESTRO School’s Evidence Based Radiation Oncology: how to evaluate the scientific evidence and apply it to daily practice. 19-22 November, Sydney

Volume 12 No 4 I September 2016

Radiation Oncology

Help APROSIG Assist Radiotherapy Departments in Asia-Pacific The Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) was founded in 2012 and has undertaken a number of important initiatives, including the training of radiotherapy staff in Vietnam and Myanmar. When Prof Graeme Morgan retired earlier this year, Dr Iain Ward and Dr Mei Ling Yap took on the role of APROSIG co-chairs. Iain is a radiation oncologist from Christchurch and has had previous experience working with departments in the Pacific, including liaising with the Fiji Government regarding the establishment of radiotherapy services. Mei Ling is a radiation oncologist from Sydney, was a member of the Union for International Cancer Control (UICC) global taskforce on radiotherapy for cancer control and co-runs the online advocacy platform globalrt.org APROSIG aims to promote safe and effective radiotherapy by developing activities such as bilateral exchange visits, training workshops and the twinning of departments. One of our current initatives is to support the

Dr Mei Ling Yap and Dr Meredith Johnston, Imam Khomeini Hospital, Tehran, Iran

establishment and safe running of a modern radiotherapy department at the National Cancer Centre in Calmette Hospital, Phnom Penh, Cambodia. The department is currently being built and scheduled to begin treating patients in early 2017. This radiotherapy centre is long awaited, as the Cambodian people had no radiotherapy available for many years, and prior to this, treatment was limited to cobalt machines with 2D planning. APROSIG is sending a team of radiation oncologists, a radiation therapist and medical physicist next month to Cambodia. We are excited to take on this new role as co-chairs and for the potential that APROSIG has in further supporting radiation therapy departments in low and middle-income countries (LMICs) in the Asia-Pacific region. In the last few months we have also made it a priority to build ties with our radiation physics and radiation therapy colleagues, including forming an alliance with the ACPSEM’s Asia-Pacific special interest group, APSIG.

Dr Iain Ward, Christchurch Hospital

Inside News

We are aware that there is a lot of interest from College Fellows and trainees to support radiotherapy in LMICs and there is already a lot of work being done independently by College members. It would be fantastic if we

could bring these interested members together to share experiences, learn from each other and pool resources—we encourage all to join APROSIG and get in contact with us. We would also like to extend our thanks to the College for their support, including the recent International Development Fund Grant, which will fund our upcoming activities in Cambodia. If you are interested in joining/ working with APROSIG, please contact: Iain.Ward@cdhb.health.nz mei.yap@sswahs.nsw.gov.au Dr Iain Ward and Dr Mei Ling Yap Co-chairs APROSIG

We welcome you to join the APROSIG meeting at the College Annual Scientific Meeting on Friday 14 October 7.00-7.55 am in Room 3 of the Gold Coast Convention and Exhibition Centre.

General Interest

New Zealand Branch News

Dr Lance Lawler

First things first, the Hurricanes won the final of the Super Rugby! I am tempted to stop here, after all what else is important to say? Appealing as that might be, I will stammer a few more words to ensure compliance with College etiquette, and to prevent getting into trouble. On the first weekend in August, the New Zealand Annual Scientific Meeting (ASM) was held in Wellington. I am grateful to the convenors Dr Iain Morle (Hawkes Bay) and Dr Rix Du Plessis (Palmerston North) for organising this event. Lung cancer is one of New Zealand’s most prolific killers and was a worthy theme for the meeting. The keynote speakers were Dr John Mayo who covered CT radiation dose; Dr David Wilson and Dr Gina Allen who discussed advances in musculoskeletal radiology; and Dr Shankar Siva who worked through SABR for oligometastatic prostate cancer—all did an excellent job. It was also very pleasing to see the following awards presented to recognise the high standard of our members: 1. (OBEX) William A Cook Award, Best Radiology Registrar Presentation: Dr Greg Tarr 2. FRONNZ Best Radiation Oncology Registrar Presentation: Dr Saad Maqsood 3. New Zealand Radiology Education Trust Poster Prize: Dr Matthew Mouat The NZ ASM is an important event and something that as a Branch we should not take for granted. Given continued decline in the level of

