Issuu

Volume 14 No 4 / September 2018

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

UNWINDING Tips and Tools to Avoid Burnout

Also Featured in this edition

Doctor’s Health Advisory Service

– your best move

Changes to Medical Registration

New Technology – MARS Spectral X-Ray Scanner

“We deliver the highest quality.” At I-MED Radiology Network we are committed to consistently delivering high quality and expert care in each of our clinics. We attract the best people to work with us and invest in your training and development to ensure better health outcomes for our patients. Join us in our pursuit of excellence and experience an interesting clinical career in a doctor-led and patient centred organisation. T: +61 2 8274 1080 E: careers@i-med.com.au www.i-med.com.au/careers

Editor’s Pick 5

The Burning Issues behind Burnout

6 9 11

Recovery Strategies to Assist Work-Related Stress Doctors’ Health Advisory Service – your best move

Courses, Workshops and Events

Changes to Medical Registration

Training and Assessment Reform Update

A Message from the Dean of Clinical Radiology

Targeting Cancer Marks Fifth Anniversary

A Message from the Chief Censor of Clinical Radiology

InsideRadiology

Clinical Radiology Trainee News

RANZCR Welcomes AMA’s Position Statement on Diagnostic Imaging

Nominate your colleagues for a College Honour

A Message from the Dean of Radiation Oncology

A Message from the Chief Censor of Radiation Oncology

Radiation Oncology Trainee News

43 45 47

News from the Professions New Zealand Branch News Australian Branch News

New Technology: MARS Spectral X-Ray Scanner

97% of members have logged into the new MyRANZCR, Portal! Start updating your contact details, login today at www.myranzcr.com Inside News is printed on Sovereign Silk. Sovereign Silk 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.

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WITH SPECIAL GUESTS: Prof Hugh Bradlow

President, Australian Academy of Technology and Engineering

Assoc. Prof. Yves-Alexandre de Montjoye Lecturer at Imperial College London

Dr Jordan Nguyen

Inventor, Biomedical Engineer and Thought-Leader

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Introduction

The Burning Issues Behind Burnout A Message from the President

Dr Lance Lawler

Many of you may recall reading in Inside News in 2016 about a College survey of stress and burnout among radiation oncology trainees. The survey found that almost half of our trainees admitted to feelings of emotional exhaustion or ‘depersonalisation,’ due at least in part to work-related stress.1 This followed an Australian mental health survey in 2013 in which doctors and medical students reported higher-than-average rates of psychological distress and attempted suicide.2 In response to these findings the College has worked to create greater awareness around burnout and related issues and provide increased support for its members, especially trainees, to maintain or improve their wellbeing (e.g. www.ranzcr.com/trainees/general/yourwellbeing). The causes behind burnout are complex but, according to the literature, we understand that factors such as a perceived lack of resources in a demanding work environment are significant. A 2015 study among cancer workers (mostly oncology nurses) in Queensland noted the risks imposed on clinicians dealing with emotionally taxing caseloads, with symptoms of burnout evident in a third of the cohort. This same study examined the efforts clinicians make to recover from work stress by, for example, taking coffee breaks, getting regular physical exercise, ‘switching off’ after work and on weekends, or taking up a new challenge outside of work. Many of us know the value of these recovery

strategies already, but what is worrying was the study’s finding that the cancer workers reporting the highest burnout scores were among the least likely to participate in recovery experiences.3 This suggests that some clinicians aren’t getting the message or they believe stress is a serious health risk for lesser mortals, but not them. Two of the authors of the Queensland study have contributed a feature article to this edition of Inside News (see page 6), detailing the 4Rs of recovery to prevent burnout in the medical workplace. I recommend all members read this article and, if you are not regularly undertaking at least some of the suggested strategies, then you are putting your health and the health of your patients at risk. The reality is that clinical medicine is a stressful profession, not just because of excessive workloads and exacting standards—these are common in most professions—but also because of the emotional attachments clinicians form with their patients and the criticallyimportant outcomes they seek on their behalf. While the 4Rs article mentions this fact in passing, the emphasis here is primarily on individual self-help, such as relaxation, sleeping well and exercise. I might also draw your attention to a recent online comment piece on burnout in the New England Journal of Medicine (NEJM). The author’s focus is on the nexus between clinician burnout and the health outcomes experienced by poor and socially marginalised patients. Despite our best efforts to

address their ills, these patients are often beyond the reach of medicine, at least that form of medicine wielded by individual practitioners, and which in itself is a source of disillusionment and, yes, burnout. The author is a fourth-year medical student at Harvard so maybe he knows first-hand what he’s on about. And what’s his advice? Stop acting the ‘lone hero’ and instead organise collectively and advocate for better outcomes for such patients—be they the homeless, the addicted, the abused, the isolated or the displaced.4 I raise the value of advocacy in this context because in our College members have the resources, expertise and colleagues to do just this, if they choose to get involved. So, perhaps some members might consider a fifth R to combat burnout: Reconnect.

