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Volume 13 No 4 / Sep 2017

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

The Future of Particle Therapy in Radiation Oncology

PLUS New Exam Revolution turn to page 33 for more

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M V M V M V M V M V

In this edition 5 President’s Message COVER STORIES: 6 The Future of Particle Therapy in Radiation Oncology 8 Supporting Trainees and Reducing Burnout 11 CEO Message Leadership 12 Policy Making is Inherently Political Engaged Members 15 Member Health and Well-being 17 Member Profiles 19 2017 Annual Scientific Meeting Profile and Presence 20 Targeting Cancer 21 InsideRadiology

Quality Practice 29 The Future for Digital Health Quality Training 32 Exam and Assessment Review Update 33 Clinical Radiology Viva Examinations makes its move Clinical Radiology 37 Message from the Dean 39 Chief Censor 40 Trainee News Radiation Oncology 45 Message from the Dean 47 Chief Censor 49 Trainee News General Interest 55 New Zealand Branch 57 Australian Branches 59 From the Archives 61 Meetings and Events Inside News is printed on Titan Satin. Titan is produced in an ISO 14001 accredited facility ensuring all processes involved in production are of the highest environmental standards. FSC mixed Sources Chain of Custody (CoC) certification ensures fibre is sourced from certified and well managed forests.

Editor-In-Chief Dr Allan Wycherley Sub Editors Sarah Hall Bertha Harvey

Editor’s Desk Inside News is distributed to our members as well as a growing number of external organisations involved in health care. The original purpose of the newsletter was set out in the first edition as ‘a means of keeping you informed of the activities of your Council, Executive and Membership Board’. Although we have made many changes and additions over time, our goal today essentially remains the same.

Dr Allan Wycherley

We believe it is important to keep members up to date with the activities of the College and to cover the developments nationally and internationally that affect our professions.

Access to Quality Services 22 The College’s International Development Fund in Action 25 Direct to Consumer Health ‘Screening’

Editorial Staff

From the

In this edition, our cover stories focus on the future of particle therapy in radiation oncology, with an interesting article by Dr Hien Le and Clin A/ Prof Verity Ahern who delve into the solutions and journey ahead when it comes to particle therapy, while Prof Michael Poulsen discusses the support to trainees in relation to high levels of burnout and the need to develop a framework to promote motivation and reduce burnout. We focus on the challenges that 21st century health care faces in a discussion on public policy making. We introduce you to two of our members who are involved with College activities and committees and announce the introduction of the new resources pages on our website. There is an update on the bowel cancer screening pilot in New Zealand along with information around the data analyses and modelling to help guide the College position on numerous policies. We congratulate those involved in the success of the clinical radiology viva examinationrevolution which made its big move in May of this year and relish in the positive feedback from all examiners across the sittings. All this plus much more in our third edition of 2017. Allan Wycherley Editor-in-Chief editor@ranzcr.com The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street Sydney NSW 2000 Ph: +61 2 9268 9777 Web: www.ranzcr.com Email: ranzcr@ranzcr.com

Submissions The submission of articles, letters and news items is encouraged. Submissions should be sent to editor@ranzcr.com The Editor reserves the right to make literary corrections and to withhold from publication any or part of any material submitted.

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

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Introduction

Protons with Political Spin A Message from the

President Dr Greg Slater

The Commonwealth giveth, and the Commonwealth taketh away. In its May Budget, the Federal Government announced a $68 million investment in Australia’s first proton beam therapy centre. To be built at the South Australian Health and Medical Research Institute (SAHMRI) in Adelaide, the facility is expected to be operational in three years’ time.1 This was clearly welcome news for radiation oncologists and local particle therapy facility is a decision the College had advocated for some years. The chief beneficiaries of proton therapy in Australia will initially be children with certain cancers—among them neuroblastoma, low-grade glioma and craniopharyngioma—as well as adults with tumours in regions such as the spine and base of the skull, to mention just a few of many likely applications. Co-location with SAHMRI will aid research and facilitate the direct translation of research findings into improvements for patient care. That’s the good news. However, if we wind back the clock to the midyear economic and fiscal outlook in December last year, you may recall Canberra’s decision to severely reduce national funds for the Radiation Oncology Health Programs Grants (ROHPG) scheme, which contributes to the cost of new equipment and equipment upgrades for standard radiation therapies. Among the therapies most affected by these cuts, which came into force on 1 July 2017, is brachytherapy, which is

so important today in the treatment of cervical and prostatic cancers. The cuts are also likely to disproportionately affect specialised techniques such as intensity-modulated radiation therapy and radiosurgery. Health services will struggle to replace out-of-date equipment and this will only lessen the efficacy of radiation treatments and restrict patient access. The impact of the decision will be felt by tens of thousands of cancer patients, especially among those patients in rural and regional centres where small health services often lack the financial flexibility of the large city-based services.

Today’s political climate, state and federal, has become as volatile and unpredictable as many of us can ever remember, and that makes advocacy with governments as difficult as ever. However, we do not intend to let this state of affairs deter our continuing efforts to fight for a better deal for radiation oncology. We welcome the planned arrival of proton therapies to Australia, and we will continue to press for strong government support of all the other radiation therapies proven to benefit cancer patients.

And here’s the sting: the College has estimated the changes to the ROHPG scheme will cost the sector $67 million over the next three years.2 That’s almost the same amount, over about the same period, as the Government’s investment in the new proton facility. It’s the kind of fiscal sleight of hand that earns politics a cynical reputation and prompts us to wonder if politicians are addicted to opening new, shiny facilities in marginal seats, even when it’s at the expense of an older, proven facility in dire need of an upgrade. The Adelaide proton facility’s future is now itself in question after reports have surfaced in the media of procurement irregularities. The recently announced Inquiry into diagnostic imaging equipment availability is another opportunity we will take to advocate for better access to technology, particularly MRI.

References 1. Commonwealth of Australia. “Budget to support establishment of world-leading proton beam therapy facility,” Ministerial media release, http://tinyurl.com/ y9buruz2 2. RANZCR, Faculty of Radiation Oncology. “Commonwealth Government withdrawing funding from cancer treatment,” consumer fact sheet, http:// tinyurl.com/ybeq36y2

Volume 13 No 4 I September 2017

Introduction

The Future of Particle Therapy in Radiation Oncology Although proton therapy has been used clinically since 1954, there has never been a facility capable of treating cancer patients in our region. Patients who require this treatment have had to travel to the Northern Hemisphere at great expense to the Government and patient, potentially with detrimental impact on cancer outcome due to difficulties in timely access. In May 2017, the Federal Government committed funding in the Budget for the establishment of a proton therapy facility in Australia, simultaneously acknowledging a growing problem of access, whilst also offering a solution. However, this has not happened overnight and has required huge effort in the radiation oncology community – and the work has only just begun. Business cases for proton facilities in Brisbane and Melbourne, as well as a national carbon ion (and proton) facility in Sydney, are well developed.

The Issue Our peers in the United States find it difficult to comprehend why the decision to establish a proton therapy facility has taken this long. Australia on the world stage is considered a wealthy country, with an excellent medical system and amazing oncology community to match. With the Trans Tasman Radiation Oncology Group (TROG) as our backbone, we consistently produce world class research that has impacted the way our specialty is practised. Yet for years, our patients diagnosed with certain base of skull tumours, paediatric malignancies and the like, have had to apply to the Federal Medical Treatment Overseas Program (MTOP) for financial support. This process has been described as long, arduous and with little feedback to the applicant until a final decision has been reached. The emotional impact for the patient, family

Inside News

Artists impression of future proton therapy centre in Adelaide

and health care team is considerable and can only be compounded if the application is denied. The financial cost of treatment overseas is significant, with a course of therapy often in the realms of $300,000 USD for the proton therapy component alone.

“It presents an opportunity to hone skills and techniques in proton therapy.“ For those countries with no immediate plans to establish a proton therapy facility, clear guidelines for referral overseas have been developed. Such documents have existed for the Netherlands in 2009, the United Kingdom in 2011 and Canada, with the Alberta guidelines in 2013. Since

then, the National Health Service has announced the development of a centre each in London and Manchester. Some detractors of proton therapy would argue that the scale of the problem is not sufficient enough to warrant the capital upfront cost of a proton unit. However, based on the Dutch guidelines and Australian cancer registry data, it has been suggested that approximately 5000 patients will benefit from proton therapy annually. Indeed, with ongoing research in this area, it is possible the potential clinical applications of the technology will increase even further over time. In 2014, Kerstiens et al1 recommended that in the US health system, one proton therapy room would require a captive population of 1,000,000 people.

Introduction

Many countries worldwide have established proton therapy facilities or have had centres in development for the last few years. Countries such as India, China and Taiwan are now investing in the development of proton centres. There are now around 10 carbon ion facilities world-wide, with the first for North America (Stanford) announced in October 2016. With no clear plans to develop a particle therapy facility, Australia was at risk of falling behind and our specialty faced the possibility of missing significant opportunities to carry out critical research in particle therapy and to become an early adopter of carbon ion therapy.

Solutions In 2015 a group of particle therapy ‘enthusiasts’ were loosely established and later that year, the College Position Paper on Particle Therapy was released. In 2017, the College Particle Therapy Special Interest Group was established to lead the work required to ensure equitable patient access to quality particle therapy in Australia and New Zealand. This will include the development of standardised treatment indications, protocols and follow-up programs (including clinical trials), as well as collaborating in the care of patients referred to particle centres in each nation. A specific goal has been to formalise a referral pathway for proton therapy overseas. It is anticipated this process will involve review of potential cases by an expert panel specialising in the management of the specific disease. It is expected this process will act as a conduit for potential referrals in a timely and clinically appropriate manner.

The MTOP process has been improved with the recent establishment of protonphoton comparative planning available at the Royal Adelaide Hospital which aims to provide objective criteria to inform decision making. Although this program does not receive external funding it has been embraced as it presents an opportunity to hone skills and techniques in proton therapy, develop research protocols and strengthen existing relationships with well-established proton therapy facilities overseas. The recent Federal Budget announcement of $68 million to establish a proton therapy facility in Adelaide’s burgeoning biomedical precinct has been a welcome and exciting development.

The College referral guidelines will need further refinement to incorporate the proposed referral network pathway. Linked with this work will be establishment of a research database and development of research protocols. Dr Hien Le Head of Research Royal Adelaide Hospital Clin A/Prof Verity Ahern Director, Sydney West Radiation Oncology Network Crown Princess Mary Cancer Centre

The Journey Ahead The funding announcements for proton therapy have been met with great excitement, However, there is no doubt that a huge effort will be required to ensure the necessary infrastructure is in place for the first proton centre and future centres, including a national carbon ion facility. One large component will be to ensure adequate training of staff. This includes radiation oncologists, radiation therapists and radiation oncology medical physicists involved. Engagement with the Department of Health began late last year to establish item numbers for proton therapy through the Medicare Services Advisory Committee. This work is ongoing and is expected to take a number of months as the process is negotiated through the various evaluation steps. Medicare support for particle therapy will likely be indication-based to ensure that appropriate access is available for what will be a scarce resource.

References 1. Proton Therapy Expansion Under Current United States Reimbursement Models www.sciencedirect. com/science/article/pii/S0360301614001990

Volume 13 No 4 I September 2017

Introduction

Supporting Trainees and Reducing Burnout In a recent cross-sectional study of radiation oncology trainees in Australia and New Zealand, high levels of emotional exhaustion were identified in 49.9 per cent of trainees1. Like most specialists in training, they face the challenges of a heavy and demanding clinical workload and in addition have to confront the stress of preparing for specialist exams. Many are also juggling young families and relationships. Similar findings were revealed in a large cross-sectional study of 579 cancer workers in Queensland, where burnout occurred in 31.1 per cent of participants which included a broad cross section of professional streams2. While the measurements for the levels of burnout will vary from study to study, it is reasonable to assume that approximately one third of College members will be experiencing the symptoms of burnout. The syndrome of burnout is characterised by emotional exhaustion, depersonalisation and diminished personal accomplishment. Commonly reported symptoms include the feelings of exhaustion, ineffectiveness, emotional depletion and a sense of detachment. The presence of burnout in medical practitioners is not surprising given the high level of emotional burden and stress that medical specialists are exposed to. The consequences of burnout are substantial, not only to individuals but also to employers, work colleagues, families and patients. What is less well known is that the symptoms of burnout may be modified by changes in lifestyle and in the work environment. In addition, workers who have well developed personal resources are more likely to be able to buffer the stresses that occur in the workplace. The single most important factor that will help guide individuals through the stressors of everyday life is motivation.

Inside News

By definition, motivation is the inner bearing passion caused by needs, wants and desires which propels an individual to achieve their desired objectives. Burnout is “the extinction of motivation.” By understanding the theory of motivation, a framework can be developed to provide a better environment for trainees to flourish not only at work but in life as well3. Motivation can be either external or internal. People are often moved by external factors such as reward systems, grades, evaluations, or the opinions they fear others might have of them. Yet, just as frequently, people are motivated from within, by interests, a love of learning, and the satisfaction of giving to others. These intrinsic motivations are not directly rewarded but nonetheless they can sustain interests, learning, creativity, and effort. The interaction between the extrinsic forces acting on persons and the intrinsic motives and needs inherent in human nature is the territory of SelfDetermination Theory (SDT).

SDT is a broad framework for the study of human motivation. SDT provides a formal theory that defines intrinsic and extrinsic sources of motivation, and a description of the respective roles of intrinsic and types of extrinsic motivation in cognitive and social development. Edward L. Deci and Richard Ryan proposed three main intrinsic needs involved in self-determination4 5. Psychological needs help motivate the self to initiate behaviours that are essential for psychological health and well-being. These needs are said to be universal, innate and psychological and include the need for competence, autonomy, and psychological relatedness. This theory can be universally applied to many domains including work, education, sport and hobbies. •C ompetence is to seek to control the outcome and to experience mastery.

Introduction

• Relatedness is the universal want to interact, be connected to, and experience caring for others. •A utonomy is the universal urge to control one’s life and act in harmony with one’s self. An environment that supports the individual’s experience of autonomy, competence, and relatedness will foster motivation and work engagement which in turn will improve performance, resilience and creativity. In addition, SDT proposes that the degree to which any of these three psychological needs is unsupported will have a detrimental impact on wellbeing. The SDT framework has broad implications for understanding practices and structures that enhance versus diminish need satisfaction.

“By understanding the theory of motivation, a framework can be developed to provide a better environment for trainees to flourish not only at work but in life as well.“

A Framework for Promoting Motivation The Faculty of Radiation Oncology has recognised the risks of a workforce with high levels of burnout and the need to develop a framework to promote motivation and reduce burnout.

The College The College is aware of the prevalence of burnout amongst its members. Following the work undertaken in 2014 amongst radiation oncologists, Dr John Leung conducted a Stress, Satisfaction and Burnout survey amongst radiation oncology trainees. This work was directed on behalf of the Economics and Workforce Committee. More information on the survey can be sourced on page 54 of the December 2016 edition of Inside News. Workshops which promote interventions for recovery also have some efficacy and have been tested in a randomised controlled trial for radiation therapists and oncology nurses6 and have been shown to be more effective than written information. Interventions such as these might allow members to recognise the symptoms and signs of burnout and provide them with the personal resources to promote recovery and protection from external stressors. Workshops should include some time allocated to the art of mentoring. The mentor is required to be non-judgemental and supportive. Motivational interviewing techniques are also invaluable in this setting. This is an effective technique to promote behavioural change by providing an autonomy-supportive atmosphere which allows the trainee to find their own source of motivation and achieve their own success.