sponsorship income, it is critical that we keep supporting the event through attendance. Accordingly, I look forward to the NZ ASM in Nelson next year and what the convenors Dr Rebecca Harris and Dr Jamie Evans conjure up. On a policy footing, the Branch has had constructive meetings with stakeholders, responded to several HealPACT submissions and formally endorsed various clinical guidelines from external bodies. Additionally, an important meeting was held with Immigration New Zealand (INZ) around immigration medical examinations. Working with the Onshore Panel Physician Network from 1 April 2015 to 31 March 2016, 184,061 medicals were assessed, with 58,290 (31.7%) being submitted from New Zealand-based clinics. INZ uses X-rays to pick up tuberculosis, and also to provide a valuable source of information on applicants with abdominal clips or sternal wires as they may not have mentioned any surgery. INZ is looking into changing their processes so that all applicants requiring a chest X-ray visit a panel physician first. If this change takes place, applicants won’t need to turn up to a radiology practice needing a photo and a pre-exam done, as this would all get processed at a panel physician clinic first.

of the National Maternity Monitoring Group and the Maternal Fetal Medicine Clinical Governance Board, it highlighted that the volumes of ultrasounds being performed on fetuses are higher than clinically recommended. Dr Rachael McEwing sits on the above mentioned committees for the College. It is pivotal that radiology works through the issues raised by this data. Lastly, I record the results of the recent Branch elections and congratulate Dr Lisa Sweetman on being re-elected to the position of Branch Education Officer, this time for a three-year term, and to Dr Gabriel Lau for being elected as a Branch Committee member. As always, I am happy to talk to anybody about Branch matters, or any other issues that they might have. Please feel free to contact me at lance.lawler@ranzcr.org.nz

The New Zealand launch of Choosing Wisely occurred in September. Important data was presented by the College of Midwives at the Choosing Wisely Clinical Conversations meeting held in May. Stemming from the work

Volume 12 No 4 I September 2016

Stepping out of the Shadows – Collaboration and Communication Rutherford Hotel, Nelson, New Zealand

Radiology Invited Speaker Professor Jeffrey Kanne MD Chief of Radiology and Thoracic Imaging, Vice Chair of Quality University of Wisconsin, School of Medicine and Public Health Madison, USA

Radiation Oncology Invited Speaker Associate Professor Jarad Martin MB ChB, FRANZCR Director of Research Calvary Mater Newcastle NSW, Australia

www.ranzcr2017.co.nz

General Interest

Australian Branch News NSW Branch The NSW Branch of the College represented clinical radiology at the NSW AMA Medical Careers Expo on 6 August 2016. Dr Rajiv Rattan, NSW Branch Alternate BEO, promoted radiology training to medical students from a variety of universities who were interested in radiology as a career and provided details on how to join the training program. If you are interested in volunteering at a Branch medical careers expo event, please contact sarah.hall@ranzcr.edu.au

Medical students with Dr Rattan

WA Branch Professor Turab Chakera’s Farewell Function

sons, Jakob and Arun and his daughterin-law Kieran were in attendance.

Radiation Oncology Chapter of NSW Branch

The RANZCR Board meeting was convened in Perth on the Thursday and Friday preceding the dinner to allow the College Board, Faculty and Senior Executive staff to attend Turab’s celebration dinner.

The NSW Radiation Oncology Directors Group has been changed to the Radiation Oncology Chapter of the NSW Branch of the College. This now gives official status within the College with a defined membership and Terms of Reference. Each NSW department, public and private, has a representative on the Chapter Committee. This is usually, but not necessarily, the Department Director. The Chapter Committee met on 20 July and elected a Chair (currently Michael Jackson) and Secretary/Treasurer (Dion Forstner).

College President, Dr Greg Slater, gave an entertaining speech highlighting Turab’s contribution as a past RANZCR President and his role as College Censor for Radiology for many years. Prof Mark Khangure acted as the Master of Ceremonies on the evening. Prof Bryant Stokes, a long-time friend of Turab’s and past Director General of Health for Western Australia, spoke of Turab’s contributions as a pioneering neuroradiologist in Western Australia. Turab’s Order of Australia for community service and his contribution to academic radiology and his leadership in training radiology registrars was acknowledged. It was particularly gratifying to see so many senior Western Australian clinicians attend the dinner to honour Turab’s contribution as a leader in the Western Australian medical community. A large contingent of Western Australian radiologists who had migrated from Sri Lanka were present to celebrate Turab’s remarkable contribution teaching and collaborating with the Sri Lanka College of Radiologists. Six current and past presidents of the College were present, as the guests included Dr Trevor ApSimon and Dr Paul Sprague.