References 1 RANZCR, Inside News, vol. 13, no. 1 (December 2016), 54. 2 Beyond Blue Ltd, National Mental Health Survey of Doctors and Medical Students, October 2013, https://www.beyondblue.org.au/docs/default-source/ research-project-files/bl1132-report---nmhdmss-fullreport_web 3 Michael G. Poulsen et al., “Recovery experience and burnout in cancer workers in Queensland,” European Journal of Oncology Nursing, vol. 19 (2015), 23–28, http://dx.doi.org/10.1016/j.ejon.2014.08.003 4 Leo Eisenstein, “To fight burnout, organize,” New England Journal of Medicine (NEJM), 20 June 2018, http://dx.doi.org/ 10.1056/NEJMp1803771

Volume 14 No 4 I September 2018

Feature

Strategies to Assist Recovery from Work-Related Stress for Medical Practitioners Adopting the 4Rs: Relaxation, Resilience, Rebuild, Reboot

In 1975, a Queensland Radiation Oncologist named Rodney Withers, described what has become the cornerstone of radiation therapy. He coined the term the “4R’s” and these principles of radiobiology still apply: Repair; Reoxygenation; Redistribution; Regeneration. This “4R’s” acronym can also be used to understand how adoption of recovery strategies can protect against burnout. Recovery strategies have potential to repair or return an individual to pre-stress levels after exposure to toxic elements. Recovery refers to the need to recuperate and wind down following strenuous effort invested in work-related activities. Radiosensitivity is a newer member of the R’s. It reminds us that apart from

Inside News

repair, redistribution, reoxygenation of and repopulation there is an intrinsic radioresistance in different cell types. This is a timely warning that some members of the medical workforce may not pay sufficient attention to their own self-care needs and potentially experiencing burnout (i.e. physical, mental and emotional exhaustion, withdrawal and detachment). The subject of burnout in the medical workforce has received considerable interest in the medical literature and rightly so1. Primary care physicians in the front-line of health care are exposed to considerable stressors related to patient care contributing to burnout. These may originate from emotional attachments that can develop with their patient’s medical care, or they may arise from the

work environment related to tensions between colleagues or from issues related to Information Technology. It behoves all practitioners to consider their own “repair capacity” and the need to ensure personal health and wellbeing when exposed to chronic stress. Early adoption of recovery strategies may help prevent cardiovascular disease, back pain and psychological distress, all of which are associated with burnout2. Optimal recovery occurs when an individual’s functioning returns to prestressor levels3. Daily recovery is crucial for the maintenance of wellbeing and job performance. While some individuals can alter unhealthy habits and redistribute resources to move towards healthy growth, it is more difficult for others to change. “Repair and

Feature

reoxygenation” are akin to replenishing and may come from within (i.e. selfdetermined goal setting) or from without (i.e. through social support from friends, colleagues or team leaders). There are multiple recovery strategies that individuals can consider when developing a healthy self-care plan. Sonnentag and colleagues identified four processes that assisted recovery in a study of 147 employees over five days, demonstrating that daily recovery was positively related to daily work engagement during the subsequent workday4. A “4R’s” acronym can be used to categorise these 4 groups of recovery strategies: • Reboot outside of work to eliminate ruminative work-related thoughts during the “out-of-work” hours and learn to “switch off”; • Relaxation to allow rest and recuperation; • Rebuild personal resources to combat stress and improve motivation; • Rechallenge - by creating new mastery experiences outside work; Psychological detachment: (i.e. being able to “switch off” from work-related thoughts during the “out-of-work” hours); relaxation (i.e. unwinding from work mentally/physically with activities such as listening to music or going for a jog); mastery experiences (i.e. taking on a new challenge outside of work such as learning a new language or learning a new skill); and increasing control over work/life balance5. Reboot • “Switch off” after work and set work/life balance

activity concluded that in both healthy and diseased populations, yoga may be as effective or better than exercise at improving a variety of health related outcomes associated with wellbeing12. • “Switch off” with laughter. This is associated with higher levels of life satisfaction13. Relaxation • Relax with friends and family in activities that help individuals unwind. Social support is a key basic psychological need along with autonomy and competence which are the cornerstones of Self-Determination Theory which is linked to motivation, wellbeing and flourishing15 • Good sleep hygiene at night can help recovery. Insufficient sleep is a strong risk factor for burnout16. Mednick’s research into sleep demonstrated the beneficial outcomes of a 20-minute nap that exceeded the benefits of caffeine.17 • Taking your allocated holidays – Health and wellbeing are restored during holiday breaks and seem to peak on the 8th day of vacation. • Breathe – deep breathing can play a vital component in the relaxation response and is something that can be monitored and improved with little cost or effort18. • Massage is a proven and effective way to decrease cortisol levels in the body which in turn decreases stress. Rebuild

• Set boundaries with emails – quarantine time to strictly limited periods of email or messaging as this can help individuals switch off.