Institutional Work Environment The Director of the Department should be pivotal in this role. One of the key actions is to consider the importance of positive feedback. This needs to be buffered with criticism where appropriate. The importance of supervisor and co-worker support was confirmed in a cross sectional study of cancer workers in Queensland7. Social support can take many forms and includes structured discussions, mentoring and debriefing with colleagues and other staff in a non-judgemental and confidential environment. When individuals work in relative isolation from peers and perceive low satisfaction with social support from supervisors or have poor team engagement, this can affect staff wellbeing, including burnout and disengagement8. Conversely, it can be predicted from the literature that engaged workers who experience social support are more likely to report positive emotions, experience better health, create their own job and personal resources, and transfer their engagement to others9. The nature of support at work may take a number of different formats, including: • I nformational – where guidance, advice and reports can be obtained from colleagues on a critical matter; •E motional – providing care and trust in a reliable alliance where one can count on others for assistance in times of need; • I nstrumental – facilitation to complete tasks; •A ppraisal – evaluation and feedback, reassurance of one’s worth.

continued over... Volume 13 No 4 I September 2017

Introduction

Personal Resources of Trainees Knowledge of one’s personal resources is important and has been linked to resilience10. Improving personal resources through positive strengthsbased self-evaluation and development is associated with improved motivation, job performance, life satisfaction and job retention11. Web-based interventions have been shown in randomised controlled trials to reduce the levels of depression and improve levels of happiness with benefits apparent at six months12. These interventions are relatively low cost and can be made available to large numbers in workers within an organisation. Job resources, such as participating in recovery experiences, social support from supervisors and colleagues, as well as performance feedback, can individually or collectively contribute to motivational processes that impact work engagement. Restoring or replenishing job and personal resources are of central importance in facilitating recovery. High levels of negative strain, occurring when job demands are high, act in a manner to diminish resources. Resource-demand imbalance will have a detrimental effect on workers unless recovery is possible13. In summary, SDT provides a very useful theory that can assist the College to develop a framework to help promote motivation and reduce burnout in members. The key concepts of autonomy, competence and relatedness are applicable at multiple levels within the context of an individual’s life. The Faculty of Radiation Oncology, and in indeed the College more broadly, have an opportunity to act as a facilitator to disseminate knowledge about promoting motivation. Ideally this should be done early in the trainee’s course work – which would not only prepare them better during the five

Inside News

years of training, but should also equip them better for their working career. The most important area is for individuals to learn how to improve their own personal resources and build this in to their own schedules. These are important strategies for life which will keep them ‘fit for the long run’. This in turn should reduce the probability of losing members from the profession, while simultaneously improving the wellbeing of our members and ultimately, patient care. Prof Michael Poulsen Radiation Oncology Mater Centre

References 1. Leung J., Rioseco P. Burnout, stress and satisfaction among Australian and New Zealand radiation oncology trainees. Journal of Medical Imaging and Radiation Oncology. 2016, in print. 2. Poulsen M., Poulsen A., Khan A., Poulsen E., Khan S. Work engagement in cancer workers in Queensland: the flip side of burnout. J Med Imaging and Rad Onc 55, 425-432, 2011 3. Ryan, R. M. & Deci, E. L. (Eds.). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68-78, 2002. 4. Deci, E., & Ryan, R. A motivational approach to self: Integration in personality. In R. Dienstbier (Ed.), Nebraska symposium on motivation: Vol. 38. Perspectives on motivation (pp. 237–288). Lincoln: University of Nebraska Press. 1991. 5. Deci, E. L., & Ryan, R. M. Human autonomy: The basis for true self-esteem. In M. Kernis (Ed.), Efficacy, agency, and self-esteem (pp. 3149). New York: Plenum, 1995. 6. Poulsen A, Sharpley C. Baumann K, Henderson J., Poulsen MG. Evaluation of the effect of a one day interventional workshop on recovery from job stress for radiation therapists and oncology nurses: A randomised trial. Journal of Medical Imaging and Radiation Oncology 59(4): 491-498, 2015 7. Poulsen M., Khan A, Poulsen E., Khan S., Poulsen A. Work Engagement in Cancer Care: The power of co-worker and supervisor support. European J of Oncology Nursing. 21 134-138, 2016 8. Turner, J., Kelly, B., & Girgis, A. Supporting oncology health professionals: a review. Psychooncology, 5, 77-82, 2011. 9. Friedrickson, B. The role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions. American Psychologist, 56, 218-226, 2001. 10. Hobfoll SE, Johnson RJ, Ennis N, Jackson AP. Resource loss, resource gain, and emotional outcomes in inner city women. Journal of Social Psychology. 84:632-43, 2003. 11. Judge TA, Van Vianen AEM, De Pater I. Emotional stability, core self evaluations and job outcomes: a review of the evidence and an agenda for future research. Human Performance. 17:325-46, 2004. 12. Seligman MEP, Steen TA, Park N, Peterson C. Positive psychology progress: Empirical validation of interventions. American Psychologist. 60(5):410-21, 2005. 13. Demerouti, E., Bakker, A.B., Geurts, S., Taris, T.W. Daily Recovery from work-related effort during nonwork time. Research in Occupational Stress and Well Being 7, 85-123, 2009.

Introduction

Leading Cross-College Collaboration From the

Chief Executive Officer Ms Natalia Vukolova

Improving member services and the impact of our work can be achieved by sharing knowledge across medical colleges – that was the message from our College open day, held on Tuesday, 1 August 2017 at our Sydney Head Office. Our College suggested the idea of a ‘CEO study tour’ among all College CEOs and senior managers and organised the first such Open Day.

“Our College is stronger due to the combination of dedicated clinical leaders and committed professional staff.“

It was delightful to host fifteen senior executives from a variety of medical colleges and have a series of animated discussions on matters as varied as workforce planning, examination candidate support and Indigenous trainee programs. As hosts, we put together a series of short presentations detailing our College’s approach and recent experiences in a number of pivotal areas, including successes and challenges across: • Advocacy to Australian and New Zealand governments • Policy development; How to get member input • Data analytics and its use in advocacy • Public information campaigns and outreach to general practitioners • Stakeholder involvement and management of partnerships

• The move of the clinical radiology viva exams to the AMC Assessment Centre • Member engagement strategies and encouragement of volunteering • Inaugural member survey and implementing its findings • Information Technology Strategy and how it links to business prerogatives • Courses, events and building successful international partnerships The professional team within the College includes staff with extensive experience and skills ranging from political economy, public health to educational theory, events management and economic modelling. The Open Day highlighted what an asset our professional team is to the organisation. Our College is stronger due to the combination of dedicated clinical leaders and committed professional staff. In the words of Tim Wills, CEO at the Australian College of Dermatologists, the Open Day was: “A great learning and sharing experience. Thank you again for hosting. You have built a great team and a professional culture shines through. Well done you!” Let’s hope that other Colleges continue to build on this collaborative idea.

• MBS Review • The use of Standards for practices to enhance patient care • Training and Assessment Reforms currently underway

If you have any comments or ideas, as always, please email me at ceo@ranzcr.com

Volume 13 No 4 I September 2017

Leadership

Public Policy Making is Inherently Political Public Policy Context The recent Federal Government budget was disappointing for the College, with the Government failing to implement key election commitments for diagnostic imaging. This outcome brings into clearer focus the reality that public policy making is an inherently political process and that, amongst the myriad of factors that inform and influence policy making, political agendas play a key role. Public policy is the outcome of a complex set of interactions among the many actors in the system. These include Ministers, Government departments, businesses, charities, universities and research institutes, non-Government organisations, consultants and individual citizens. In the 21st century, we do not have a political system that is aligned to Australia’s pluralised society and our present political and policy system is largely gridlocked. The current political incentive structure favours an adversarial approach and is not conducive to producing support for sensible reforms. Over the last ten years politics has become a daily contest, dominated by career politicians concentrated on winning the daily news battle or points on the other side; and where obstruction rather than the interests of the community and developing good public policy prevail. Populism is on the rise with equally opportunistic minor parties and independents attracting support in protest. Unfortunately, the skill sets and experience of career politicians generally do not make them competent to govern effectively. Many become ministers responsible for significant government portfolios and large budgets, with no management experience and little or no relevant experience, skills or commitment to the policy area.

Inside News

According to the Institute of Public Administration Australia1, governments are failing to commit to and adhere to good policy making criteria and a well-defined process, rather making ‘policy on the run’ often to exploit or react to a burning political issue. Within the contemporary policy making environment there is pressure for senior politicians in governments and oppositions to make decisions quickly and confidently, to pander to populist ideas, to manufacture wedge issues to distinguish themselves from their opponents and to put a spin on everything to exaggerate its significance. Policy success is very much a matter of chance. The present political system has almost no capacity to create a political conversation around single issues that can be independent of the struggle for office between the major parties. It lacks any capacity for bi-partisanship or consensus-building in the unfolding of contested policy issues. Today, the bureaucracy too is heavily politicised and often does not have sound policy making capabilities. Decades ago it was more permanent and motivated to give full and fearless advice. A shift towards being more responsive to ministers and political priorities risks leaving departments as overly-reactive and focused only on issues linked to political goals.

Health Policy Context The challenges for 21st century health care in Australia are well-known. They include population growth, ageing and the rise of chronic disease, inequality in access to care and health outcomes, technological change and escalating public expenditure. However, health is a public policy area where governments find it difficult to get policy traction and an area that is becoming increasingly problematic. Health policy is complex and often controversial while the overall Australian health care system is complex. It has been described by the Australian Institute of Health and Welfare (AIHW)2 as a multi-faceted web of public and private providers, settings, participants and supporting mechanisms. Health providers include medical practitioners, nurses, allied and other health professionals, hospitals, clinics and government and non-government agencies who deliver a plethora of services. The chart below provides an ‘at

Leadership

a glance’ picture of the main services, funding responsibilities and providers. Many of the factors driving up health costs are related to the complexity of the health care system. Further, the Federal Government has limited policy levers for controlling the growth of its health care expenditure with some 80 per cent of its expenditure related to demand driven programs (Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and Private Health Insurance). In a three-part series on health policy reform3, John Menadue (a public commentator involved in health policy for more than 20 years, former senior public servant and diplomat) notes that in health, delivering services is not in itself, the objective. That objective is serving the community by helping to keep the population healthy. Whilst acknowledging that Australia has one of the best health services in the world in terms of efficiency and equity (thanks to Medicare, which was established over 40 years ago), Menadue says the current health care arrangements cannot be called a “system”. Comprising many distinct parts, there are no clear underlying principles and because of the fragmentation and lack of coherence there is a lot of waste in the current arrangements. Menadue’s health policy reform series presents a good overview of the priority areas where reform is needed, explains why health sector reform is so difficult; and discusses reform principles and processes for overcoming obstacles. Over the past ten years, despite successive governments having commissioned at least ten reviews and consultations directed at reforming and modernising parts of the Australian health ‘system’, there has been only a series of policy failures and no significant

reform of the health sector. Incremental changes in response to political and budgetary pressures have continued to produce arrangements that lack the guiding values and principles that should drive a health care ‘system’. A serious barrier to improving health policy and programs is the failure of the ministerial/departmental model. In December 2014, a capability review of the Commonwealth Department of Health by the Australian Public Service

“Incremental changes in response to political and budgetary pressures have continued to produce arrangements that lack the guiding values and principles that should drive a health care ‘system’.“ Commission found that despite playing an integral role in the development of health policies and the administration and delivery of health programs to support improved Australian health outcomes, the Department:

inform and guide the department’s advice in an increasingly contested policy environment. The review also found limited evidence of horizonscanning or internal discussion on whole-of-health system policy.” • I n an increasingly contested policy environment, “needs to ensure it adequately captures the views of stakeholder groups.” The public health policy debate is generally conducted between interest groups (e.g. the Australian Medical Association) and the Minister – the public is excluded and the media is less likely to be investigative or to undertake critical examination of key health policy issues, relying increasingly on handouts from vested interest groups. Reform disrupts established arrangements and existing interests, vested interests can exercise a lot of power by opposing or delaying reforms and they generally win out over the public interest. Health Ministers depend on the Department for advice, particularly when they are not across the issues and do not have a clear policy program themselves; the Department is then ill-equipped for health policy reform. Ministerial leadership is critical in the health system. The most recent health policy success was tobacco plain packaging, championed by Nicola Roxon as Minister for Health almost ten years ago.

•D id “not have a high level policy framework to support the development of coherent policies and programs that are guided by and support a single strategic intent.” •“ Needs to better connect sources of evidence across the organisation to support the development of a highlevel whole-of-health-system view to

continued over... Volume 13 No 4 I September 2017

RANZCR PERTH 2017

68th Annual Scientific Meeting

explore the

extraordinary extraordinary explore the

19 – 22 October 2017 Crown Perth, Western Australia www.ranzcr2017.com

There’s still time to register...

Leadership

How can the College Contribute to Public Health Policy Making? Making submissions to policy reviews and consultations that have potential to impact on diagnostic imaging (DI) and radiation therapy (RT), despite the significant burden on College resources, is essential to public interest. In the absence of an overarching vision for the Australian healthcare system, making submissions enables the College to at least ensure that policy makers are kept informed about the vital contributions of DI and RT to patient outcomes when developing broader health care reform policies to meet the needs of patients in the 21st century. For example, the Medicare Benefits Schedule (MBS) is a policy instrument/ change management tool, not just a funding vehicle and changes to the MBS can have unpredictable effects. There needs to be a clear vision of the objectives of changes in health care delivery to ensure there are no detrimental impacts on sustainability, access and affordability.

Australia, and developing sound policy positions that are principled, forward looking, knowledge-informed and fair. In the face of global trends, including the likely and potentially disruptive impact of digital health advances and the direction of health care system reforms in other countries, it should be a priority of the College to incorporate this into the strategic priorities to ensure relevance. Sandra Keogh, BSc Policy Advisor The Royal Australian and New Zealand College of Radiologists

Find the College’s submissions and position statements here www.ranzcr.com/ourwork/advocacy/positionstatements-and-submissions

Pressure for reform in health care will continue in Australia and it can be expected that there will continue to be a focus on DI as part of ongoing attempts to contain health expenditure. The pace of reform in the Australian health sector has been slow and generally tends to lag behind global trends. This provides an opportunity for the College to influence future health policy making in Australia directed at ensuring patients continue to receive high quality imaging and cancer services by: being proactive in keeping abreast of key global trends and forecasts, stimulating thinking about challenges and possible impacts of trends on both imaging and cancer treatment in

References 1. www.ipaa.org.au/documents/2012/05/publicpolicy-drift.pdf 2. Australia’s health 2014, www.aihw.gov.au/australiashealth/2014/health-system 3. www.johnmenadue.com/john-menadue-healthpolicy-reform-part-1-why-reform-is-needed-2

Volume 13 No 4 I September 2017

Engaged Members

Member Health and Well-being New Resources Page at ranzcr.com The results from our 2016 member survey highlighted that issues relating to workload, work-life balance and burnout are a real concern for many members. These findings are consistent with the results from two recent Stress, Satisfaction and Burnout surveys conducted by Prof John Leung with the College’s radiation oncology members, and also reflect the concerns of the medical profession in general, as identified in Beyond Blue’s 2013 National Mental Health Survey of Doctors and Medical Students. Articles from members Prof Michael Poulsen

(page 8) and Dr Cara Odenthal (page 40) discuss these issues in more detail. The College recognises that it has a role to play in promoting the importance of health and well-being among our members, and we are exploring a number of possible programs and activities to support members in this regard. In the meantime, we have published a resources page on the RANZCR website dedicated to health and well-being; a collation of quality information and support from trusted sources such as the Australian Medical Association and the Australasian Doctors’ Health Service.

Updated RANZCR Website Wins Design Award The College’s website has been announced as Gold Winner at the Sydney Design Awards in the Digital – Health category. The website was redeveloped earlier this year in response to member feedback and the findings from our recent member survey. Visit www.ranzcr.com to explore the updated website. We are continuing to work on and enhance the website, and welcome your feedback. Please get in touch via the online feedback form at www.ranzcr.com/feedback or email editor@ranzcr.com

Inside News

Find out more Fellows and Educational Affiliates: www.ranzcr.com/fellows/wellbeing Trainees: www.ranzcr.com/trainees/wellbeing

If you have any questions or comments, or would like to recommend a resource to list on our health and well-being page, please contact Susie Musgrove at members@ranzcr.com

Engaged Members

Dr Melissa James Radiation Oncologist, Christchurch Hospital Senior Lecturer (clinical) University of Otago Director of Training Phase 2 Examiner, Radiation Oncology Education and Training Committee, Faculty of Radiation Oncology Network New Zealand, New Zealand Radiation Oncology Executive Committee, Economics and Workforce Committee Dr Melissa James

Background I commenced my training in Sydney at the Prince of Wales Hospital, however, a career opportunity for my husband in New Zealand resulted in me completing my training in Christchurch. I was awarded my Fellowship in 2003 and have worked as a consultant in Christchurch Hospital since 2005. I was very fortunate to have been trained in both Australia and New Zealand, which allowed me to see firsthand the benefits and challenges of training in the two countries. We had not trained a great number of radiation oncologists in Christchurch immediately prior to my arrival so, with the valuable support of my senior colleagues, I began navigating the training system and enlisting support from many places, from within our hospital and across the Tasman, in order to gain the knowledge and experience to pass my Fellowship exams. Having obtained my Fellowship, I felt keen to pass my experience on to future trainees and this enthusiasm resulted in me being given the role of Director of Training at Christchurch Hospital when I started as a consultant.