Some of the guests at Prof Chakera’s farewell dinner On Saturday the 14 May 2016, 125 guests assembled at the University Club of Western Australia to celebrate Prof Turab Chakera’s professional life and his contribution to Australian radiology. Turab, his wife Margaret and their two

Turab made a point of acknowledging Mrs Sheena Mathie his friend and longtime Executive Personal Assistant at Royal Perth Hospital who sadly passed away in March of this year. As a token of their appreciation and respect the guests gifted Turab and Margaret a framed limited edition Leon Pericles collage.

The Radiotherapy Club meeting format is unchanged and will meet on the same day if possible. The inaugural meeting under the new system was also held on 20 July at the Ingham Institute at Liverpool and attracted over 40 members. There were three interesting presentations and a tour of the very impressive new MRI Linac. The next meeting will be hosted by Royal North Shore Hospital at the Park Royal Hotel Darling Harbour on Wednesday 16 November 2016. Visit http://www.ranzcr.edu.au/ organisation/australian-branches/ nsw-radiotherapy-club to view the presentations from the night, as well as past presentations. If you would like to volunteer to give a talk, please contact sarah.hall@ranzcr.edu.au.

RT Club Prof Gary Liney presentation

Volume 12 No 4 I September 2016

General Interest

Australian Branch Meeting Dates Overview 2016

NSW

NSW RT Club

Academic Meeting (ACI Lecture Series) Tuesday 8 November

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

Wednesday 16 November

Cockle Bay Room Park Royal Hotel Darling Harbour 150 Day Street Sydney NSW 2000

Thursday 17 November

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

Monthly Professional Meeting (MPM) Wednesday 21 September Wednesday 16 November

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

VIC

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

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

Inside News

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

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

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

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

SA Chair: Dr Chris Pozza E: cpozza@usa.net Honorary Secretary: Vacant TAS Chair: Dr Rajendra Doolabh E: Rajendra.Doolabh@regionalimaging. com.au Honorary Secretary: Dr Jonathan Shulman E: Jonathan.Shulman@regionalimaging.com.au

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

General Interest

From the Trainor/Owen Collection A Glimpse into Remote Radiology

It is hard to imagine, with the wealth of technology at our fingertips today, the lengths a visiting medical officer would go to in order to return correspondence and opinions on cases some 40 years ago. In keeping with this year’s theme of taking a closer look into the individual collections that create the historic Trainor/Owen archive, a box full of letters and carbon copy replies was uncovered. Once sorted, the collection revealed the reality of the practice of radiology in Papua and New Guinea (PNG) during the 1970s and the support offered by practising radiologists in Australia. Based in Sydney, with a team of trainee radiologists stationed in various hospitals across PNG, these doctors found a way to consult on cases and

have results returned within 24-48 hours to bring medical services to regional centres and remote villages throughout PNG. X-rays and patient notes from regional centres such as Madang, Rabaul and Mount Hagen would be sent to Port Moresby, and from there on an overnight flight to Sydney. Then reported on by the senior radiologist and returned on the very next outbound flight, giving juniors enough information to set a broken bone or diagnose more serious illnesses. This style of reporting fitted well into the lifestyle of the tribal people who were moving through or returning to remote villages, most with a diagnosis or course of treatment and a medical answer for their ailments.

Comprising more than 300 letters, the collection provides an insight into the hard work and dedication of the people and doctors who struggled with outdated and failing machines and lack of continuing industry based education. But it also leaves many questions unanswered. The snapshot of this practice during the 1970s has been made possible through a donation of more letters to the archives from the estate of Dr Nils Korner. It is a reminder of the importance of supporting international relations and communications to improve patient care in developing countries.

Member Participation Opportunity Do you enjoy discovering stories or solving mysteries? Why not volunteer to help with the Trainor/Owen collection.

Interested in Learning More Want to learn more about the HR Withers collection or other collections in the College archives? Why not make an appointment to visit this unique archive, museum and library recording the history of radiology and radiation oncology.