• Rebuild leisure networks and hobbies – hobbies provide contexts in which individuals can forget work and demonstrate mastery in non-work domains.

• Exercise can also allow individuals to switch off. Moderate to vigorous physical activity three to five times a week is associated with a greater sense of wellbeing and lower rates of depression and anxiety across all age groups14

• Identify new learning opportunities include challenging non-physical pursuits, such as learning a language, participating in a book club, or taking art classes or acquiring and new skill not directly related to work.

• “Switch off” with yoga – Ross and Thomas’s meta-analysis of a range of structured forms of physical

• Engage in professional networks and peer mentoring support outside work.

Resilience • Practice self-compassion. Be aware of stressful times and “be kind to yourself”. • M indfulness-Based Stress Reduction (MBSR) uses “here and now” strategies (i.e. being focussed on the “here and now” rather than worrying about the past or the future. Meta analyses have reported medium effect sizes in reducing anxiety and depression that cannot be explained by relaxation alone19. • Learn active coping techniques – take ownership of personal development in acquisition of recovery approaches and a selfcare plan. In conclusion, there is a strong association between use of recovery strategies and wellbeing. Individuals need to develop their own strategies to build their resilience and personal resources to overcome work-related stress. Organisations can facilitate recovery by creating opportunities for workplace support and improving the workplace culture. Success may well be determined by taking control of this yourself. Prof Michael Poulsen MB BS, FRANZCR, MD Professor University of Queensland, Radiation Oncology Mater Centre, Radiation Oncology Centres A/Prof Anne Poulsen PhD, B Occ Thy (Hons) Honorary Associate Professor, School of Health & Rehabilitation Sciences, The University of Queensland

continued over...

Volume 14 No 4 I September 2018

References 1. Eisenstein L. To fight burnout, Organize. The New England journal of medicine. 2018;July 19:1-3. 2. Coffeng JK, Hendrikson IJ, Duijts SF, Proper KI, Van Mechelen W, Boot CL. The development of the Be Active and Relax “Vitality in Practice” (VIP) project and design of an RCT to reduce the need for recovery in office employees. BMC Public Health. 2012;12:592. 3. Sonnentag S, Natter e. Flight attendants’ daily recovery from work: is there no place like home? . International Journal of Stress Management. 2004;11:366-91. 4. Sonnentag S. Recovery, work engagement, and proactive behavior: a new look at the interface between nonwork and work. J Appl Psychol. 2003;88(3):518-28. 5. Sonnentag S, & Fritz, C. . The recovery experience questionnaire: Development and validation of a measure for assessing recuperation and unwinding from work. . Journal of Occupational Health Psychology. 2007;12:204-21. 6. Poulsen MG, Poulsen AA, Khan A, Poulsen EE, Khan SR. Recovery experience and burnout in cancer workers in Queensland. European journal of oncology

Inside News

nursing : the official journal of European Oncology Nursing Society. 2015;19(1):23-8. 7. Rook JW, Zijlstra FRH. The contribution of various types of activities to recovery. Europen Journal of Work and Organisational Psychology. 2006;2006(15):218-40. 8. Sonnentag S. Work, recovery activities, and individual well being. Journal of Occupational Health Psychology. 2001;6:196-210. 9. Norris R, Carroll D, Cochrane R. The effects of aerobic and anaerobic training on fitness, blood pressure and psychological stress and well-being. J Psychosom Res. 1990;34:367-75. 10. Lechner L, de Vries H. Effects of employer fitness program on reduced absenteeism. J Occup Environ Med. 1997;39:827-31. 11. Rosenfeld O, Tenebaum G, Ruskin H. Behavioural modifications following physical activity program in the Israeli pharmaceutical industry. J Sci Med Sport. 1990;22:93-6. 12. Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med. 2010;16(1):3-12. 13. McGhee P. Rx: laughter. RN. 1998;61(7):50-3.

14. Huppert FA, Keverne B, Batylis N. The science of wellbeing. Oxford, United Kingdom: Oxford University Press. 2005. 15. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68-78. 16. Soderstrom M, Jeding K, Ekstedt M, Perski A, Akerstedt T. Insufficient sleep predicts clinical burnout. J Occup Health Psychol. 2012;17(2):175-83. 17. Mednick SC, Cai DJ, Kanady J, Drummond SP. Comparing the benefits of caffeine, naps and placebo on verbal, motor and perceptual memory. Behavioural brain research. 2008;193(1):79-86. 18. Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry. 1974;37(1):37-46. 19. Sedlmeier P, Eberth J, Schwarz M, Zimmermann D, Haarig F, Jaeger S, et al. The psychological effects of meditation: a meta-analysis. Psychological bulletin. 2012;138(6):1139-71.

Features

Doctors’ Health Advisory Service for NSW and ACT Contacting us Could be Your Best Move (DHAS). The DHAS was founded in 1982 to assist medical practitioners with personal and health problems. It is an independent and confidential service offering advice, support and, where required, referral pathways for doctors, medical students, their families and colleagues. The DHAS aims to provide a service where you can feel safe discussing any issues that may be affecting you either professionally or personally. The DHAS is also available should you feel concern for a colleague or family member and wish to discuss how best to manage that situation. The DHAS is an advisory, not treatment service. How does it currently operate?