Why I Am Involved I realised very early on that I was going to need support, advice and mentoring in the role of Director of Training, as enthusiasm alone seemed to equip me poorly to train. Once again, supportive colleagues in Christchurch nominated me to be involved in the Education Board (now Radiation

Oncology Education and Training Committee) so I could see firsthand the development and implementation of the training curriculum and thus be better prepared to train our registrars. A feeling of relative isolation was quickly remedied by my involvement in ROETC and also involvement in the initial stages of the development of the New Zealand Network. Aware that I still needed experience to train our Phase 2 registrars, I responded to the expression

“Getting involved in training and education is as rewarding as it is vital to the future of our specialty.” of interest for Phase 2 examiners and soon joined the ranks. Apart from waking up on my first day examining with a dream that I was actually sitting the exam again rather than examining, I have greatly valued the opportunity to be part of the examination team. It has helped me better prepare our local registrars and also helped me to feel more up-to-date in treatment sites that I do not usually treat. As part of my role on the Education Board, I began to show interest in predicting workforce needs and workforce planning as recruitment in New Zealand can be challenging. This

resulted in me working alongside the Economics and Workforce Committee performing and analysing surveys and eventually lead to an invitation to join the committee.

Encouragement to Others We have a great specialty and have the privilege of being able to pass on our experience to our trainees, but it is important we do this well. Getting involved in training and education is as rewarding as it is vital to the future of our specialty. As a New Zealand radiation oncologist, I feel it is important our voice is heard on College committees, who in my experience are very keen to hear this perspective. We are not many in number and so proportionally the demand is heavier and we can feel a bit daunted by the thought of involvement in College activities. It is my experience that, once again, this is as rewarding as it is vital to the future of our specialty in New Zealand.

To get involved or to share your experiences and be featured in the member profiles, please contact Sarah Hall at editor@ranzcr.com or +61 2 9268 9752

Volume 13 No 4 I September 2017

Engaged Members

Dr Hien Le Radiation Oncologist, Royal Adelaide Hospital Committee Member, Media and Profile Committee Committee Member, Economics and Workforce Committee

Dr Hien Le

Background I am a Radiation Oncologist from the Royal Adelaide Hospital with a keen interest in the application of innovative and emerging cancer technologies. I was fortunate enough to receive the Windeyer Fellowship award in 2011 and with this spent a year at Mount Vernon Cancer Centre learning the techniques involved in Cyberknife and MRI based image guided brachytherapy. In 2013, I received the Thomas Baker Fellowship and undertook an observership at the Massachusetts General Hospital where I trained in spread out Bragg peak and intensity modulated proton therapy. I am also a member of the College Media and Profile and the Economics and Workforce Committees. With Dr Michael Penniment, I find a lot of my working efforts are divided between establishing Australia’s first proton therapy centre, research, clinical work and ensuring smooth transition to our new hospital in Adelaide’s biomedical precinct.

Why I am Involved in Advocating for our Specialty In my career I have had the opportunity to work in various health systems, both interstate and abroad. This has provided a great appreciation for our current health system. However, I often look longingly at our American counterparts as they appear to enjoy a significantly higher profile in their country. For example, the United States radiation oncology training program is amongst the most popular, consistently ranking at

Inside News

the top year after year and attracting the best candidates from around the globe. This is in stark contrast to the trends observed currently in New Zealand where training posts are often left unfilled. In the US, patients from far and wide often travel across borders to have therapy or receive a second opinion. Some of this can be related to individual or institutional marketing but I believe together as a community we can do more in this region to raise the profile of our own discipline. Which specialty has moved forward in such leaps and bounds in the last few decades? Not many disciplines have observed huge advancements in exciting technology as ours. It does not seem that long ago 2D planning with chinagraph pencils and manual dosimetry was practiced, whilst now we have VMAT, SABR, SRS and remote after loading MRI guided HDR brachytherapy and soon to be MRI linacs and proton therapy in our arsenal. This fact, coupled with our high-quality oncology training, many believe we are entering into a golden era for radiation oncology. Although our medical oncology colleagues benefit greatly from industry support in the areas of clinical research, education and advocacy, for our specialty, much of this work must be initiated and developed from within our group. It was exceptionally pleasing to see the College take the necessary steps a few years ago to support this cause and facilitate the great work that has been carried out by the Media and Profile Committee. Of course, many of these initiatives are the brain child

of our chairperson, A/Prof Sandra Turner, whose tireless work and fearless approach to these issues has been an inspiration. She is ably supported by the team at College and together, we instantly have the foundation for a formidable force.

Encouragement to Others If these words somehow resonate with you, I encourage you to join this movement. There are many ways in which your contribution can help and I can assure you, it will be rewarding. However, if nominating for the Media and Profile Committee is not for you, please consider other options such as conducting a local GP information night at your site, joining another relevant Faculty committee, contributing to our ever-expanding website www. targetingcancer.com.au or sharing the efforts of the various bodies that represent our specialty on social media. We hope to see you all do your bit for radiation oncology.

To get involved or to share your experiences and be featured in the member profiles, please contact Sarah Hall at editor@ranzcr.com or +61 2 9268 9752

Engaged Members

RANZCR 2017 ASM

Register today! Please join us at The Royal Australian and New Zealand College of Radiologists 68th Annual Scientific Meeting, being held from 19–22 October at Crown Perth. Through a program of world-class international and local speakers, the ASM’s theme Explore the Extraordinary will create thought provoking conversation, challenge traditional thinking and discuss the implementation of best practice, while exploring innovative and challenging advances for the future.

Clinical Radiology Program The full scientific program has been finalised. Highlights of the clinical radiology program include keynote presentations from an international faculty consisting of Prof Suresh K. Mukherji, Prof Michael P. Federle, and Prof Mark J. Kransdorf, who will be joined by invited speakers Dr Richard Ehman, Prof Declan O’Regan, Dr Nicola Strickland and Prof Bernd Hamm. Prof Enrico Coiera will head up the Faculty Forum discussing how artificial intelligence (AI) and pattern recognition software will impact on the role of clinical radiologists in coming years. The role of machine learning in clinical decision support will also be discussed by Dr Tanveer Syeda-Mahmood.

Role of Machine Learning in Clinical Decision Support With advances in machine learning and AI, a new role is emerging for machines as intelligent assistants to radiologists in their clinical workflows. After the success of Watson Jeopardy challenge, IBM researchers are now engaged in a new radiology grand challenge that extends Watson to become such a cognitive assistant. It uses sophisticated multimodal medical image analysis, deep learning, and clinical inference

technologies to analyse patient cases using a systematic clinical thought process similar to radiologists. IBM Fellow Dr Tanveer Syeda-Mahmood will be presenting via video conference these latest innovations at the ASM. She will provide a perspective on where the role of machine learning in clinical decision support can assist and present IBM Research Labs work in this area. Dr Syeda-Mahmood will also discuss the results of a successful observational study rolled out at the Radiological Society of North America conference in 2016 showing how machines of the future may be able to assist radiologists, not only in their training but also by reducing the time to diagnose, increasing efficiency in their clinical workflows.

Radiation Oncology Program Highlights of the radiation oncology program include presentations from an international faculty consisting of Prof Brian O’Sullivan, Prof Lena Specht and Dr Joost Nuyttens, along with American Society for Radiation Oncology representative Prof Bruce G. Haffty. The Faculty Forum will focus on protons as a prime treatment for paediatric and prostate cancers. The cutting edge CyberKnife® technology will also be discussed by Dr Joost Nuyttens.

guidance and robotic mobility to deliver treatments characterised by high conformality and steep dose gradients. We are excited to have renowned radiation oncologist and CyberKnife® expert Dr Joost Nuyttens join us at the ASM to share his expertise and demonstrate its ability.

Workshops The highly popular BreastScreen Reader Assessment Strategy (BREAST) Workshops, designed for readers to test their proficiency on a set of 60 mammography cases, will be held at the ASM, along with CPR Workshops and FALCON Educase Contouring Workshops on Lymphoma. Workshop places are limited so you are encouraged to register early to secure your place. Please refer to the ASM website at www.ranzcr2017.com for full details including fees.

Call for 2019 ASM Convenors We are calling for nominations for convenors for the 2019 ASM which will be held in Auckland, New Zealand. If any New Zealand members are interested in putting your name forward, please contact the College’s Conferences and Events team via events@ranzcr.com

Cutting Edge Technology CyberKnife® Being Presented at the 2017 ASM In the field of radiation oncology, the CyberKnife® Robotic Radiosurgery System is universally recognised as the premier radiosurgery system capable of delivering high doses of radiation with sub-millimetre accuracy anywhere in the body. As validated and proven in numerous peer-reviewed publications, the precision and accuracy of the system combines with continual image Volume 13 No 4 I September 2017

Profile and Presence

Targeting Cancer – Advocacy for Men with Prostate Cancer Continues Advocacy for men with prostate cancer, as a core area of focus of the Targeting Cancer campaign, continues with the message that men should consult with a radiation oncologist as well as a urologist before deciding on active treatment.

Strategy for Prostate Cancer Advocacy Following the ‘Design and Discovery’ Workshop earlier this year, we are in the final stage of confirming the strategy and formulating a high-level project plan for the next stage of the campaign, with the focus on prostate cancer. The team is also building a compelling case, drawing together scientific and other evidence regarding prostate cancer and the need for men to receive adequate information from all specialists prior to making their treatment decision. The compelling case will be used to assist with College advocacy activities, including alliance building and lobbying, and influencing policies. There have been supportive quotes, articles and commentary recently supporting our cause from important partners in these messages including Cancer Council Australia, Cancer Institute NSW, Cancer Voices and Prostate Cancer Foundation Australia.

Media/Social Media Campaign Targeting Cancer has an active media/ social media platform to promote our key campaign messages. Two opinion editorial pieces on prostate cancer were developed, one from A/Prof Dion Forstner, and the other by Mr David Letts, a prostate cancer consumer and Professor of Law at Australian National University. Both stressed the importance of fully understanding treatment options for ‘informed consent’. A media release also went out aligned with the Men’s

Inside News

Health Week in Australia (12-18 June 2017), and several interviews resulted following those media releases. The mini media/social media campaign reached millions of people and sparked some good discussions and many positive comments. Communication experts advise that social media is a proven effective channel to amplify key messages and build relationships with key stakeholder groups, leveraging and using existing active communities. We strongly encourage our members to join us in social media, ‘Like’ Targeting Cancer on Facebook, or ‘Follow’ @targetingcancer on Twitter, and help us spread the word. In the near future, we plan to also promote excellent examples of where true multidisciplinary models in prostate cancer care are working well. We encourage members to please send ideas and experiences to faculty@ranzcr.com

Resources Development Three prostate cancer advocacy videos – It’s A Big Decision – were developed in collaboration with Tonic Health Media, again highlighting the need for men to fully investigate their prostate cancer treatment options. A tri-fold brochure has been developed to complement

the videos. Both resources are being promoted through the Tonic Health Media GP Clinics Network in Australia (around 1,500 practice waiting rooms), but are also relevant for use in New Zealand. The videos are also available on the Targeting Cancer website at: www.targetingcancer.com.au/videosabout-radiation-therapy The campaign team has also developed a variety of promotional materials. If you need any of those resources to be displayed at your clinic, used for promotional events around radiation therapy or distributed to your patients, please email info@targetingcancer.com. au Don’t forget to mention Targeting Cancer in all your education sessions with patients and other health professionals and share the website link – targetingcancer.com.au or targetingcancer.co.nz. Remember this is OUR campaign! Thanks to those who have already jumped on board. A/Prof Sandra Turner Chair, Faculty of Radiation Oncology Media and Profile Committee Clinical Lead, Targeting Cancer Campaign

Profile and Presence

Men’s Health Month #Movember

Get involved with InsideRadiology

 

 

Promoting InsideRadiology in your professional networks. Supplementing your hospital or practice resources using links to InsideRadiology. Recommending any topics that could be considered for inclusion. Volunteering to assist with content.

InsideRadiology aims to be the leading Australasian resource on clinical radiology tests, procedures, and interventions. It provides up-todate information to health consumers (patients, their families and friends) and health professionals (referring clinicians and allied health professionals), and fosters and encourages doctor-patient communication.

Movember November, or as it’s now known – Movember, is the month for Men’s Health (see: au.movember.com). 70 per cent of men say their friends can rely on them for support, but only 48 per cent say that they rely on their friends. In other words: we’re here for our mates, but worried about asking for help for ourselves. Reaching out is crucial. Catch up regularly, check in and make time. You don’t need to be an expert and you don’t have to be the sole solution, but being there for someone, listening and giving your time can be life-saving.’1 InsideRadiology has specific topics on men’s health that can help health professionals and health consumers understand the test or procedure they, or a family member/friend/colleague, may be having. Questions that may be asked of procedures include: • How do I prepare…? • What happens during…? • Are there any after effects? • How long does it take? • What are the risks of the …?

Reach out and share our printable topics: - MRI scan of the prostate (www. insideradiology.com.au/mri-prostate) A magnetic resonance imaging (MRI) scanner uses strong magnetic fields to create an image (or picture) of the prostate and surrounding tissues. - Ultrasound guided prostate biopsy (www.insideradiology.com.au/ ultrasound-guided-prostate-biopsy) An ultrasound guided prostate biopsy is a procedure where a special needle is inserted into the prostate gland to take a small sample of tissue from the gland. The sample is then sent to a laboratory for testing, to determine the presence or absence of prostate cancer. - Urethrogram (www.insideradiology. com.au/urethrogram) A urethrogram is usually carried out to show the cause of poor urinary flow thought to be caused by narrowing (a stricture) of the urethra. The most common cause for narrowing of the urethra in men is benign (noncancerous) enlargement of the prostate gland. A urethrogram is most often used to diagnose causes of narrowing of the urethra that are not caused by benign enlargement of the prostate gland. Further information about InsideRadiology can be found at www.insideradiology.com.au/aboutradiology/about-insideradiology Please help us promote InsideRadiology by following us on Twitter @InsideRadiology

• What are the benefits of the …? References 1. www.misternewsletter.com.au/_literature_226935/ April_2017

If you need further information please contact insideradiology@ranzcr.com

Volume 13 No 4 I September 2017

Profile and Presence

The Importance of the Clinical Radiologist The Faculty of Clinical Radiology has developed a short video to inform consumers and health professionals about the value clinical radiologists bring to healthcare – and how InsideRadiology can play a part in preparation for a test or procedure.

Scan here to watch the full video on the importance of the Clinical Radiologist

Scan here to watch the snippet on digital mammography

Scan here to watch the snippet on subarachnoid hemorrhage

Please contact us on InsideRadiology@ranzcr.com to order complimentary InsideRadiology health consumer leaflets and pens for your practice or department.

www.insideradiology.com.au / www.insideradiology.co.nz 22

Inside News

Access to Quality Services

Win for Bowel Cancer Patients in New Zealand

Bowel cancer is one of the most common cancers in New Zealand, affecting almost 3,000 New Zealanders every year. In order to address such a serious health issue, the Government developed a Bowel Screening Pilot in Waitemata DHB in 2011.

As outlined in our election submission document, the use of Computed Tomography Colonography (CTC) will be important to support the management of patients deemed at risk following screening. The College advocates the use of CTC in certain target populations:

Following the successful implementation of the pilot, a National Bowel Screening Programme will be rolled out progressively across all district health boards (DHBs) from July 2017. The roll-out will begin with Hutt Valley and Wairarapa DHBs in July 2017, with other DHBs following in stages. A National Coordination Centre (NCC) will be established in 2018 to take over the management and coordination of the screening program. The NCC will host the 0800 number (0800 924 432), send letters to participants following a negative result and notify GPs electronically of all results.

• Symptomatic patients with a suspicion of bowel cancer

The College has been advocating to government regarding the importance of clinical radiology in the successful rollout of this programme, including most recently in our election briefing. The College commends the Government for their decision to extend the bowel screening programme nationally. A comprehensive screening programme will be critical to efforts to reduce the toll this deadly disease is taking on New Zealand.

• Those who have had an incomplete colonoscopy • Patients for whom colonoscopy is contraindicated • Patients who are symptomatic or at high risk and require exclusion or diagnosis of colorectal cancer but have limited access to colonoscopy such as to delay diagnosis.