Contact Please contact Eva Stokes-Blake, Project Officer, Archivist, at the College for more information on +61 2 9268 9725 or email archives@ranzcr.edu.au

Image courtesy of OCHA

Volume 12 No 4 I September 2016

General Interest

Congratulate your Colleagues

Nina Sacharias with Dinesh Varma

Dr Trevor Paul FitzJohn ONZM

Chair, Pacific Radiology, New Zealand Congratulations to Dr Trevor FitzJohn for his recent recognition as an Officer of the New Zealand Order of Merit for services to radiology in the Queen’s 90th Birthday Honours List 2016. Colleagues who have had the opportunity to work with Dr FitzJohn can attest to his commitment to radiology, education and the New Zealand Branch. Among his many achievements are the introduction of Positron Emission Tomography (PET) scanning into New Zealand and overseeing the installation of the first MRI scanner in the greater Wellington area, as well as establishing interventional radiology in the region. He was also a central figure in establishing minimally invasive treatment of aneurysms and other neurological conditions.

Professional Documents and Publications

A/Prof Nina Sacharias OAM

Department of Radiology, Alfred Hospital Melbourne Congratulations to A/Prof Nina Sacharias who received a Medal of the Order of Australia in recognition of her service to medicine in the field of radiology in the Queen’s Birthday 2016 Honours List. In 2011 Nina Sacharias received the Roentgen Medal from the College recognising the very valuable contribution to the affairs of the College over a significant period of time. Nina has been an outstanding Fellow of the College as not only a radiologist, but as an educator and an innovator extending over more than 30 years of practice. Her devotion to the teaching of trainees is legendary. In 2004 she was the author of Radiology: Beyond a Textbook.

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

Revised Professional Documents Consideration of Special Circumstances Policy Grievance Policy

Inside News

As Dr Anthony Felber said in a Letter to the Editor for Inside News: “Nina moulded my career. Nina moulded the career of so many other radiologists, some of whom are now the leaders in our radiological community.” In June 2012 we reported that Breastscreen Victoria had recognised her contribution to breast imaging by naming an upgraded and rebranded Mobile Screening Service van after “educator extraordinaire” Nina. There are other numerous commendations for this remarkable person. The College salutes Nina Sacharias as one of its most treasured Fellows.

All College standards, policies and guidelines are available on the College website www.ranzcr.edu.au/resources/ professional-documents All College position statements and reports can be found here: www.ranzcr.edu.au/advocacy/statements If you have any enquiries about these documents, please contact the College on +61 2 9268 9777

General Interest

Australasian Meetings 2016 October ANZSPR 2016 Gold Coast, QLD – 16-19 October 2016 www.anzspr16.com/ ANZHNCS Annual Scientific Meeting and IFHNOS 2016 World Tour Auckland, New Zealand – 25-27 October 2016 www.ifhnosauckland2016.org/ ASUM 2016 Brisbane, QLD – 28-30 October 2016 http://asumconference.com.au The Australian Melanoma Conference Sydney, NSW – 28-29 October 2016 http://melanoma2016.com.au/

November COSA and ANZBCTG ASM Gold Coast, QLD – 15-17 November 2016 http://cosa2016.org/ SABR Symposium 2016 Melbourne, VIC – 18-19 November 2016 https://sabr2016.com/

RANZCR Annual Scientific Meeting Dates ASM 2016 Gold Coast, Queensland 13-16 October 2016 www.ranzcr2016.com NZ ASM 2017 Nelson, New Zealand 4-6 August 2017 www.ranzcr2017.co.nz ASM 2017 19-22 October 2017 Perth, WA

Board 17-18 November

November

RSNA 2016 Chicago, USA – 27 Nov – 2 Dec 2016 http://rsna.org/

December

Faculty Council – Radiation Oncology 21 October

17th World Conference on Lung Cancer Vienna, Austria – 4-7 December 2016 http://wclc2016.iaslc.org/

2017 March ECR 2017 Vienna, Austria – 1-5 March 2017 www.myesr.org

April

~ Death Notices ~

ARGANZ 2017 Sydney, NSW – 11-12 February 2017 www.arganzmeeting.com

The College notes with regret the death of the following members:

ILROG 2017 Melbourne, VIC – 7-8 April 2017 http://www.ilrogmelbourne2017.org

UICC World Cancer Conference Paris, France – 31 October – 3 November 2016 www.worldcancercongress.org/