The subject of doctors’ health is commanding increasing attention in the media. Justifiably so. There are myriad pressures impacting on medical practitioners at all career stages. These pressures find potential expression in the full range of psychological and psychiatric problems: anxiety, depression, alcohol and substance misuse, etc. Of course, the most tragic of outcomes is suicide. Accordingly, it is worth reminding radiologists and trainees about the Doctors’ Health Advisory Service

The DHAS provides a 24-hour phone line, which is manned by an answering service. Calls – which have almost trebled in recent months – are then returned by qualified DHAS staff (a psychiatrist and medical social worker) or affiliated health professional. Callers are not required to leave any identifying data, only a phone number to enable a return call to be made. Depending on the nature of the call and discussion with the caller, advice will be provided about “next steps”, if these are needed. The next steps may take the form of one or more of the following: • Subsequent discussion between the caller and the DHAS staff or associate. • Referral(s) may be suggested to a GP, psychiatrist, drug and alcohol specialist, other medical specialist, psychologist, or other allied health professional.

• On a case-by-case basis, and with the caller’s permission, the above-named professionals may be contacted by the DHAS to facilitate the referral. • An offer is always made to the caller for ongoing contact and support with the DHAS. A key piece of advice that will invariably be given by the DHAS to callers is the following: regardless of career stage, having one’s own GP is a plank for current and future health care needs. Importantly, the DHAS is not an emergency service – the answering service advises callers to contact 000 in the case of an emergency. If required, we trust that we can assist you, so do think of us _ we welcome your call on 02 9437 6552 (www.dhas. org.au). Finally, the DHAS’s role extends beyond providing phone advice. The DHAS provides education and training in the area of doctors’ and students’ health and wellbeing, and fosters relationships with key stakeholders. We hope to see you at a future DHAS function. Prof Garry Walter AM, MB BS, BMedSc, PhD, FRANZCP Medical Director, Doctors’ Health Advisory Service (NSW & ACT)

Trainees are also encouraged to contact the College’s Trainee Liasion Officer for any wellbeing or training matters on rodtaa@ranzcr.com

Volume 14 No 4 I September 2018

NOW OPEN!

Nominate a Colleague for a College Honour Do you know a colleague who has made a significant contribution to the clinical radiology and radiation oncology professions or the College? Why not nominate them for a College Honour?

College Honours Acknowledge outstanding contributions to the College and to the clinical radiology and radiation oncology professions. • Gold Medal • Roentgen Medal • Honorary Fellowship • Life Membership • Clinical Radiology Educational Service Award • Denise Lonergan Educational Service Award • Sally Crossing Award for Consumer Advocacy

Educational Fellowships Provide members with financial support through a funded grant to further their knowledge or research project. • Thomas Baker Fellowship • Rouse Travelling Fellowship • Bill Hare Fellowship • Windeyer Fellowship Visit www.ranzcr.com/college/awards-and-prizes to download nomination forms, guidelines and terms and conditions

Closing APRIL 2019

Advocacy

Targeting Cancer Marks Fifth Year Anniversary

October marks the five-year anniversary of Targeting Cancer, the flagship binational campaign of the Faculty of Radiation Oncology. Based around the Targeting Cancer website (www.targetingcancer.com.au), which features a host of resources aimed at improving knowledge of radiation therapy among GPs and the wider community, the campaign aims to raise awareness of radiation therapy as an effective, safe and sophisticated treatment for cancer. The website continues to receive thousands of visitors from across the globe each month, while the campaign has also achieved reached an audience of millions through its media activities. The social media presence – a vital tool for promoting further awareness of the campaign’s objectives – also continues to grow. The campaign has a range of helpful resources and merchandise that can be used for promotional opportunities and we welcome anyone wishing to assist the campaign in any capacity. Anyone interested in promoting Targeting Cancer at fundraising or other relevant events, or in running a GP oncology education evening should email the Targeting Cancer team on info@targetingcancer.com.au

Informed Decision-Making in the Management of Localised Prostate Cancer Targeting Cancer has been promoting and advocating the Faculty of Radiation Oncology’s recent ‘Informed Decision Making in the Management of Localised Prostate Cancer – A Patient-Focused Perspective’ position statement. The statement, published in June, stresses the importance of men with prostate cancer understanding all available treatment options.

BIG ACHIEVEMENTS OF THE TARGETING CANCER CAMPAIGN SO FAR:

➢ Provided support to more than 50 GP/radiation oncology

awareness evenings promoting awareness of and knowledge of radiation therapy as a curative treatment for cancer patients.

➢ Established the Targeting Cancer website, which has attracted

hundreds of thousands of visitors from across the globe since its creation. During the last 12 months the site has had over 100,000 visits and currently ranks as one the most popular cancer and radiation therapy related websites in Australia.