“A National Report of bowel cancer patients found that only 67% of acute presentations and 59% of non-acute presentations for bowel cancer received a staging CT of the abdomen and pelvis within eight weeks.”

As the screening programme scales up during 2018, the impact on clincal radiology will be significant. The College is already making the case to the New Zealand Government that adequate resourcing for radiology departments and practices is essential to support this patient group into the future.

Volume 13 No 4 I September 2017

What’s in Issue 5? Medical Imaging Review Article: Review of axillary lesions, emphasising some distinctive imaging and pathology findings Corresponding author: Dr Donna Taylor, Royal Perth Hospital, Perth, WA, Australia. The axilla is often included on mammography, ultrasound (US), CT and MRI. Axillary masses can arise from any of the tissue components present in this region including breast parenchyma. Aetiologies include: lymphadenopathy due to inflammation, malignancy and degenerative causes; soft tissue tumours such as haemangioma, lymphangioma, peripheral nerve sheath tumours and lipomas; post-surgical complications such as seroma, lymphocoele and haematoma; lesions arising in accessory breast tissue such as fibroadenoma and carcinoma. Some of these entities have distinctive imaging appearances knowledge of which can be helpful in suggesting the correct diagnosis.

Medical Imaging Editorial: Future Proofing Radiologists Corresponding author: Associate Professor Tom Sutherland, St Vincent’s Hospital Medical Imaging Department, Fitzroy, Victoria, Australia. There has been a rapid evolution in radiology over the last few decades, but unfortunately radiologists have struggled to evolve with the new landscape(1). To survive we need to look at who we are and what we want. What is the role of a radiologist and where do we fit? Are we service providers playing a supporting role with patients or are we clinicians?

Radiation Oncology Original Article: Intervention quality is not routinely assessed in Cochrane systematic reviews of radiation therapy interventions Corresponding author: Dr Mohamad R Abdul Rahim, Dept. of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia. Introduction: The aim of this study was to maximise the benefits from clinical trials involving technological interventions such as radiation therapy. High compliance to the quality assurance protocols is crucial. We assessed whether the quality of radiation therapy intervention was evaluated in Cochrane systematic reviews. Methods: We searched 416 published Cochrane systematic reviews and identified 67 Cochrane systematic reviews that investigated radiation therapy or radiotherapy as an intervention. For each systematic review, either quality assurance or quality control for the intervention was identified by a description of such processes in the published systematic reviews. Results: Of the 67 Cochrane systematic reviews studied, only two mentioned quality assurance or quality control. Conclusions: Our findings revealed that 65 of 67 (97%) Cochrane systematic reviews of radiation therapy interventions failed to consider the quality of the intervention. We suggest that advice about the evaluation of intervention quality be added to author support materials.

Medical Imaging - Radiation Oncology Original Article: Prognostic significance of SUVmax on pretreatment 18F-FDG PET/CT in early-stage non-small cell lung cancer treated with stereotactic body radiotherapy: A meta-analysis Corresponding author: Dr Ligang Xing, Department of Radiation Oncology, Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academic of Medicine Science, Jinan, Shandong, China. Introduction: The prognostic importance of the 18F-FDG PET maximum standardized uptake value (SUVmax) for early stage non-small cell lung cancer (NSCLC) patients receiving stereotactic body radiotherapy (SBRT) is not well defined. The purpose of this meta-analysis is to evaluate the efficacy of SUVmax on pretreatment 18F-FDG PET imaging to predict prognosis after SBRT. Methods: All published English-language studies that assessed the treatment response after SBRT in patients with early-stage NSCLC using 18F-FDG PET were collected from the EMBASE and MEDLINE databases. All the included studies were published between January 2000 and June 2015 and limited to NSCLC, PET/CT, SBRT, and the impact of SUVmax on survival. The necessary data for the calculation of individual hazard ratios (HRs) were extracted from each publication. All the results were independently verified and examined by two reviewers to ensure accuracy. Results: After evaluating the original articles, 11 retrospective studies (1008 patients) were included into the meta-analysis. Data were available in 11 studies for pre-SBRT primary tumour SUVmax. Seven studies (798 patients) were included for the overall survival (OS) analysis with a combined HR of 1.10 (95% CI, 1.05–1.15). Five studies (487 patients) were included for the local control analysis with a combined HR of 1.13 (95% CI, 1.06–1.21). Three studies (365 patients) were analysed for distant metastasis with a combined HR of 1.09 (95% CI, 1.03–1.16). Conclusion: Patients with high levels of pre-SBRT SUVmax had poorer overall survival and local control and higher distant metastases. Further prospective studies are warranted to confirm the prognostic value of FDG uptake in early-stage NSCLC patients receiving SBRT.

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!

Access to Quality Services

Increased workload for clinical radiology must be factored in to forward planning, as a result of the increased use of CTC in diagnosis; the use of imaging, in particular CT and MRI, for the purposes of staging and treatment planning; and ongoing imaging for surveillance following treatment. Moreover, the Standards of Service Provision for Bowel Cancer Patients in New Zealand recommends that all bowel cancer patients should have a staging CT. A National Report of bowel cancer patients found that only 67% of acute presentations and 59% of non-acute presentations for bowel cancer received

a staging CT of the abdomen and pelvis within eight weeks. Furthermore, the use of multidisciplinary team meetings are considered the standard of care for bowel cancer and require significant clinical radiologist input.

If you have any enquiries, please contact Kate Scott-Murphy, Senior Advocacy Officer on kate.scottmurphy@ranzcr.com or call +61 2 9268 9722

Radiology departments and practices are already under pressure due to increased demand for services and increasing complexity of procedures. Bowel cancer screening will have to be factored into this environment. The increased demand will likely require additional resources, in particular the number of radiologists and support staff, as well as additional CT scanners.

Mammography Education Coming to Australia! November 2017

COURSE DIRECTOR

Professor László Tabár,

M.D., F.A.C.R. (Hon)

Mammography Education, Inc., the leader in state-of-the-art Continuing Medical Education (CME) courses on the diagnosis and treatment of breast diseases, will be conducting two important courses in Queensland led by course director László Tabár, M.D., F.A.C.R. (Hon).

Multimodality Course November 8-10, 2017

Physicians - $1,500 USD Residents/Fellows - $1,200 USD Radiology Techs - $995 USD

Screening Course

November 14-17, 2017 Physicians - $1,500 USD Residents/Fellows - $1,200 USD (Space is limited to 100 attendees)

Both courses will be held at the QT Gold Coast Hotel 7 Staghorn Avenue, Surfer's Paradise, QLD. For hotel reservations, call +61 07 5584 1200 sales_goldcoast@qthotels.com.au Please visit www.mammographyed.com for course details and to register.

Volume 13 No 4 I September 2017

Access to Quality Services

Economic Analysis and Modelling Radiation Oncology and Clinical Radiology The Policy and Advocacy Unit (PAU) performs a range of data analyses and modelling to help guide the College position on internal or external policies. In recent times, the Australian Government has undertaken numerous policy changes to funding structures in both diagnostic imagining and radiation oncology. The modelling performed within PAU has allowed us to analyse the economic and financial impact of these changes, arming the team with vital information to put it on the front foot when discussing the policy changes with government and the two sectors more broadly. Underpinning most of our analyses is the data that we obtain. We source this information from multiple areas such as publicly available government data (e.g. Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, Australian Bureau of Statistics, etc.), the College led surveys (e.g. the Radiation Oncology Facilities Survey), sector research (Workforce Census Report for each Faculty), academic research and via consultation with the sector (clinicians, private providers, vendors and related organisations). Although some sources provide us with more detailed data sets, our team works hard to ensure we can reconcile variations in each, which sometimes helps us to find proxies for answers we were previously unable to obtain.

Inside News

An example of current work being performed in this area stem from changes the Australian Government made to the Radiation Oncology Health Program Grants (ROHPG) scheme, announced in its 2016/17 Mid-year Economic and Fiscal Outlook (MYEFO) released at the end of 2016. The Government outlined $18.7million in “efficiencies” (i.e. cuts) to be generated over the coming three years. However, the MYEFO release provided very little information as to how these efficiencies would be generated, whilst they projected the impact over the next three years – the long-term impact was not provided. Working closely with the sector, the College duly assumed the task of modelling out the short and long-term impact of the changes to the ROHPG scheme. This has allowed the College to understand the drivers of the scheme, and identify the assumptions necessary to analyse how the scheme works in practice rather than based on a theoretical framework. We have been able to overlay these findings to the projected costs associated with the ROHPG over a 10-year period. Based on the information available to us, we formed the opinion that these cuts understate the short-term impact of the scheme. It also disregarded the more concerning argument that the cuts

rose considerably once all providers had transitioned from the old to the new scheme in 10 years’ time. Therefore, by appropriately modelling out the entire transitionary period (rather than insist on focusing on the short-term), the College has been able to able to call on these figures, which enabled meaningful engagement with the Government. The benefits of the modelling have enabled us to identify the overarching financial impact of the revised ROHPG scheme. There are many nuances to the sector, and by modelling out these variations (such and public/private, rural and remote etc.) we have been able to analyse who will be most heavily impacted by these cuts, and how that may impact on the ability of the sector to continue to provide access to quality radiation therapy services. This work is ongoing and will rely heavily on the modelling performed at the College, as will other policies the PAU team is working on for both diagnostic imaging and radiation oncology.

For more information, please contact Andrew Paine, Manager, Economics and Analytics at andrew.paine@ranzcr.com or +61 2 9268 9744

Access to Quality Services

Opinion: Improving the Role of Radiology Reporting in the Management of High Risk Osteoporosis Patients “Consider if this fracture may be a fragility fracture which should trigger consideration of management of osteoporosis.”

Background By 2022, it is estimated that 6.2 million Australians over the age of 50 will have osteoporosis or osteopenia, a rise of 31 per cent from 2012. A similar increase in the rate of fracture, from 140,882 in 2012 to 183,105 in 2022, is anticipated if action is not taken to improve the diagnosis and management of osteoporosis. The rise in osteoporosis related fractures and morbidity is not just a consequence of the age-related bone loss in an aging population. It is also driven by increasing use of long term hormone deprivation treatments for common cancers and other chronic conditions treatments that impact on bone health. Evidence shows that timely diagnosis and appropriate pharmacological management reduces fracture rates. However, osteoporosis remains significantly under-diagnosed and inadequately managed in Australia.

Which Patients Would Benefit from Treatment Pharmacological treatment of osteoporosis can typically reduce fracture risk by around 30-40 per cent. When this is combined with comprehensive implementation of nonpharmacological measures the risk can be reduced even further. This relative risk reduction is most important in those at high absolute risk of fracture. The absolute benefit of treatment is greater for those at high risk. The existence of a fragility fracture is one of the strongest risk factors for future fragility fractures. It is therefore very important that the health system

identifies these cases and implements best osteoporosis management. Unfortunately, several Australian studies show persisting low rates of appropriate treatment of these patients at highest risk of further fractures. Typically, less than 20 per cent of patients presenting to health care services with minimal trauma fractures are investigated or treated for osteoporosis. This is a failing of both primary care and hospital services.

Evidence-based management guidelines can be found at www. racgp.org.au/your-practice/guidelines/ musculoskeletal/osteoporosis/ or in your local Healthpathways pages. Dr Dan Ewald General Practitioner Lead Clinical Adviser, North Coast Primary Health Network Adjunct Associate Professor Sydney University School of Medicine

Recommendation The appropriate treatment is relatively simple to initiate and implement, and there are a number of local and national evidence based guidelines designed to assist general practitioners and other clinicians do this work. Part of the failing seems to be that the focus on acute fracture management is not followed up with long term fracture risk management; i.e. the fracture but not the underlying osteoporosis is in the clinician’s mind.

Please contact quality@ranzcr.com with any enquiries relating to this article

If radiology reports for any fracture in a person over 50 years old included a prompt to consider osteoporosis management it could help the management of osteoporosis get its rightful prominence in the clinicians thinking and responsibilities. This would not be “over-servicing” nor “disease-mongering” given the clear high-quality evidence of benefit of treatment for secondary fracture prevention. An example of a standard reporting comment in a patient over 50 years with a fracture could be: Consider if this fracture may be a fragility fracture which should trigger consideration of management of osteoporosis.

References Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age, 2nd edition. RACGP 2017 www.racgp.org.au/your-practice/guidelines/ musculoskeletal/osteoporosis This has been reviewed by the Safety, Quality and Standards Committee.

Volume 13 No 4 I September 2017

Access to Quality Services

The MBS Review Taskforce Update

In the 2017/18 Budget it was announced that the Federal Government will fund the MBS Review Taskforce for an additional three year. Each section of the MBS is being reviewed by a clinical committee made up of clinicians from the relevant craft group as well as clinicians for related craft groups, referrers and consumers. RANZCR members continue to be heavily involved, not only in the Diagnostic Imaging Clinical Committee and Oncology Clinical Committee but also in a range of other clinical committees and working groups such as the Orthopaedic Clinical Committee and the Nuclear Medicine Working Group. The College is also fully engaged with the Review and regularly meets with Professor Bruce Robinson and other stakeholders to ensure that the importance of diagnostic imaging and radiation oncology is included in their considerations.

The College regularly submits policy recommendations for consideration by a range of clinical committees to increase patient’s access to vital examinations and treatments and to improve the structure of the MBS. Recent submissions include: • Quality of Referrals Position Paper • Test Substitution by a Clinical Radiologist Position Paper • Multiple Services Rules Position Paper • Definition of a Radiology Consultation Position Paper • Greater Access to MRI for Cervical Cancer Patients

Diagnostic Imaging The College recently responded to the Diagnostic Imaging Clinical Committee Reports on: • PE/DVT • Knee Imaging

Radiation Oncology The report from the Oncology Clinical Committee is expected to be published for consultation soon. We are very hopeful that the recommendations will include a restructure of the Radiation Oncology schedule so that it will better reflect the way that treatment is planned and delivered to patients, thus streamlining the MBS. The College would like to thank the manyclinical radiologists and radiation oncologists who have already made a significant contribution to this Review. There will be more opportunities to contribute to the Review in the future and we encourage members to continue to engage in this important work. College submissions and consultation responses are available on our website at: www.ranzcr.com/college/ document-library

If you have any questions or comment, please contact Melissa Doyle, Manager, Policy, on +61 2 9268 9777 or quality@ranzcr.com

MQAP is going 3D The Mammography Quality Assurance Program (MQAP) is pleased to announce that it is now able to accredit tomosynthesis-capable (3D) mammography equipment and will now accept 3D images and synthesised 2D images.

Inside News

For further information please contact Leanne Wilson, Standards of Practice and Accreditation Officer on mqap@ranzcr.com

Quality Practice

The Future for Digital Health

The Australian Digital Health Agency (the Agency) is responsible for the national digital health strategy for Australia. This includes supporting the delivery of seamless digital health services across the different sectors of our health system. The Agency has authority to develop digital health supporting software and fund pilots that target priority areas for digital health such as general practice and clinical radiology. The Agency has recognised that radiology is a priority area of work – overcoming technical complexities in the sharing imaging reports and image files, as well as ensuring that security of the patient’s information is paramount.

My Health Record A key topic of discussion for several years now, the My Health Record is progressing. As members would be aware, the My Health Record is intended to support consumers in their healthcare journey by allowing them to access their own information more easily. The My Health Record itself is a secure online history of a patient’s health information, bringing this together from the wide range of locations a person might visit as a patient. This same information will also be able to be viewed by the person and their doctors. My Health Record is envisioned as central to delivering the national digital health agenda. It is designed to have the following document types uploaded and viewed: shared health summary, event summary, discharge summary, medication record, and specialist reports such as from clinical radiologists. A patient can also enter their own information, for example an advance care directive, emergency contact details and personal health notes.

The My Health Record has been operational since 2012. Some 20 per cent of Australians are now registered. While the My Health Record is presently still a voluntary (opt-in) system for individuals, it will soon move to a national opt-out model in 2018. Importantly, the My Health Record is not a replacement for clinical records. Rather, it is intended to provide a summary of medical information for other clinicians.

Moving to Opt-Out Nationally As the My Health Record moves from an opt-in model to opt-out, it is anticipated that the number of users will increase from around five million to some 24 million. This will bring profound changes to the profile and usage of the My Health Record. Clinical Radiology needs to be prepared for this coming change and the shift in consumer expectations regarding access to information about their care.

Software Offer In June 2017 the Agency issued an Industry Partnership Offer for organisations that develop and maintain radiology information systems (RIS). The offer included some limited funding and support for providers of diagnostic imaging software in the private sector to upgrade their RIS to allow connection to the My Health Record. Responses to the offer have now closed and we understand there was a good response from industry.