Annual General Meeting 13 October 2016

February

April

ESTI Thoracic Summit Krakow, Poland – 23-24 October 2016 www.myesti.org/congress-2016

College Meetings 2016

2017

TROG ASM Auckland, New Zealand – 6-9 March 2017 www.cmnzl.co.nz/trog-2017-asm/home/

October

BIR Annual Congress 2016 London, UK – 3-4 November 2016 www.bir.org.uk/

8th Multidisciplinary Breast Cancer Conference Perth, WA – 19-20 November 2016 https://air.eventsair.com/ QuickEventWebsitePortal/breast-cancerconference-2016/home

March

International Meetings 2016

Dr Lars Bark, Fellow NSW Dr William Nairn, Fellow, NSW

ARRS 2017 New Orleans, USA – 30 April – 5 May 2017 http://www.arrs.org/am17

May ESTRO 36 Vienna, Austria – 5-9 May 2017 www.estro.org/congresses-meetings/ items/estro-36

Dr Eric Sclavos, Fellow, QLD

Volume 12 No 4 I September 2016

Your RANZCR Member Benefits

• • • • • • •

Dining Entertainment Shopping Travel Technology Financial Insurance

Member Advantage is the ultimate benefit experience. Your RANZCR Member Advantage program offers you and your family unlimited use and allows you to save money on your everyday expenses. Access an extensive range of financial and lifestyle member benefits.

How do I access my benefits? Your member benefits can be accessed by phone and online via the Member Advantage website. For your dining and entertainment benefits, simply show the Ambassador Card logo on the front of your membership card at the point of sale. This membership card is also available in a digital version, accessible on your smartphone.

How do I use the Member Advantage website? Visit www.memberadvantage.com.au/ranzcr for full details of the benefits available to you and your family. Please note that you will need to enter your membership number as your password. This number is also displayed on the front of your RANZCR Member Advantage card, for future reference.

www.memberadvantage.com.au/ranzcr

Call 1300 853 352 (AU) or 0800 453 244 (NZ)

MRI in Practice

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3 - 6 February 2017 RANZCR CPD points can be claimed for attendance Venue: Novotel Sydney Central, Sydney Early-bird registration fee $1500 www.mrieducation.com/australasia

FLINDERS MEDICAL CENTRE PATHOLOGY COURSE 18 & 19 FEBRUARY 2017 The Division of Medical Imaging at Flinders Medical Centre in Adelaide will offer a two day Pathology Course, consisting of lectures and “pots” sessions. The course will be of particular value to registrars and candidates preparing for the Part II FRANZCR examination. It will also provide an overview of pathology for practising radiologists who are encouraged to attend.

Workshop: Roadmap to practice ownership

Closing date for registrations is Friday 18 November 2016 For registration form and further information please contact: Helen Sainsbury (08) 8204 4405, helen.sainsbury@health.sa.gov.au

Corporate Members of the College Alpenglow Pty Ltd www.alpenglow.com.au Bayer Australia Ltd www.bayer.com.au Brainlab Australia www.brainlab.com/en/ ChoiceOne Pty Ltd www.choiceone.com.au Comrad www.comrad.co.nz EIZO www.eizo-apac.com/medical Elekta Pty Ltd www.elekta.com

Everlight Radiology www.everlightradiology.com.au Everx www.everx.com GE Healthcare www.gehealthcare.com.au/ Health Imaging Solutions www.healthimaging.com.au Hologic Australia www.hologic.com/ Integral Diagnostics www.integraldiagnostics.com.au I-MED Network Radiology www.i-med.com.au Ipsen Pty Ltd www.ipsen.com.au Lightbox Radiology Education www.lightboxradiology.com.au/

Starting your own practice is a big commitment and the process can be overwhelming and confusing, but it doesn’t need to be a daunting project. We have gathered a team of experts to help you uncover your practice ownership goals and help you set the necessary direction to achieve them.

RSVP by Wed, 12 October at boqspecialist.com.au/roadmap

Cost: $150 (includes parking in Chifley Tower, tools, resources and lunch) Date: Friday, 21 October Time: 12:00pm 6:30pm Address: Level 23, 2 Chifley Square Sydney

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

Visit us at the 2016 RANZCR Annual Scientific Meeting

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