➢ Attained mass media coverage promoting both the campaign and importance of radiation therapy as a treatment option for cancer patients in Australia and New Zealand.

➢ Established links and collaborations with cancer patient support groups and organisations across Australia and internationally.

WAYS YOU CAN HELP PROMOTE THE TARGETING CANCER MESSAGE:

➢ Retweet articles/tweets from the Targeting Cancer Twitter account ➢ Refer patients and other professionals to the Targeting Cancer website (www.targetingcancer.com.au), which contains a wealth of information resources

➢ Promote the campaign through an awareness or oncology education evening

➢ Let your colleagues know about the campaign!

The statement was developed in consultation with, and has the support of, prostate cancer support groups across the country and states the best practice model of care to support men in making decisions about curative treatment.

Julie McCrossin

Anyone wishing to view the statement should visit www.ranzcr.com/ documents/4670-informed-decisionmaking-in-the-management-oflocalised-prostate-cancer-positionpaper/file continued over... Volume 14 No 4 I September 2018

Advocacy

Targeting Cancer Featured in New Learning Module

For more information, visit www.futurelearn.com

Targeting Cancer is delighted to feature alongside international experts in a world-first online course aimed at the general community and those affected by cancer. ‘An Introduction to Radiation Oncology: From Diagnosis to Survivorship’ promotes the importance of modern radiation therapy in the management of many different cancers and the role of specialist healthcare teams delivering treatment and patient care.

Cancer Nurses Society of Australia (CNSA) Annual Congress

Developed and run by Trinity College Dublin, Ireland’s highest-ranked university, and hosted on Futurelearn, the social learning platform, the free course features one of the ambassadors of The College’s Targeting Cancer campaign, Julie McCrossin, in its teaching material.

Targeting Cancer campaign ambassador, former ABC broadcaster Julie McCrossin, hosted an interactive plenary session that drew the congress to a close. The multidisciplinary panel discussion promoted the Targeting Cancer campaign and highlighted the importance of radiation therapy as a treatment option.

Designed as a Massive Online Open Course (MOOC) and open to worldwide participants, it is expected to have a global reach to many thousands of people who might be unaware or have a poor understanding that radiation therapy is a highly effective and sophisticated cancer treatment.

Inside News

The Cancer Nurses Society of Australia (CNSA) hosted their 21st annual congress in June. Held in Brisbane, the congress brought together over 700 delegates. For the first time, radiation therapy had a strong feature, including Targeting Cancer representation in the exhibition hall.

Targeting Cancer Fun Run at RANZCR ASM Targeting Cancer is once again hosting a 5km fun run (or 3km walk) at the forthcoming College ASM in Canberra.

The annual event, which has become a welcome addition to the ASM program, will be a refreshing way to start the penultimate day of the ASM. For the first time, entries are being opened to members of the public. With limited places available, make sure you’ve registered: https://eecw. eventsair.com/ranzcr18/targetingcancer/ Site/Register Please email the Targeting Cancer team on info@targetingcancer.com.au for your Targeting Cancer fun run merchandise, including water bottle, shirt/singlet and cap. For enquiries about Targeting Cancer, email our team on info@targetingcancer.com.au

Advocacy

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

Breast Imaging

Breast Ultrasound

October is Breast Cancer Awareness month, an annual campaign to increase awareness of the disease.

Breast ultrasound is the examination of the breast tissue using an ultrasound scan. Ultrasound uses high frequency soundwaves to produce images of the body that are displayed on a screen.

InsideRadiology has a range of information items around detection and diagnosis of breast cancer in its breast imaging section to provide health consumers and health professionals with more information about the different tests available including:

Mammography Mammography is a low-dose X-ray examination of breasts and is used to detect breast cancer when that cancer is too small to be felt as a lump, or to investigate unusual signs or symptoms. The aim of screening mammography is to reduce the death rate from breast cancer by detecting unsuspected breast cancers at an early stage. A diagnostic mammogram is performed when a person, their doctor or another health professional discovers unusual signs or symptoms in one or both breasts, i.e. a lump, tenderness, nipple discharge or skin changes. The mammogram confirms whether the changes are benign (non-cancerous) and no treatment is needed, or whether the changes indicate breast cancer and further tests and treatment will be required.

Promote InsideRadiology to Patients and Colleagues

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Ultrasound of the breast helps to distinguish fluid filled lumps in the breast (cysts) from solid lumps which may be cancerous or benign (noncancerous). It is often useful to examine the breasts of younger women because the breast tissue is much denser than it is in older women, and this density can make it harder to detect an abnormality if a mammogram is performed.

Breast Tomosynthesis Breast tomosynthesis is an X-ray examination similar to mammography that provides a 3D view of the breast. It is a relatively new technology, and research about how to fully utilise it is still being carried out. It has already been shown to be beneficial in the detection of small breast cancers compared with conventional mammography, particularly in women with dense breast tissue, which can mask abnormal areas in a conventional mammogram.