Current Status of Imaging Reports and the My Health Record Imaging reports have started to be uploaded to the My Health Record in some public hospitals. • Northern Territory Health commenced upload of diagnostic imaging reports in late 2015. • Projects are underway with ACT, New South Wales, Queensland and Tasmania health departments to commence upload through 2017/18. • The Agency is currently working with the other States to progress agreements for the upload of diagnostic imaging reports. Private practices have greater complexities, for example funding to compensate for the additional work, and have therefore moved at a slower pace. Queensland XRay (QXR) has become the first private provider to upload reports. Following the industry partnership offer, the Agency is intending for more private radiology practices to begin uploads to the My Health Record. Imaging reports that were produced before a patient created a My Health Record will not be included.

continued over...

Those successful in the tender will start to build the IT links between RIS systems and the My Health Record. The College will communicate further as developments take place.

Volume 13 No 4 I September 2017

What is your Future? Where will you be? When and how often will you report? Surf in Cornwall Christmas in London

Vancouver

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Cape Town for Cricket Auckland for Rugby

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Quality Practice

Use of Consumer Friendly Language in Reports Radiologist members are reminded to use consumer friendly language in your reports, as noted in the 2017 Written Report Guidelines (available on the College website). Members should be mindful that consumers are increasingly likely to read their report and, where possible, reports should be worded accordingly.

Challenges Remaining The College has been working closely with the Australian Diagnostic Imaging Association (ADIA) and the Agency throughout the year regarding the challenges for diagnostic imaging in integrating with a national digital health system.

For more information, please contact Melissa Doyle, Manager, Policy on +61 2 9268 9766 or on melissa.doyle@ranzcr.com

A number of concerns have been raised about the impacts of a move towards greater usage of the My Health Records for private providers. • Technical issues that may impede seamless connectivity of the RIS to the My Health Record still need working through. • Medico-legal risks associated with the use of the record are not clear. The Agency has assured ADIA and the College that an accidental upload of a patient report would not breach the My Health Records Act 2012. However, as a developing area of law it is unclear how the courts would interpret current legislation. • The additional costs for clinical radiology providers to adjust their work practices to the My Health Record remains a key area of concern.

Patient & Referrer Information in one convenient website: • Information about radiology tests and procedures • Items written for consumers and health professionals

• Fully searchable with printer friendly downloads • Written by experts and reviewed by GP and consumer writers

Developed and maintained by the RANZCR

Volume 13 No 4 I September 2017

Quality Training

Examination and Assessment Reform Update Steady progress has been made on the recommendations made by the Australian Council for Educational Research (ACER) for the development and delivery of formal examinations.

examination performance. Thorough psychometric analysis is conducted to ensure that pass/fail decisions are consistent, reliable and fair for all candidates.

Broadly, ACER recommended:

• Increased training for examiners.

As of Series 1, 2017, results to candidates now include specific information on their examination scores, and feedback from examiners has been expanded to include additional detail and comments. Information to Directors of Training has also been improved, to provide data on the site’s performance relative to their Branch and the overall cohort. Further improvements to examination feedback remain in development.

The challenge of implementing these changes has been taken up by the members of the Examination Review Panels in each Faculty, with guidance from ACER and ongoing support from College staff.

The Clinical Radiology Examination Review Panel (CRERP) has additionally overseen the successful transition of the Part 2 Viva Exams to the Australian Medical Council National Testing Centre.

In upcoming months, ACER will work closely with the College to continue improving examination resources and feedback, and will design tailored calibration modules to be used for examiner training and moderation.

Radiation Oncology

The College is indebted to its many examiners for their ongoing commitment and their willingness to embrace the task of making all College examinations an example of best practice in medical education.

• More robust processes for examination development, psychometric analysis and review • Greater collaboration and transparency in decision-making • Improved data collection and more detailed feedback to trainees and supervisors

Clinical Radiology Overall, the Faculty of Clinical Radiology has made excellent improvements in every area of the examinations. Each examination panel has now adopted a comprehensive annual cycle to develop content, set examinations, review candidate results and evaluate

Inside News

The Faculty of Radiation Oncology had a smaller number of recommendations to address and with ACER advice, substantial progress has been made, including training workshops, increased meetings and more robust and transparent processes for examination development and review.

The Phase 1 examiners have made their blueprinting and examination writing procedures more collaborative, begun work on expanded examination review protocols and are currently reviewing the structure of the Phase 1 examination. In Phase 2, considerable work has been undertaken on continuous, iterative quality improvement of examination questions and marking templates. The smaller cohort numbers in Radiation Oncology preclude the use of statistical psychometric analysis methods, so the Panel has commenced review protocols including formal standard setting to strengthen the validity and consistency of each examination series.

Please contact Adam Rayment on radtaa@ranzcr.com with any enquiries

Quality Training

Clinical Radiology Viva Examinations Makes its Move On Monday 23 May 2017, the College’s clinical radiology viva examinations moved to the Australian Medical Council Vernon C Marshall National Testing Centre (AMC NTC) in Melbourne. This was an exciting opportunity for the College and the culmination of extensive work by the College staff, the Chief Censor, the Clinical Radiology Examination Review Panel (CRERP), the Part 2 viva examiners and the Clinical Radiology Education and Training Committee (CRETC). The move followed recommendations from the Education and Assessment Reform that suggested the College record the examinations and improve the professional standard, which would provide better outcomes for both examiners and candidates. Historically, the viva examinations were held in a hotel where it was a bespoke setting that did not necessarily offer the world class standard that the College was striving for. The AMC NTC is a purpose built, state of the art examination centre providing a hospital standard clinical examination setting, with the ability to deliver world leading examinations. It enabled the College to the improve the quality, efficiency and transparency of the viva examinations. The AMC NTC splits into two areas, one for examiners and one for candidates – allowing for a private and controlled setting. The AMC NTC also has the ability to record the examinations with full CCTV and audio recording capability. More information on the recording of the examinations can be found at www.ranzcr.com/trainees/ clinical-radiology/exams Previously vivas at the hotels were held over two days; due to the increasing number of candidates sitting the examinations and the AMC NTC having twenty examination rooms, the

Examiners, Sitting A

vivas were spread out over four days in two sittings (Sitting A and Sitting B). Now, with the ability to introduce a structured timing system, examiners and candidates can relax and be guided by the experienced staff at the AMC NTC and the College. The first sitting of the viva examinations launched on the Monday night with an examiner orientation, where the examiners had a firsthand tour of the centre, an orientation meeting and the opportunity to get into their exam rooms to set up and go through their cases with their co-examiners. This also provided an opportunity for the examiners to ask questions and work through any apprehensions they had with the examination process. Tuesday heralded the start of Sitting A examinations with the eager staff and examiners awaiting the candidates. On the candidate side of the AMC NTC, the staff registered the anxious and apprehensive candidates and prepared them for their examinations.

Candidates ‘relaxed’ in the candidate lounge, enjoying some water, tea or fruit before moving into the candidate briefing room to fully focus on the task ahead. A ten minute briefing outlined what to expect during the examination along with the new timings. Wellbriefed, the candidates filed into the candidate corridor and waited outside their examination rooms for the call for the examinations to start and enter the room. It was a long day for examiners and candidates alike. In the evening, the examiners enjoyed the opportunity to reconnect with peers and network at the examiner dinner. An early night was had by all in preparation for the second day of the examinations.

continued over... Volume 13 No 4 I September 2017

Quality Training

Examiners, Sitting A

The second day of the examinations started early with the examiners arriving at the AMC NTC by bus. After registration, the examiners made their way into the examiner lounge to prepare for the day ahead. Valuables now in their lockers, the examiners moved to their examination rooms waiting for the first candidates. The two minute candidate warning was announced and they were off like horses out of a starting gate. Another full day with the Sitting A examinations concluding by Wednesday 5.45pm. The examiners packed their cases and cleared their lockers at which time they assembled in the large meeting room to attend the Court of Examiners and enjoy a congratulatory drink and food with each other. Meanwhile, in the background the College and AMC NTC staff swiftly prepared the examination rooms and the centre for the Sitting B examiners who were due to start their tour and their examination experience at 6 pm.

Inside News

The first viva series at the AMC NTC was very rewarding and a big win for the work and commitment of all those involved with both Sitting A and Sitting B examinations running like clockwork, which is a testament to the diligence and commitment of both sets of examiner teams. The feedback from the examiners was very positive with some of the feedback received including: ‘Overall, it was the most successful viva examination in recent times. The change to the Testing Centre has been well received’ Sitting B Examiner ‘Have been examining for 20 years. Best examination series ever.’ Examiner Survey Comment ‘Again, I was really impressed with the exams, having been an examiner for many years it was by far the most stress free exams I have been involved, Congratulations to all involved’ Sitting B Examiner

‘All in all - a very positive and satisfying experience. Amazingly complex task executed with clockwork precision. Hats off to the entire team!’ Sitting A Examiner Preparations for the next viva examinations at the AMC NTC are well underway and we look forward to seeing the examiners and candidates for Sitting A (14-15 November 2017) and Siting B (16-17 November).

The College is looking for Part 2 viva examiners and if you are interested you can find more information at www.ranzcr.com/ fellows/clinical-radiology/trainersand-examiners. Alternatively, you can contact Mr Shane Bryan, Senior Project Officer, Specialty Training shane.bryan@ranzcr.com or on +61 2 9268 9742

Quality Training

RANZCR Courses and Workshops RANZCR/ACR Educational Courses The College hosted a series of educational courses in Sydney throughout August in partnership with the American College of Radiology (ACR) Education Center. These courses were met with high demand, with all courses (Musculoskeletal MR – Commonly Imaged Joints, Neuroradiology – Brain, Head/Neck and Spine, Body and Pelvic MR, and High Resolution CT of the Chest) selling out. The courses presented a unique opportunity for participants to undertake the renowned ACR Education Center courses within Australia. The intensive, hands on courses were delivered on individual workstations emulating the clinical environment, in conjunction with practical lectures. Course participants experienced a customised learning environment through the ACR Case Engine and case-by-case feedback provided by ACR course directors. There was also review time available at the end of each day to focus on any problem areas. The Musculoskeletal MR course, led by course directors Mark Murphey, MD, Donna Blankenbaker, MD and Ali Naraghi, MD, was focused toward the non-musculoskeletal-trained radiologist responsible for interpretation of MR imaging of the knee, shoulder, ankle/ foot and hip. It provided an intensive hands-on experience in the technique and interpretation of MR imaging of these often-complex examinations.

Studying cases at the ACR Course

“Can’t explain how grateful, excited and satisfied I am about this course. Best I have been to for a long time!” Would you recommend your colleague to attend ACR Education Centre Course brought to you by RANZCR?

The Neuroradiology course, led by Nafi Aygun, MD and David Yousem, MD, MBA incorporated the four domains of neuroradiology in brain, spine, head and neck, and paediatric neuroimaging, and included content focused on CT and MR imaging with advanced application techniques. Case material covered vascular, inflammatory, demyelinating, traumatic, degenerative, neoplastic, congenital and metabolic diseases of the CNS and the head and neck in both adults and children. The Body and Pelvic MR course, led by Diego Martin, MD, PhD, FRCPC, Bobby Kalb, MD and Daniel Karolyi, MD, PhD, focused on the most common current indications for abdominal and pelvic MR – the imaging of the liver, pancreas, pelvis and kidneys. The High Resolution CT of the Chest course, led by Jeffrey Kanne, MD, FCCP, Gerald Abbott, MD, FACR and Travis Henry, MD provided the practicing radiologists in attendance with the skills and understanding necessary to interpret high-resolution CT of the chest in diffuse infiltrative lung diseases.

 100% SAID YES

(based on the feedback from one of the surveys)

The College would like to thank Fujifilm Australia for assisting in the delivery of these courses by providing specialist support to ensure course participants got the most out of the hands-on interpretation of related cases using Synapse PACS. Additionally, the College would like to thank the ACR Education Center teaching faculty and its operations team led by Vinay Sandhir for their time, effort and investment in ensuring the courses’ success.

The College plans to host an educational course series again in 2018, so we encourage members register their interest via events@ ranzcr.com. Further information will be released soon

continued over... Volume 13 No 4 I September 2017

Quality Training

Faculty of Radiation Oncology Phase 1 Foundation and Exam Preparation Course The Phase 1 Foundation and Exam Preparation Courses were held between 15-18 June at Rydges World Square in Sydney, NSW. The annual courses are designed for Phase 1 trainees who are aiming to sit the Phase 1 exams. 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 courses were attended by 50 trainees. Course co-convenors Drs Claire Hardie and Marcus Dreosti would like to thank the facilitators, speakers and College staff for their time in running the program. The Phase 1 Foundation and Exam Preparation Course will be held once again in June 2018. Trainees aiming to sit their Phase 1 exams are strongly encouraged to attend the course to assist in preparing for their exams. Details will be available via the College website or by emailing the conferences and events team at events@ranzcr.com

Inside News

ESTRO Basic Clinical Radiobiology Course The College and the European Society for Therapeutic Radiology and Oncology (ESTRO) School will be jointly hosting the ESTRO Basic Clinical Radiobiology course in Melbourne from 10-13 May 2018. The course is designed to be an introduction to radiation biology as applied to radiotherapy, focusing on technology, biology and molecular oncology, and represents a valuable opportunity for radiation oncology professionals to learn from an international faculty of expert radiobiologists and clinicians in Australia. Please save the date – more information will be available shortly.

Statistics and Research Methods (SMART) Workshop – registration now open! The SMART Workshop will be taking place on Monday 19 March 2018 to coincide with the 2018 Trans Tasman Radiation Oncology Group (TROG) Annual Scientific Meeting in Hobart, Tasmania. The workshop is aimed at post Phase 1 exam radiation oncology trainees and is designed around eight short didactic presentations by biostatisticians followed by interactive sessions during which groups of five to seven trainees are guided by radiation oncologist facilitators. Each small group session links back to the minilectures, prompting discussion of the key statistics and research methods concepts through structured question sets relating to mostly radiation oncology trial publications. The workshop also provides an opportunity for trainees to stay on to see their new knowledge in action in subsequent clinical trials. Trainees attending the SMART Workshop have access to a discounted registration rate to attend the TROG ASM. For more information and to register please visit www.trog2018.com

Clinical Radiology

A Message

from the Dean

Prof John Slavotinek The recently announced Inquiry into diagnostic imaging equipment availability is an opportunity we will take to advocate for better access to technology, particularly MRI.

Digital Health In mid-August, the Australian Digital Health Agency published its flagship strategy to support consumers and delivery of care through confidential and secure exchange of data across the health system. As members will appreciate, a digital health revolution has been underway for many years in clinical radiology and you will be well accustomed to the opportunities and challenges in that space. Notwithstanding this, timely access to clinical information when transitioning care, through referrals, shared health records and medications unfortunately remains patchy. An article on page 29 provides a neat summary of activities already underway, which the College is closely involved in. From an advocacy perspective, the Faculty meets regularly with the Agency directly and through committee structures. We are working with them to set commonly agreed priorities. Staff from the Faculty and I will meet with senior executives from the Agency this month to set those common goals and discuss how they will be resourced in a climate without indexation.

Professional Standards The setting of professional standards requires balanced consideration of patient safety, quality service delivery and access, particularly across the

dispersed populations of Australia and New Zealand. Many of these standards have been in place for several years now and should be subject to review. The Faculty of Clinical Radiology (FCR) Council has initiated a review of CTCA in response to member feedback and concern in order to address this balance going forward. FCR Council will give similar consideration to CTC. Member feedback will be sought on purpose, use in hospitals and community practices, structure and general value for patient care. Since the implications of professional standards are far-reaching, your input is crucial and greatly assists Faculty Council in determining how a balance can be struck.

Role Extension by Allied Health Members in Queensland will have seen several Dean communiques outlining the Faculty’s position on role extension by allied health professionals (AHPs). Although we support several areas where this can enhance patient care, such as insertion of PICC lines by AHPs, there are some areas we do not support as they are beyond AHPs’ training and understanding. An example of the latter is radiographers seeking to interpret X-rays in the emergency setting. Faculty Council has overseen development of a position paper that includes consideration of the studies purportedly validating radiographer comments that has found the evidence lacking. Our firm view is that anyone interpreting imaging studies must achieve the same professional standards and outcomes for patients. The position paper will be circulated for member and stakeholder consultation.