A breast MRI is a medical test where magnetic fields, radio waves and an advanced computer are used to produce very detailed images of the breasts without using X-rays.

any  Recommending topics that could be

considered for inclusion.

Breast Fine Needle Aspiration (FNA) A breast FNA is a quick and simple procedure to perform, which removes some fluid or cells from a breast lesion or cyst with a fine needle similar to a blood sample needle.

Breast Core Biopsy A breast core biopsy is where a special needle (or probe) is inserted into the breast to take a small sample of breast tissue from an area of concern so that it can be sent to a laboratory for testing. It is done using local anaesthetic to numb the breast in the area that is being biopsied.

Breast Hookwire Localisation Mammography, ultrasound and MRI scan images or pictures sometimes show abnormalities in the breast that cannot be felt by a doctor. If the abnormality is to be surgically removed, it is necessary to place a fine wire, called a hookwire, in the breast with its tip at the site of the abnormality.

Vacuum-Assisted Core Biopsy

Breast MRI

Promoting InsideRadiology in your professional networks.

Further procedures are often recommended to aid diagnosis and removal of suspicious breast tissue. These include:



Vacuum-assisted core biopsy is a safe and minimally invasive procedure in which a sample of breast tissue is removed for examination. When breast imaging shows up very small abnormalities too small to be felt (i.e. anything unusual in the structure of the breast), Vacuum-assisted core biopsy is used to obtain samples of the breast tissue.

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Volume 14 No 4 I September 2018

CLINICAL R ADIOLOGY AND R ADIATION ONCOLOGY Exclusively at RSNA 2018 Monday, November 26 | 10:30am – 12:00 pm Join The Royal Australian and New Zealand College of Radiologists as it presents a special in-depth look at Australian and New Zealand radiology practices at RSNA 2018, the world’s leading radiology event.

MORE ABOUT RSNA 2018! Hosted by the Radiological Society of North America in one of America’s most vibrant cities, RSNA 2018: Tomorrow’s Radiology Today allows you to discover cutting-edge technological and scientific breakthroughs, learn from leading experts and network with colleagues from around the globe. While you’re there, be sure to visit exhibiting companies from Australia and New Zealand throughout the North and South Halls! Attendees from Australia and New Zealand will receive a special ribbon to wear on their badge.

Advocacy

RANZCR Welcomes AMA’s Position Statement on Diagnostic Imaging RANZCR has welcomed the launch of the Australian Medical Association’s (AMA) first-ever overarching diagnostic imaging policy, which highlights the critical role diagnostic imaging plays in modern healthcare and support for those who provide it. The AMA’s Position Statement on Diagnostic Imaging outlines the AMA’s position on various issues related to diagnostic image, including the importance of radiologists being able to determine the most clinically appropriate service for the diagnosis of a patient’s condition. It also recognised the benefits to patients from comprehensive diagnostic imaging practices, emphasises the need for radiologists supervising services provided in radiology practices, ongoing research to underpin evidence-based practice and education to provide this practice. RANZCR President Dr Lance Lawler said the statement, which also stressed the importance of aligning government rebates for diagnostic imaging services with the cost of service provision, was a valuable piece of work.

“It is excellent that the AMA has recognised the vital contribution diagnostic imaging plays in the treatment of patients,” Dr Lawler said. “It is right that radiologists are recognised as the most appropriate medical practitioners to decide on the best imaging and treatment provision for patients. “RANZCR also welcomes the AMA’s statement that governments must continue to engage with medical practitioners to ensure that its regulatory framework is fit for purpose and matches evolving clinical practice. RANZCR also acknowledges the AMA’s support for our role in providing evidence-based advice and guidance to health professionals and patients on the safe, cost-effective and quality use of diagnostic imaging.

It also supported the current national accreditation scheme, which ensures all providers, practices and sites offering diagnostic imaging services meet high standards of safety and quality. AMA President Dr Michael Gannon said the vital role of diagnostic imaging to health care, as provided by radiologists and other specialists, is too often undervalued. “Diagnostic imaging plays a critical role in 21st century health care,” Dr Gannon said. “It underpins and guides much of what we do in medicine. “It is integral to diagnosis and screening, formulating treatment plans and monitoring responses, performing minimally invasive procedures and interventional procedures.”

“The statement is also testament to the quality of RANZCR’s policy and advocacy work and emphasises that major health stakeholders like the AMA back our positions and recognise the valuable efforts of those who provide radiology services.”

“Investment in high quality diagnostic imaging services ultimately saves taxpayers from higher downstream costs in the acute care sector. It also greatly improves the patient’s health care experiences and outcomes.”

The statement also highlighted the clinical and ethical importance of people living in regional, rural, and remote areas having access to comprehensive, local diagnostic services.

The statement can be found in full in the ‘Advocacy – Position Statements’ section of www.ama.com.au

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Volume 14 No 4 I September 2018

Education

RANZCR Courses and Workshops Faculty of Radiation Oncology Phase 1 Foundation and Exam Preparation Course The Phase 1 Foundation and Exam Preparation Courses were held on 15 and 16 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 52 trainees. Course co-convenors Drs Claire Hardie and Carminia Lapuz 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.edu.au.

RANZCR/ACR Educational Courses – Another Successful Year! 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 including Musculoskeletal MR – Commonly Imaged Joints, Abdominal Imaging and Breast Imaging Boot Camp

Inside News

with Tomosynthesis selling out. The courses presented a unique opportunity for participants to undertake the highly 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 William Morrison 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.

The Abdominal Imaging course, led by Dushyant Sahani, MD, Avinash Kambadakone-Ramesh, MD and Kumar Sandrasegaran, MD cover up-to-date CT protocols, latest guidelines on managing incidentalomas, how to report complex post-operative CT, customising reporting templates for cancer staging, with special reference to what the surgeon needs to know. The Breast Imaging Boot Camp with Tomosynthesis course, led by Michael Linver, MD, Christopher Comstock, MD, and David Schacht, MD provided delegates with intensive, hands-on experience in breast imaging. The participants developed their interpretive expertise in the evaluation of mammography studies through handson interpretation of over 500 digital screening, diagnostic mammograms and digital breast tomosynthesis cases 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

Education

interpretation of related cases using Synapse PACS. Additionally, the College would like to thank the ACR Education Centre 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 from 9 – 18 August 2019 in Melbourne, so register your interest via events@ranzcr.edu.au. Further information will be released soon.

Intelligence 18 – AI in Healthcare Summit The College is proud to present Intelligence 18 - AI in Healthcare Summit. This inaugural event will be held Wednesday 21 November at Dolton House Hyde Park, Sydney. Intelligence18 has been curated to equip, educate and discuss how Artificial Intelligence in Healthcare will change, disrupt and affect doctors, health professionals, healthcare providers and the wider Healthcare Sector. A jam-packed programme filled with a variety of topics focused on Artificial Intelligence including Big Data, Deep Learning, Internet of Things (IoT), Machine Learning, Ethics, Policy and

Government will provide rich content from leading authorities across technology and healthcare. The faculty for 2018 will include international and local Australian thought-leaders including: • Assoc. Prof. Yves-Alexandre de Montjoye – Imperial College London (advisor to Bill & Melinda Gates Foundation) • Prof Hugh Bradlow – President, Australian Academy of Engineering and Technology • Dr Jordan Nguyen – Inventor, Biomedical Engineer • Prof Meredith Makeham – Chief Medical Officer, Australian Digital Health Agency • Dr Jed Horner Policy Manger, Standards Australia • Dr Olivier Salvado – Head of Imaging and Computer Vision, Data61 (CSIRO) Further speakers are to be announced shortly. Intelligence18 is your opportunity to receive the latest information and case-studies with over thirteen sessions presented through plenary, panel discussions and your choice of two elective streams. A full trade expo and ample time for networking will ensure you have access to those at the forefront of AI in Healthcare. It is anticipated that the event will attract 350-400 professionals across the Healthcare sector, including radiologists, radiation oncologists, physicists, executive’s, senior management and administration, strategy and business transformation managers, allied health professionals, digital health agencies and peak body representatives. Registration fees: RANZCR Members Non-Members

com/whats-on/events To sponsor or be involved in the trade expo, please contact the RANZCR Events team on +61 2 968 9777 or events@ranzcr.com

Statistics and Research Methods (SMART) Workshop – registration opening soon! The SMART Workshop will be taking place on Friday 15 March to coincide with the TROG ASM from Tuesday 12 until Thursday 14 March 2019 at the Melbourne Cricket Ground, Victoria. The workshop is aimed at post phase 1 exam radiation oncology trainees and is designed around short didactic presentations 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. 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.cmnzl.co.nz/trog-2019-asm

$650 $800

To register, simply head to www.ranzcr.

Volume 14 No 4 I September 2018

Education

Changes to Australian Medical Registration Requirements You may have heard that the Medical Board of Australia (MBA) are changing their registration requirements for doctors in a few years-time. So, what’s it all about?

Why are the MBA changing the requirements for registration? The MBA are introducing the new requirements, not the College. However, the College is actively preparing to assist members with meeting the new requirements. The MBA would say that Australia has a high standard of medicine and high levels of public trust in doctors. Despite this, there is no current system to ensure doctors remain competent throughout their whole career. They aim to introduce a system that will confirm the competency of doctors across their professional journey and ensure doctors are doing more effective CPD (not simply more CPD) that is robust, evidence-based and clearly linked to patient safety and improved performance.