Access to clinical radiologists in Australia is very good, our trainee numbers and training remains strong, and we do not face the shortages in jurisdictions such as the UK where these models have been implemented. If role extension initiatives are progressing within your hospital, feel free to contact the Faculty directly for assistance on fcr@ranzcr.com and we will be pleased to advise.

Standards of Practice The major review of the Standards of Practice for Diagnostic and Interventional Radiology continues apace. The Safety, Quality and Standards Committee and our Standards Reference Groups are making an enormous effort. The revised standards will be shared with members soon for comment. Our standards of practice need strong advocacy to ensure their application across the health system. Through my membership of the Diagnostic Imaging Accreditation Scheme (DIAS) Advisory Committee, I am making the case for improvements to the DIAS to lessen the gap between those and the RANZCR Standards of Practice. The New Zealand Branch is working with International Accreditation New Zealand (IANZ) and the Ministry of Health to improve standards and relations in that setting. The College recently responded to the Health and Disability Services Standards to make the case for consistent application of registration requirements by service providers. Please email fcr@ranzcr.com with any enquiries. Volume 13 No 4 I September 2017

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PRIVACY STATEMENT: By accepting this invitation you consent to us collecting your personal information and disclosing that information to third parties for administration purposes relevant to the event the subject of this invitation. We collect personal information only when you provide it to us, through registration, completion of forms or e-mails, as part of an order for products or services, inquiries or requests about materials being ordered and similar situations in which you have chosen to provide the information to us. For our policy on the collection and use of your personal information see Bayer’s full privacy statement which can be found at www.bayer.com.au. If you have any questions, please contact the Privacy Officer, email: Privacy.Officer@bayer.com. If you no longer wish to receive Information please mail or fax to Bayer Australia Ltd, Medical Care Division, 875 Pacific Highway, Pymble, NSW 2073. Fax +612 9391 6633. ABN 22 000 138 714. Gadovist® 1.0 & Primovist® are registered trademarks of Bayer AG, Germany Bayer Australia Ltd, ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. ® Registered trademark of the Bayer Group, Germany.

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Clinical Radiology

Chief Censor in Clinical Radiology

A/Prof Dinesh Varma

There have been ongoing developments across many projects over the past few months, one of which will be of particular interest to those of you involved in trainee selection and recruiting, and relates to the College’s selection guideline project. This is a project that is quite comprehensive and has started with the development of a competency framework. The framework considers clinical experience, technical knowledge, academic skills, professional skills, critical thinking and decision making, to name just a few. A verification survey about the competencies was recently distributed to all clinical radiology members. Your feedback will further develop the selection guidelines and inform the selection criteria and recruitment in the future, details of which will be presented in early 2018. In July I was delighted to be able to attend the New Zealand Directors of Training (DOT) Meeting and observe at their trainee national match. I was joined by Mrs Pamela Spoors, Head of Specialty Training and together presented and discussed the current activities within our Examination and Assessment Reform some of which is detailed on page 32. Thank you to the Directors of Training (DoTs) who attended and provided their very frank and effective feedback, this was very useful. An area that we have continued to develop as part of the reform is feedback to candidates and supervisors. Following the Series 1 examinations this year, all candidates were provided with details about their individual

examination performance and for those that requested feedback more in-depth feedback was provided. DoTs were also provided with their trainee results and information about the overall series cohort. Ensuring that DoTs are aware of the progression of their trainees has been identified as important. With this in mind some DoTs received additional correspondence to identify trainees that may need additional learning support. The success of the transition of the viva examinations to the AMC National Testing Centre has been a great achievement by all members involved, whom I thank again. An insightful story on the transition is highlighted on page 33 of this edition of the newsletter. I invite all members to read the article and encourage any member interested in becoming an examiner to find out more by emailing radtaa@ranzcr. com or perusing the College’s Get Involved page on the website where opportunities are published www.ranzcr. com/fellows/general/get-involved/ current-opportunities DoTs travelling to this year’s Annual Scientific Meeting (ASM) in Perth are encouraged to attend the DoT workshop on Wednesday 19 October, where further insight into the Examination and Assessment Reform will be shared along with a practical insightful demonstration from the Australian Council of Education and Research (ACER) on how an examination is developed.

to provide information and support to our trainees. Chris will be present at a number of trainee events, have dedicated times at the College’s exhibition booth and is also available to meet on a one to one basis with trainees. Trainees are encouraged to contact Chris to set up a meeting at the event. Please contact Chris at chris. bartley@ranzcr.com. Chris can also be contacted to address questions or concerns that trainees may have about their training on the phone +61 2 9268 9713 or email. Finally, if you are a training department or practice who supports international medical graduates (IMGs) please be aware that there is now a policy that sets out the IMG assessment process, details of which are available on page 60 or on the College website. Thank you to all the members who are involved in our educational activities, your dedication and enthusiasm is appreciated.

Please contact Pamela Spoors, Head of Specialty Training with any training enquiries on radtaa@ranzcr.com or +61 2 9268 9704

The Trainee Liaison Officer Chris Bartley will also be attending the ASM

Volume 13 No 4 I September 2017

Clinical Radiology

Clinical Radiology Trainees Committee “Do not judge me by my successes. Judge me by how many times I fell down and got back up again.” – Nelson Mandela Don’t get me wrong – I love my job. On the majority of days, I am genuinely excited to go to work. But sometimes, it can be tough. Rotating to sites several hours away from home; sleep deprivation from nights spent on-call; being quizzed about cases in front of my peers; and seemingly constant study for the ever-looming exams. Exams like I’ve never sat before, with a very real possibility I may need to re-sit at least one component. All the while attempting to maintain some semblance of a social life. As doctors in training, we can often feel overwhelmed. Finding adequate time to combine specialty training with our

personal lives can be a challenge. Throw some children into the mix and it’s a sure recipe for a panic attack. As doctors, we are trained to recognise the signs and symptoms of disease in other people. However, it turns out we are pretty rubbish at identifying and addressing illness in ourselves, particularly in regards to our mental health. In 2013, beyondblue conducted the National Mental Health Survey of doctors and medical students. They found that levels of very high psychological distress were significantly greater in doctors compared to the general population (3.4 per cent vs 0.7 per cent). Levels of emotional exhaustion and cynicism were highest amongst younger doctors. Moreover, doctors were found to be less likely to seek help for mental health due to

embarrassment (37.4 per cent), lack of time (28.5 per cent), and concerns about career development or progress (27.5 per cent). (See the report at: www. beyondblue.org.au/docs/default-source/ research-project-files/bl1132-report--nmhdmss-full-report_web) It is only through supporting one another and fostering dialogue around this issue that we can break the stigma surrounding mental illness amongst the medical profession. It only takes a brief gesture, a quick phone call, or a quiet word of encouragement, to help a colleague who might be having a rough day – to help them get back up again. Yours in support, Dr Cara Odenthal Chair QLD Trainee Representative

“Radiology Saves Lives” campaign underway A powerful, long-term national communications campaign is now underway, strengthening industry efforts to end the near 20-year freeze on Medicare rebates for clinical radiology.

and highest patient gaps. Through Medicare, the Federal Government must increase its investment in patient rebates to ensure it is accessible by everyone, not just those who can afford it.

The Australian Diagnostic Imaging Association (ADIA) has launched the multi-layered strategy to highlight how “Radiology Saves Lives” and in turn to increase the pressure on the Federal Government to keep its public commitment to fully reinstate indexation.

The campaign is designed to increase general awareness of clinical radiology’s importance and the many, very real problems caused by the indexation freeze. By making clinical radiology an issue for more voters we make it an issue for our politicians.

As we all know, clinical radiology is a crucial component in Australia’s primary healthcare system, given that it’s vital for the early and accurate diagnosis of a vast array of illnesses and injuries. However, due to the rebate freeze, clinical radiology is now the most difficult form of primary care to access with the negative trifecta of the lowest bulk billing rate, highest upfront costs

Inside News

Stories supporting our position have already been secured in major newspapers. A dedicated Twitter account is now operating (@ AustDIAssoc), a Facebook page has been launched (www.facebook.com/ AustDIAssoc) and a suite of human interest stories is being developed. There are positive stories highlighting the lives saved by clinical radiology, the technical advances and the vital role

played by radiologists themselves, as well as negative pieces reinforcing the hardship brought about by increasing gap payments and diminishing access. ADIA’s website will be a key information channel as well. Interested practices have received an information kit which included campaign material and a draft letter to send to their local member of parliament. By empowering clinical radiology practices and their patients with more knowledge about the freeze we are confident our message will spread. If you would like any more information on the campaign, please visit the ADIA website or email ADIA at pbeerens@adia.asn.au Dr Christian Wriedt President, Australian Diagnostic Imaging Association

Clinical Radiology

ANZSNR Update

Our 2017 (Annual Scientific Meeting (ASM) was held in Darwin in July and was hosted by Dr Con Phatouris and Dr Andrew Thompson. The feedback on the meeting has been excellent, and I would like to personally congratulate our conveners, secretariat and conference organisers. This was the first time the meeting has been held in Darwin, the facilities were superb, and the excellent national faculty complemented our international guests – Prof Anne Osborne and Prof Christine Glastonbury, both of whom generously gave many lectures, supported our trainees with popular additional lunchtime image interpretation session. The President of RANZCR, Dr Greg Slater, and the Dean, Faculty of Clinical Radiology, Prof John Slavotinek attended as guests of ANZSNR, with Prof Slavotinek presenting a paper on the interaction of interventional radiology, interventional neuroradiology, the College and our society.

2018 Annual Scientific Meeting Next year’s annual scientific meeting will be held Hobart where Prof Jens Froelich Dr Catherine Mandel and A/Prof Andy Whyte are planning an educational and practical, hands-on program. The conference will be held in central Hobart from 16-18 March 2018.

ANZSNR Strategic Planning The membership and council considered facilitated strategic planning to be important to inform the future direction of the society, and will occur in August in Sydney. Attendees will prepare a report for council, after which further information will be communicated to the membership.

A/Prof Elizabeth Wylie winding up her time on the Breast Imaging Reference Group Upcoming Meetings The ESNR meeting will be held in Mälmo 13-17 September, and the. WFITN meeting will be held in Budapest October 16-19, 2017. I look forward to seeing members of the society in Hungary. Professor Peter Mitchell President, ANZSNR

It is with regret we note that Associate Professor Elizabeth Wylie stepped down from the College’s Breast Imaging Reference Group at the end of April 2017. A/Prof Wylie is well known in Australia and New Zealand for her contribution to breast imaging and clinical radiology. She belongs to the elite club of HR Sear prize winners for Part II exam (gold medal). A/Prof Wylie has taught generations of clinical radiologists in Western Australia. She has been the Director of Breast Screen WA since 2000 and Head of Department of Radiology at Royal Perth Hospital since 2007. A/Prof Wylie has presented and published over one hundred journal articles and presentations. A/Prof Wylie served on the College Council (2005–2007) and a number of committees, including Standards of Practice and Accreditation Committee, CPD Committee and MQAP Management Panel. A/Prof Wylie has also been a College WA Branch Committee Executive since 2005. She served as a member of several Breast Screen Australia, National Breast Cancer Centre, various State and Federal Government committees over many years. A/Prof Wylie’s involvement with BIRG dates back to 1997. From 1999 she held the position of Chair of BIRG, only stepping down from this role in 2014. BIRG members and the College will miss her invaluable contribution and wise counsel. We hope A/Prof Wylie will continue to play an active role in other College committees in the future. Dr Michelle Reintals Chair, Breast Imaging Reference Group

Volume 13 No 4 I September 2017

RANZCR NZ ASM Millennium Hotel 3-5 August 2018

www.ranzcr2018.co.nz

Clinical Radiology

IRSA Update

I have the great privilege of greeting you as the President of IRSA and it is an honour to be able to take IRSA forwards over the next two years. It my pleasure to introduce you to the newly elected executive IRSA committee for 2017-2019. Dr Gabriel Lau is continuing as Treasurer, Dr Christopher Rogan has been elected as Secretary and Dr John Vrazas continues on the executive as the past-president. We are looking forward to working during the exciting years ahead in an important time for interventional radiology (IR) in both Australia and New Zealand. Congratulations to Dr Nigel Mott and Dr James Burnes for organising a highly successful annual scientific meeting in Port Douglas this year. An excellent meeting was organised with highly acclaimed international and national speakers giving lectures on a wide range of topics. The inaugural stroke workshop was held in conjunction with the IRSA ASM. Several internationally renowned Interventionalists were invited to give lectures on stroke therapy and thanks to Dr John Vrazas and Dr Marcus Mykytowycz for organising a highly successful course.

As the chief examiner for the EBIR in Australia/New Zealand it is with pleasure that I report that the 3rd running of the EBIR in Australia and New Zealand was highly successful, with all 12 candidates successfully passing the exam. Congratulations to all the candidates. The next EBIR will be held just prior to the combined Asia Pacific Congress of Cardiovascular and Interventional Radiology/IRSA meeting in March 2018 in Auckland, New Zealand. I encourage all IRs to consider sitting the most internationally recognised certification of IR skills and training, now recognised by 34 international IR societies around the world. Changes to the IRSA constitution were passed at the recent annual general meeting and IRSA will soon become a charitable society. This is an exciting initiative as IRSA embarks to benefit the health and wellbeing of all Australians and New Zealanders through interventional radiology. IRSA will be continuing the work on IR accreditation standards in Australia and New Zealand and will be consulting the College and CIRSE with these draft standards. IRSA will continue to work closely with the College with the great amount of work

ahead to consolidate the position of interventional radiology. The 2018 APCCVIR/IRSA meeting will be held from 8-11 March 2018 in Auckland, New Zealand. A/Prof Andrew Holden and his team are busy organising what looks to be an exciting meeting with many renowned international speakers, live cases from around the world and an impressive scientific program. Registration is currently open and can be found by visiting the meeting website www.apscvir2018.com. We will be shortly seeking volunteers from the IRSA membership to become involved with the society. The 2019 IRSA ASM has been tentatively booked in for Uluru, expressions of interest will be called soon for the organising committee, and there are many other initiatives coming soon for members to become involved. I would encourage all members to consider volunteering to advance the society and specialty. Dr Gerard Goh President, IRSA Chief Examiner EBIR Australia/New Zealand

Volume 13 No 4 I September 2017

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Radiation Oncology

A Message

from the Dean

A/Prof Dion Forstner

Funding for Radiation Oncology in Australia The College is continuing its discussions with the Minister for Health regarding the Radiation Oncology Health Program Grants (ROHPGs). We have finally been provided with additional data by the Department of Health (DoH) to assist our analysis of the changes, but we still require further data to ensure we are accurately assessing the potential impact on our sector and our patients. We are working with the DoH to try and obtain this additional information. We understand that a roundtable discussion is to be convened by the DoH in coming weeks, with stakeholders from across the sector, to discuss the ROHPG changes. We are expecting the final report of the Oncology Clinical Committee of the MBS Review Taskforce to be available for public consultation soon. It is important that all members review the report and provide feedback to make sure the revised MBS schedule and item descriptors are appropriate for our sector.

Radiation Oncology in New Zealand The Faculty is continuing our advocacy in New Zealand ahead of the coming general election. Our policy priorities for radiation oncology include funding reform and workforce pressures. The College’s election submission document has been sent to the health spokespeople for all the major parties. Representatives of the College have met with Health Minister Dr Jonathan

Coleman to raise these issues directly. We also had the opportunity to join a stakeholder event with David Clarke, Health Spokesperson for Labour. The New Zealand Branch Annual Scientific Meeting was held in Nelson from 4-6 August. I have received very positive feedback from attendees and thank radiation oncology convenors Drs Jamie Evans and Nicola Naidoo for their tireless efforts.

Appointment of Chief Accreditation Officer (2018-2020) The Faculty Council re-appointed A/Prof John Leung as the Chief Accreditation Officer for the term 1 January 2018 to 31 December 2020. I am confident that John will continue to make an invaluable contribution to the Faculty, to further streamline and improve the accreditation of our training sites. I would like to take this opportunity to remind all accredited sites that compliance with the Accreditation Standards is of utmost importance to ensure our trainees receive the highest standard training program. If there are changes being made at your facility level that could jeopardise your centre complying with the Accreditation Standards, please discuss this with us. Please write to accreditation@ranzcr.com if you have any concerns or questions about the accreditation status of your centre.

Burnout Amongst Our Members I encourage all members to read the article on this topic on page 8, and I thank Prof Michael Poulsen for his work in this area. It is all our responsibility to build our personal resources and look out for each other.

Profile and Presence of Radiation Oncology The Targeting Cancer campaign continues to focus on advocacy for prostate cancer patients through media/ social media activities, stakeholder engagement and other initiatives. We encourage all members, in particular our colleagues in New Zealand, to get involved in the campaign, and provide their input and suggestions on how to amplify our message. Please see the article on page 20 for more information on the campaign.

continued over...

Volume 13 No 4 I September 2017

Radiation Oncology

Particle Therapy In May this year, the Federal Government announced its support for the first proton facility in Australia to be established in Adelaide, expected to be operational by 2020. The facility will also receive funding from the South Australian Government. I encourage members to read the article on page 6 for more information on the centre. Considerable policy and advocacy work will be required in the coming months and years to help ensure this facility will benefit patients in the region. If you are interested in contributing to developing the Faculty’s policy positions, stakeholder engagement and other key tasks in the particle therapy area, please join the Particle Therapy Special Interest Group. Interested members are encouraged to email faculty@ranzcr.com

Training and Research in Radiation Oncology Implementation of the recommendations of the Examination and Assessment Reforms has been progressing well. I am very grateful for the hard work and dedication of Chief Censor A/Prof Margot Lehman, many other Fellows and College staff in this important area, despite the challenges of prioritising the vast amount that needs to be done. The Faculty Council and I will continue to support the implementation of these essential reforms.

If you have any feedback or comments on any of the above, please email faculty@ranzcrcom

Building on the Memorandum of Understanding between the College and the Trans-Tasman Radiation Oncology Group (TROG), the Radiation Oncology Research Committee is exploring ways to improve collaboration between our two organisations to support radiation oncology research, in line with the College’s recently developed Research Strategy.

1 in 2 people with cancer would benefit from radiation therapy Greater awareness that radiation therapy is safe and provides good clinical outcomes will improve utilisation. Sign up at targetingcancer.com.au to show your support. @TargetingCancer

Inside News

RadiationOncologyTargetingCancer

Radiation-Oncology-Targeting-Cancer

Radiation Oncology

Chief Censor in Radiation Oncology

A/Prof Margot Lehman

Director of Training Workshop Director of Training (DoT) workshops play an important role in providing a forum for the dissemination of important College information, facilitating interaction between DoTs, clinical supervisors and College staff, and providing an opportunity for educational activities aimed at supporting the DoTs and clinical supervisors in their roles. To this end, we were very fortunate to have Professor Elizabeth Molloy, Professor in Work Integrated Learning in the Department of Medical Education, Melbourne Medical School as a special guest. One of Prof Molloy’s areas of expertise is on how to provide effective feedback. Much of our teaching of junior colleagues occurs through an apprenticeship model in a work-based setting – with the provision of high quality feedback on task performance an important method of work-based teaching. During an interactive session, Prof Molloy provided practical examples of how specific educator behaviours could be employed to engage and motivate learners. Some particular ‘take home messages’ were: feedback is best done face to face as soon as possible after the task in which the educator and learner were engaged; prioritise as learners can only work on one or two changes at a time; the educator should offer suggestions as opposed to giving directives and focus on actions rather than personal characteristics; the learner-educator relationship is key and collaboration is essential – the learner and educator should work together – the educators’ role is to use their expert knowledge to discuss performance task issues, explores the learner’s perspective,

help solve problems and set priorities and to offer ideas for improvement. Finally, effective feedback is an iterative process. Further information is available in: ‘Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement: BMD Med Educ 2016:16:96.’

Trainee Performance and Progression Policy/Remediation Policy/Withdrawal from Training Policy The Trainees in Difficulty Policy is to be replaced by three separate policies (the Performance and Progression Policy, Remediation Policy and Withdrawal from Training Policy). The aim of the policies is to ensure that all trainees have their training monitored and managed and to provide the framework to be used to assess, manage and monitor a trainee where there are issues or concerns about their level of performance during training or rate of progression through training. The policies also specifically define the role of the local training site, training networks, Radiation Oncology Education and Training Committee (ROETC) and Chief Censor in this process. Each trainee will have a formal review every six months to assess performance and progression with specific reference to assessment and examination status and timelines, training reports from clinical supervisors, Multi-Source Feedback (MSF) reports and other relevant documents of which the trainee is aware. If a trainee is not meeting the criteria for progression, First Stage Management will be adopted in which

an agreed action plan is developed. If the agreed outcomes are not achieved within six months of commencement of the action plan – the trainee will be referred to Remediation or referred for withdrawal. During the Remediation Phase, accrual of training time will be suspended pending satisfactory completion of agreed upon requirements. Trainees who fail or unreasonably refuse to enter into a remediation plan will be referred for consideration under Withdrawal from Training Policy. These policies will come into effect on 1 November. Further information will be provided closer to this date.

Courses/Workshops The Foundation/Phase 1 Teaching Course and Phase 2 Pre-Examination Preparation Course were held in May and June and were again very well received. My thanks to the organisers and Faculty, with particular thanks to Drs Claire Hardie, Marcus Dreosti, Alex Tan, Apsara Windsor and Rahul Mukherjee. We are also fortunate through our collaboration with ESTRO, to have hosted a Head and Neck Falcon contouring workshop and we can look forward to a lymphoma contouring Falcon workshop at the upcoming ASM in October. For those of you looking to plan ahead, the ESTRO Radiobiology course will be held in Melbourne from 10-13 May 2018, which will be an ideal time for Phase 1 trainees preparing to sit their Phase 1 exam and I would encourage all to attend. Volume 13 No 4 I September 2017

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Radiation Oncology

Radiation Oncology Trainees Committee Examination Series Congratulations to those who have recently completed Phase1/2 examinations. We sincerely hope that the results are in your favour.

Trainee Day & Trainee Forum at RANZCR ASM Dr Hendrick Tan has been tirelessly working with the Convening Committee of the upcoming College Annual Scientific Meeting in Perth to produce an exciting and stimulating ASM Trainee Day on Friday 20 October 2017. The day will consist of educational sessions by international speakers, the muchanticipated Varian Prize Session and an ESTRO FALCON Lymphoma Contouring Workshop. We will also be hosting practical sessions regarding exam preparation, and life beyond exams. We will end the day with the Trainee Forum which will provide you with an opportunity to raise and share any trainee related issues or concerns, and any feedback for the ROTC as well as 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 Trainee Forum is a worthwhile opportunity to speak

your mind (anonymously) and engage with your DoTs and the College. We encourage everyone to attend! The ASM social calendar will ensure that we both ‘work hard and play hard’ in Perth. Lastly, don’t forget to pack your sneakers and sign up for the Targeting Cancer Fun Run!

ROTC 2017 Election The nomination and voting process for the 2017 ROTC has taken place in July/August. Hopefully all trainees participated in electing their incoming ROTC members who will continue championing our concerns. I look forward to welcoming the new committee for 2018.

Education and Workforce Update – Funding Changes for Radiation Oncology in Australia The Australian Government’s funding changes to Health Program Grants (HPGs) came into effect on July 1. Our College continues to lobby against these changes as they will compromise patient access to cancer treatment. The proposed changes stipulate that only EBRT/linacs will be eligible for HPG funding (not brachytherapy,

CT scanners, radiation therapy planning systems or network infrastructure). This not only threatens patient access to brachytherapy which we know is essential in the treatment of cervix cancer; but may also impact on the efficiency and effectiveness of providing EBRT. Trainees can also play a significant role in advocating for our specialty and once again, we strongly encourage trainees to do so. We encourage members to: 1) Read and share widely press releases issued by our Faculty (available on our College website) on the topic; 2) Write to your local MP opposing funding cuts and encourage your colleagues/patients/ other advocacy groups to do the same. Our College has a template available and we would love to pass it on. Please email rotc@ranzcr.com for a copy of the template. 3) Follow, re-tweet and engage with @TargetingCancer, @ FacRadOncology and @RANZCRcollege on Twitter. Dr Kimberley Nguyen Chair, Radiation Oncology Trainee Committee 2017 rotc@ranzcr.com

Volume 13 No 4 I September 2017

Radiation Oncology

Asia Pacific News

Australian Volunteers help Bring Radiation Therapy to Cambodia The collaboration between our College’s Asia Pacific Radiation Oncology Special Interest Group, (APROSIG), the Australasian College of Physical Scientists and Engineers in Medicine’s (ACPSEM) Asia-Pacific Interest Group (APSIG) and National Cancer Centre, Calmette Hospital, Cambodia continues, with recent postings of Australian volunteers to Phnom Penh to aid in the long-awaited set up of a new radiotherapy department. Ms Kate Rogl, Radiation Therapist Trainer from Cairns, commenced a 12-month assignment in April 2017, as part of the Australian Volunteers International Development program (AVID). Ms Soo Min Heng, Medical Physics Trainer from Prince of Wales Hospital, recently returned from a two month assignment, supported by the College International Development Fund grant. Their time spent in Phnom Penh has been busy with the training of local staff - especially since there are no current training programs for radiation therapist trainers (RTT) and radiation oncology medical physicists (ROMPs) in Cambodia – and giving guidance in the lead up to commencement of clinical radiation therapy services.

It is an exciting time for Australian volunteers as the new linac and CT SIM has just arrived in Cambodia and being installed this month. Thank you to Kate and Soo Min for their wonderful commitment to helping the cancer patients of Cambodia! However, much more assistance from Australia and New Zealand radiation therapy staff will be required over the coming years, to allow safe and sustainable running of the radiotherapy department. Ways to help Cambodia: Volunteer to help. APROSIG is also looking for interested radiation oncologist colleagues to help build on this project. We are also particularly looking for radiation therapists and radiation oncology medical physicists who can spend at least a month volunteering – please inform your colleagues. We encourage members to donate towards the Cambodia project at: www.nfp.everydayhero. com/au/training-medical-physicists-indeveloping-countries-of-the-asia-pacific

Inside News

Papua New Guinea Update Thank you to those colleagues who expressed interest in assisting with short-term locums to keep the radiotherapy unit functioning at Lae in Papua New Guinea. We are still looking for assistance with these, as well as an experienced radiation oncologist who would be prepared to spend a year training local doctors and advising on developing the service further. Please contact us to find out more.

APROSIG Annual General Meeting at RANZCR ASM Perth October 2017 Our annual general meeting will be held on Friday 20 October 7:00-7:55am in Meeting Room 4. We invite both APROSIG members and non-members with an interest in radiation therapy in the Asia Pacific to please join us. Drs Mei Ling Yap and Iain Ward APROSIG Co-Chairs

Radiation Oncology

TROG World-first Trial Pioneers New Standard of Care for Skin Cancer Patients with advanced skin cancer can now be spared from having to undergo chemotherapy, with results from a new Trans Tasman Radiation Oncology Group (TROG) Cancer Research study showing that surgery combined with radiation therapy is a more effective treatment. Prof Sandro Porceddu who headed the Post-Operative Concurrent ChemoRadiotherapy Versus Post-Operative Radiotherapy for Cancer of the Head and Neck (POST) trial said the results showed that for patients with advanced squamous cell carcinoma (one of the most common forms of skin cancer) of the head and neck, surgery and postoperative radiation therapy resulted in high cure rates, in excess of 85 per cent. “This confirms that surgery and post-operative radiotherapy should be considered the standard of care for treating this disease. The trial also showed that the addition of chemotherapy did not improve cure rates. This will save patients from the added side effects associated with chemotherapy,” said Prof Porceddu. More than 320 patients from 23 hospitals and cancer centres in Australia and New

Zealand took part in the ten-year trial, which began in 2005.

US Cancer Leader to Speak at 2018 TROG Annual Scientific Meeting TROG is pleased to announce Prof Walter J. Curran, Executive Director of the Winship Cancer Institute at Emory University as the invited international speaker for its 2018 Annual Scientific Meeting (ASM). Prof Curran is an international expert in the management of patients with locally advanced lung cancer and malignant brain tumours and has led several landmark clinical and translational trials in both areas. He currently serves as a group chairman and a principal investigator of NRG Oncology, the largest of the five National Cancer Institute-funded clinical trials network group. Prof Curran’s attendance at the meeting is being sponsored by Varian Medical Systems. The 2018 TROG ASM will be the 30th meeting for the group – a major milestone. The ASM is being held in

Hobart from 19-22 March. Registrations are now open. Visit TROG2018.com for more information and to take advantage of early bird rates. TROG also invites members to submit an abstract from any area of radiation therapy cancer research for oral presentations at the 2018 ASM. The deadline for abstract submissions is Friday 15 December 2017.

Broadcaster Julie McCrossin Announced as TROG’s Ambassador TROG Cancer Research is excited to announce Julie McCrossin, a well-known and respected broadcaster, as its new ambassador. Julie has experienced cancer firsthand being diagnosed with throat cancer in 2013. TROG Cancer Research CEO Joan Torony said that Julie was a perfect fit to work with TROG as an ambassador as she had experience with both cancer and radiation treatment. “We are very much looking forward to working with Julie, not only promote the role of radiotherapy as an effective cancer treatment but also help let the community know about the important research that TROG Cancer Research undertakes.” According to Julie, research is the key to the innovation that improves treatment, saves lives and improves the quality of life for survivors. “It will be a real pleasure to help get the message out that funding research and translating the results into clinical care as quickly as is safely possible are absolutely vital for people affected by cancer,” said Julie.

Professor Sandro Porceddu with cancer trial volunteer Robert Schampers.

Joan Torony CEO TROG Cancer Research Volume 13 No 4 I September 2017

Radiation Oncology Advertorial

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InSightive offers a variety of interactive dashboards and reports that transform static information into dynamic visualisations for real-time insights.

Radiation Oncology

Lung Cancer News April 2018. We plan to run a half day FROLIC educational workshop during this meeting. A partnership with the ALCC gives us access to international speakers for our program.

The Faculty of Radiation Oncology Lung Interest Cooperative’s (FROLIC) second educational workshop was held in Melbourne on Friday, 1 September and had a variety of members attending including Fellows and trainees. The theme for the day was ‘Targeted Treatment for Advanced Lung Cancer’. Topics discussed included the treatment of brain metastases and extra-cranial oligometastases with both systemic therapy and radiation therapy. The workshop was successfully convened by A/Prof Jeremy Ruben.

If you have any queries relating to FROLIC, please contact frosigs@ranzcr.com

A number of FROLIC members are involved in developing a Lung Stereotactic Ablative Body Radiotherapy (SABR) registry in NSW in collaboration with the Cancer Institute NSW. If this is successful, this could be extended to include other body sites for SABR and to other states.

FROLIC members A/Prof Shalini Vinod, A/Prof Margot Lehman and Dr Andrew Oar are on the organising committee for the Australian Lung Cancer Conference (ALCC) to be held in Sydney from 5-7

The next face-to-face meeting will be at the College Annual Scientific Meeting, held in Perth, Western Australia on Thursday 19 October, 7:00-8:00am in Meeting Room 4, Crown Perth.

Cardiac CT Training 2017 We go beyond simply meeting training requirements: l

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TE OF CAR

Volume 13 No 4 I September 2017

General Interest

New Zealand Branch News

Dr Lance Lawler

I attended the NZ Branch ASM in Nelson this year. Over recent years this meeting has witnessed steadily falling registration numbers as well as a shrinking sponsorship pool (no doubt the two are related). On balance, it is likely that this meeting is the victim of an increasingly crowded scientific meeting calendar. Unfortunately, whatever the reason, we are approaching a point where the financial equation just does not work anymore. We all understand the implications. It would be a great shame to lose this meeting. For a general radiologist audience (and there is a little bit of the generalist in all of us) the scientific program is usually of a high standard, with excellent international and local speakers. However, the real value of this meeting is that it is our own, a once a year opportunity to mix and catch up with our New Zealand colleagues. An environment in which New Zealand and local issues are the focus of the weekend. We do not have this vibe at other meetings. The social events are always fun too!

with the Minister of Health. While the College received a fair hearing, it is evident Minister Coleman considers entities contracting radiological services as responsible for maintaining standards of care. This is an ideological position – it has pros and cons, but unfortunately cuts right across the changes to annual recertification and regular practice review. All we want is a straight answer, are these new ‘fitness for practice’ rules and regulations deemed to be the right thing or not? It doesn’t seem either morally or ethically right for him to have a dollar each way. I would like to say watch this space, but after four years I think we may have to admit defeat, at least as a lone College in this arena. Our strategy now is focused on enlisting the help of the other Colleges, thankfully they are slowly waking up to this anomaly.

While not directly involved, I was aware that centralised recruitment became interrupted this year with Wellington’s weather. Pleasingly, videoconferencing was used but of significance is that radiation oncology received more applications than training positions. This is a credible first, since centralised recruitment was instituted. The outcome indicates some things have worked. Firstly, greater promotion of the problem has ensued heightened awareness. Secondly, the New Zealand Radiology Education Trust (Trust) has facilitated the construction of a pipeline into the specialty from postgraduate medical students via a scholarship/ mentoring scheme. The initiative commenced during 2017 and represents a good use of the Trust’s fiscal resources. Congratulations to the inaugural scholarship recipients, Drs Andrew Robertson & Michelle Rarjaretnam.

I do not know what will happen to this meeting. I do know that if we lose it we would be much the poorer for it. Next year we are holding it in Queenstown 3-5 August 2018. I suggest you circle this date on the calendar – you may be very pleasantly surprised. On other matters, the ongoing ‘loophole’ for overseas radiologists reporting on New Zealand patients able to escape MCNZ registration was a focus in recent meetings, including

Highlights from the 2017 New Zealand Branch ASM continued over... Volume 13 No 4 I September 2017

General Interest

Highlights from the 2017 New Zealand Branch ASM

As many will be aware, ACC commenced a proof of concept for General Practitioner MRI referral access. The trial is taking place in Auckland. To date, 73 GPs have undertaken training and 47 MRIs have taken place with ACC hoping to get over 100 in the next couple of months. ACC’s position when we last met was that it is too early to draw conclusions about any time savings in patients obtaining a definitive treatment or rehab plan. Accordingly, ACC will be commencing research when more volumes have gone through the service. The Musculoskeletal Reference Group is keeping an eye on this. While discussing ACC, it is relevant to add that a new portfolio manager has been appointed for pain management services. Following sector feedback, and recent evidence based reviews, five procedures have been identified that ACC is seeking to make available outside of the Pain Management Service. Those being: 1. Trans-foraminal epidural steroid injections

Inside News

2. Interlaminar epidural steroid injections 3. Caudal epidural steroid injections 4. Joint, bursa and entheses injections 5. Nerve blocks. The Branch is currently helping ACC establish how these will be purchased. As was announced at the Annual General Meeting, Dr Gabriel Lau has been elected as the next Chairperson of the New Zealand Branch. I wish Gabes the very best. Gabes is no stranger to the College or the Branch, so will make a fine Chairperson. Dr Jonathan Feltham was also re-elected to the Committee and some interest was shown in the remaining two vacant positions. If you are interested, get involved. Lastly, thank you to all members who have put their hand up to complete ACC second opinions and undertake various College roles. As always, I am happy to talk to anybody about Branch matters or issues that they might have. Please feel free to contact me at lance.lawler@ranzcr.com

For any New Zealand Branch enquiries, please contact Alexander Brunt, Manager, New Zealand at nzbranch@ranzcr.com

General Interest

Australian Branch News NSW Branch In this edition, we continue to introduce some of the changes that has happpened since our last edition. We would like to take this opportunity to say thank you to A/Prof Lourens Bester for the contribution that he has made in his time as the NSW Branch Chair and we wish him all the best in his future endeavours. The NSW Branch committee has now selected a new Chair. We welcome Dr Pramod Phadke as the newly appointed NSW Branch Chair, we look forward to working with you in this new role.

NSW Branch ACI Radiology Lectures 25 July 2017 The event was hosted by the Royal Prince Alfred Hospital, Camperdown and organised by Drs Richard Waugh and Pramod Phadke. A novel feature of the series was the use of WEBEX/ WEBINAR technology to disseminate live presentations with feedback. The theme was Emergency radiology. The evening kicked off with two radiographer presentations on the theme of emergency radiology. These were followed by very interesting presentations by three eminent doctors: Dr James Edwards, Co-Director of Emergency Medicine at RPAH, A/Prof Dinesh Varma – Acting Director of Radiology, Head of Trauma and Emergency Radiology at The Alfred Hospital in Melbourne and Prof Anthony McLean, Intensivist and Director of ICU at Nepean Hospital. The presentations have been recorded and available for viewing.

Branch Member Profile Dr Pramod Phadke Chair, NSW Branch I have been the Director of Training at Nepean Hospital in Western Sydney since 2007. Diagnostic neuroradiology, musculoskeletal radiology and Emergency radiology are my clinical subspecialty interests. I am one of the Part II musculoskeletal viva examiners and I have participated in the curriculum development process as a reviewer of the musculoskeletal section of the curriculum. I have a keen interest in all aspects of health professions education. I stepped in to the role of NSW Branch Education Officer towards the end of 2014. The 2015 introduction of radiology training networks has meant new challenges and opportunities in radiology education.

Visiting International Guest Radiologist Educator, 9-11 August 2017 Gosford Hospital medical imaging department hosted Prof Chaan Ng MD, PhD, Professor of Radiology at The University of Texas MD Anderson Cancer Centre. He obtained his medical degree from University of London, and trained in radiology at Addenbrooke’s Hospital, University of Cambridge, UK. He specialises in body imaging with extensive experience in CT, MRI and PET. Prof Ng conducted a series of radiology tutorials for the trainees of LAN1 from Wednesday 9-11 August. These teaching/learning sessions were very well appreciated by the trainees.

I am actively involved in facilitating appropriate governance structures and curriculum delivery for my local area network (LAN) in my role as Network Training Director (NTD). In collaboration with NTDs of other LANs in NSW, I am contributing to successful implementation of radiology networked training in NSW. I hope to continue this work and do more for the NSW Branch in my new role as NSW Branch Chair, with the support of members and the NSW Branch Committee.

Dr Pramod Phadke

Emergency Radiology Workshop, 18 August 2017 The workshop was presented at Gosford Hospital by Dr Elizabeth Dick and A/Prof Dinesh Varma. Dr Dick is the President of the British Society of Emergency Radiology and president elect of the European Society of Emergency Radiology. A/Prof Varma, aside from his many achievements and his work for the College, is Founder Chairman of the Australian and New Zealand Emergency Radiology Group.

continued over... Volume 13 No 4 I September 2017

General Interest

QLD Branch The QLD Branch Committee hosted the QLD Branch Annual Scientific Meeting at the Noosa Sofitel on Saturday 10 June. The meeting was a huge success with almost 200 delegates attending. The program had a great line up of speakers along with a fantastic cocktail evening. The Annual General Meeting was also held that afternoon. Members of the QLD Branch look forward to the next branch ASM in 2018 which will be held on the Gold Coast.

Drs Justin Hegarty, Andrew Dettrick, Trevor Watkins and John Velkovic

Australian Branch Meeting Dates NSW Branch

NSW Branch/ACI Radiology Lectures 14 November 2017

Kerry Packer Lecture Theatre RPA Hospital, Missenden Road, Camperdown

Committee Meeting 8 November 2017

Via Teleconference

Academic Meeting NSW Radiation 16 November 2017 Oncology Chapter

Cockle Bay Room Park Royal Darling Harbour 150 Day Street, Sydney

Monthly Professional Meeting (MPM) 8 November 2017

Royal Perth Hospital 197 Wellington St, Perth WA 6000

Meeting dates are subject to change. For further information about Branch activities and event please contact Mereana Pokai on: branches@ranzcr.com, Ph: +61 2 9268 9738 or visit: www.ranzcr.com/whats-on/events

Branch Contacts 2017 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: Dr Pramod Phadke E: ppphadke@yahoo.com Honorary Secretary: Dr Chee-Chung Hiew E: chee-chung.hiew@sesiahs.health.nsw.gov.au Meeting Contact: Mr Elvis Maio E: Elvis.Maio@health.nsw.gov.au

Inside News

NSW Radiotherapy Club Ms Mereana Pokai E: branches@ranzcr.com NZ Chair: Dr Lance Lawler E: lance.lawler@ranzcr.org.nz Honorary Secretary: Dr Ben Wilson E: ben.wilson@southerndhb.govt.nz QLD Chair: Dr Mark Phillips E: ausphillips66@yahoo.com.au Honorary Secretary: Dr Peter Zheng E: secretaryranzcrq@gmail.com SA Chair: Dr Chris Pozza E: cpozza@usa.net Honorary Secretary: Dr Melissa Lea (acting in role)

TAS Chair: Dr Rajendra Doolabh E: Rajendra.Doolabh@regionalimaging.com.au Honorary Secretary: Dr Jonathan Shulman E: Jonathan.Shulman@regionalimaging.com.au VIC Chair: Prof Stephen Stuckey E: slstuckey@mac.com Honorary Secretary: Dr Gerard Goh E: G.Goh@alfred.org.au MSM Convenor: Davig Wang E: msm.convenor@gmail.com 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

RANZCR Recalls

EXPLORING THE EXTRAORDINARY Women in Leadership: Extraordinary Industry Mentors Share their Insights for the Future PROF GILLIAN DUCHNESE

Radiation Oncologist RANZCR Fellow since 1997

RESEARCH

“Understanding scientific method allows you look at things from a different perspective back at the clinic.”

CLIN PROF LESLEY CALA

Clinical Radiologist RANZCR Fellow since 1971

INNOVATION

“In 1975, I was the first to identify Multiple Sclerosis via CT here in Perth. Until then, it could only be determined post mortem.”

ADJ. CLIN PROF LIZBETH KENNY AO

Radiation Oncologist RANZCR Fellow since 1987

MENTORING

“The greatest pleasure comes from one on one teaching, that one on one mentor relationship with trainees that happens every day.”

A/PROF NINA SACHARIAS OAM

Clinical Radiologist RANZCR Fellow since 1976 and Life Member since 2002

EDUCATION

“My students definitely feel that teaching is my forte. There was never a moment of boredom while working for me!”

To listen to the audio download any QR scanner to suit your smartphone or visit bit.ly/ranzcrrecalls2017

DO YOU HAVE A STORY TO TELL?

Contact archives@ranzcr.com to share your experiences Volume 13 No 4 I September 2017

General Interest

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

RANZCR Supporters

All College standards, policies and guidelines are available on the College website here: www.ranzcr.edu.au/resources/professional-documents www.ranzcr.com/our-work/policy

Everlight www.everlightradiology.com.au

All College position statements and submissions are available on the College website here: www.ranzcr.com/our-work/advocacy/position-statements-and-submissions

TNI Pty LTD www.tni-australia.com

I-Med www.i-med.com.au

If you have any enquiries about professional documents, please contact the College on: ranzcr@ranzcr.com or phone: +61 2 9268 9777

Bayer Australia Ltd www.bayer.com

International Medical Graduate Assessment Policy (Australia)

Sectra www.sectra.com/medical

Many members may not understand the way in which International Medical Graduates (IMGs) are assessed with the College to practise in Australia. The College has recognised that this may also apply to International Medical Graduates who are undertaking the process. To assist these IMGs, potential employers and other organisations who support IMGs through the process the College has developed an International Medical Graduate Policy (Australia) which clearly sets out the assessment process, the expectations of the College and the manner or process in which the College undertakes an assessment. The policy collates the information that the College currently already provides but in a more detailed, consistent and transparent way. It is hoped that the policy will provide the appropriate amount of information to support and guide IMG’s through the assessment process. Many members will know of a colleague who has been or is currently undertaking an assessment and as a member of the College you may be interested in reviewing the policy to gain an understanding of the assessment process, the purpose and focus of the assessments, the standards expected by the College and determinations or outcomes of an assessment. A number of College members currently assist with the assessment process as appropriately trained IMG assessors. The policy is available for review on the College website at www.ranzcr.com/ college/document-library/img-assessment-policy-australia and encompasses Specialist Recognition, Area of Need and Short term training assessments and is in line with the Australian Medical Council (AMC) accreditation standards and the Medical Board of Australia’s Good Practice Guidelines. The assessment of IMGs in New Zealand is undertaken differently through the Vocational Educational Advisory Board (VEAB) on behalf of the Medical Council of New Zealand (MCNZ). A policy covering the New Zealand assessment process is planned for the future. If you would like more information regarding the assessment process for IMGs within Australia or are interested in becoming an IMG Assessor please contact Wendy Frazer, Senior Education Officer, IMG on 02 9268 9724 or at img@ranzcr.com

Inside News

Integral Diagnostics www.integraldiagnostics.com.au Deutsch Medial Pty LTD www.deutschmedical.com.au Varian Medical Systems www.varian.com Wiley Publishing www.onlinelibrary.wiley.com

Being a RANZCR Supporter entitles you to the following benefits: • Discounted advertising opportunities • A RANZCR Supporter logo to display on your website • A RANZCR Supporter listing on the College website, in Inside News and in the Annual Report • The College’s quarterly newsletter - Inside News • The College’s bi-monthly scientific journal - Journal of Medical Imaging and Radiation Oncology • The College’s monthly electronic newsletters – Faculty of Clinical Radiology and Faculty of Radiation Oncology and other associated electronic newsletters • The College’s Annual Scientific Meeting brochure • An electronic version of the College’s Annual Report.

General Interest

Australasian Meetings 2017

International Meetings 2017

October

ASBD Scientific Meeting Gold Coast, QLD – 5-7 October http://asbd.org.au/conference2017.php ANZHNCS ASM Brisbane, QLD – 12-14 October www.anzhncs.org RACMA Conference Melbourne, VIC – 18-21 October www.racmaconference.com.au ANZSPR Annual Scientific Meeting Perth, WA – 22-25 October 2017 www.anzspr17.com

Australasian Meetings 2018 March IRSA/APCCVIR Conference Auckland, New Zealand 8-11 March 2018 www.irsa.com.au/meetings ANZSNR ASM Hobart, TAS – 16-18 March 2018 www.anzsnr.org.au ARGANZ Annual Scientific Meeting Melbourne, VIC – 24-25 March 2018 www.arganz.org/index.php/ meeting-2018/home.html

RANZCR Annual Scientific Meeting Dates ASM 2017 19-22 October 2017 Perth, WA www.ranzcr2017.com NZ Branch ASM 2018 3-5 August 2018 Queenstown, New Zealand www.ranzcr2018.co.nz ASM 2018 25-28 October 2018 Canberra, ACT

College Meetings 2017

IASLC World Conference on Lung Cancer Yohohama, Japan – 15-18 October www.wclc2017.iaslc.org Korean Congress of Radiology Seoul, South Korea – 25-28 October www.kcr4u.org/index.htm

International Meetings 2018 April ARRS Annual Meeting Washington, USA – 22-27 April www.arrs.org/AM18

Board 16-17 November Annual General Meeting 19 October 2017 Faculty Council – Clinical Radiology 20 November 7 Dec (telco) Faculty Council – Radiation Oncology 13 October

April World Federation of Nuclear Medicine and Biology Congress Melbourne, VIC – 20-24 April 2018 www.wfnmb2018.com

Correct at time of print. For an updated list of events, please visit our events page on the College website at www.ranzcr.com/whats-on/events. Volume 13 No 4 I September 2017

Courses and Workshops Classifieds

MRI in Practice

FLINDERS MEDICAL CENTRE PATHOLOGY COURSE

The course started life as the famous Oxford MRI Course in 1992 and has been running continuously ever since engaging and educating thousands of radiographers, radiologists, physicists, researchers, technicians, engineers, nurses, assistant practitioners, veterinary surgeons and anyone with an interest in the exciting world of MRI.

32 - 56 February 2018 2017 RANZCR CPD RANZCR CPDpoints pointscan canbebeclaimed obtained forfor attendance attendance Venue: Novotel MenziesSydney Hotel, Sydney Central, Sydney Early-bird registration fee $1600 $1500 www.mrieducation.com/australasia

17 & 18 FEBRUARY 2018 The Division of Medical Imaging at Flinders Medical Centre will offer a two day Pathology Course, consisting of lectures and “pots” sessions to be held on Saturday 17 and Sunday 18 February 2018 at the Adelaide Convention Centre. The course will be of particular value to registrars and candidates preparing for the Part II FRANZCR examination. It will also provide an overview of pathology for practising radiologists who are encouraged to attend. Closing date for registrations is: Friday 30 November 2017 For registration form and further information please contact Helen Sainsbury: helen.sainsbury@sa.gov.au / (08) 8204 4405

Advertise your event in Inside News and receive a complimentary online listing on the College website. Email editor@ranzcr.com for more information.

~ Death Notices ~ The College notes with regret the death of the following members: Dr Brian Bousfield, Fellow, VIC Dr Cameron Leopold, Fellow, Overseas

Advertising submitted by third parties does not constitute endorsement by The Royal Australian and New Zealand College of Radiologists.

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