What are the new registration requirements? There are three core components of the new registration requirements:

Inside News

What will change in professional development? • all doctors must have a CPD program with a “CPD home”. • all doctors must complete a minimum of 50 hours of CPD per year. o at least 25% of the minimum (12.5 hours) on educational activities; o at least 25% of the minimum (12.5 hours) on reviewing performance; o at least 25% of the minimum (12.5 hours) on measuring outcomes; and o the remaining 25% can be distributed across any types of CPD. • CPD must be based on a personal professional development plan (PDP) each year that is relevant to the doctor’s scope of practice

Education

What will change to improve the wellbeing of doctors? • The MBA will develop and publish clear and relevant contemporary professional standards to support medical practice such as a revised Code of Conduct and registration standards. • The MBA will work in partnership with the profession to re-shape the culture of medicine and build a culture of respect

What will change to strengthen remediation of doctors? • Doctors at risk of poor performance will be identified and mechanisms established to support them. o Age - Doctors providing clinical care will be required to have peer review and health checks at the age of 70 and every 3 years thereafter. o Professional isolation – the MBA will provide guidelines on identifying professional isolation and manage this with increased peer-review • Doctors with three or more substantiated complaints that have an impact on patient safety over a five-year period will be required to participate in formal peer review and performance management.

When are the new requirements coming in? The MBA have informed Colleges that the implementation date is likely to be around 2021. The College understands that the MBA will allow some flexibility on this. RANZCR are continuing to liaise with the MBA to clarify this.

What is the College doing to prepare for the new requirements? The College has engaged Professor Elizabeth Farmer, the chair of the MBA’s Expert Advisory Group on revalidation to work with the College staff and Continuous Professional Development Committee and Post

Fellowship Education Committee on preparing for the new requirements. There will be regular communication with members including a dedicated page on the College website with FAQs. The College is also holding meetings with key employer stakeholders to raise awareness and steward joint approaches to the implementation of the changes.

What can I do to start preparing for the new CPD requirements? The RANZCR CPD Program Category 7 Maintenance of Professional Standards was developed in anticipation of the new requirements. It includes tools and templates for the new required categories of reviewing performance and measuring outcomes, such as a PDP template, Multi-source Feedback tool, audit tool and others. Members are also welcome to use tools and templates from other sources for this category.

What’s happening with CPD next year? The College is planning to commence a new triennium from 2019-2021 with the same categories as the current CPD program. Depending on whether you practise in Clinical Radiology or Radiation Oncology, there may be a gradual transition to the some of the new requirements. RANZCR plan to publish the requirements for the 20192021 CPD Triennium in November 2018, or as soon as possible thereafter.

If you have any questions or comments about the new registration requirements in Australia, please send them to cpd@ranzcr.edu.au

Volume 14 No 4 I September 2018

Learn your favourite Broadway play

Learn the London Underground

Learn the best kept secrets in Paris

With Everlight Radiology, you never stop learning Working for Everlight Radiology allows you to report as part of a collegiate, experienced and high-quality team. Not only will you have the support of our clinical directors, highly-trained operations coordinators and state-of-the-art reporting systems, but you will also benefit from the flexible working environment that’s designed to suit your requirements. We currently have openings for radiologists who are interested in spending time working abroad, reporting on Australasian cases in daylight hours. International teleradiology also has the benefit of flexible shift patterns that allow for leisure and travel, and offer an attractive remuneration package.

No matter what stage of your career, Everlight Radiology has an opportunity for you to join our dynamic team of FRANZCR Radiologists.

To learn more, contact Patrica Hay our recruitment specialist: Phone: +61 432 084 415 | Email: phay@everlightradiology.com.au

Education

The Training and Assessment Reform – Introduction to New Assessment Tool The Training and Assessment Reform Project has seen a surge in recent activity as it enters the consolidation stage. The Steering Committees are working to bring together the recommendations of the fifteen (15) program working groups to rationalise and consolidate them with the aim of producing world-class training programs in both Clinical Radiology and Radiation Oncology. Work is being undertaken on the revised curriculum to bring it up to date with current practice, determine learning outcomes for the program, evaluate the alignment of existing assessments to the program, and to develop the most appropriate assessment tools to measure performance against the learning outcomes. The College would like to thank all members who are involved in this project for the valuable time, commitment and expertise that has been provided.

CLINICAL RADIOLOGY Key Conditions Assessment Tool The Key Conditions in Early Training component of the curriculum defines the conditions which may be life threatening if undiagnosed over a period of 12 hours, and training sites are required to ensure trainees have had adequate teaching and exposure to those conditions prior to going on call. A new assessment tool is currently being piloted with the overarching aim to assess a trainee’s readiness for afterhours work. There has been significant variation in how training and assessment of the Key Conditions has been undertaken within departments. The new Key Conditions Assessment provides sites with a standardised tool for assessing trainee readiness and provides a clear

benchmark for measuring trainee progression in Year 1 of training. The assessment should preferably be performed at the training site where the trainee will first start their on-call duties. The assessment should reflect the case mix and conditions of the after-hours environment that the trainee will experience. A minimum of 16 cases must be assessed including at least one case from each of the Key Condition categories with the balance reflecting training site case-mix and modality usage. The overall level of competency of a trainee is assessed based on the 16 cases using a common Entrustability Scale which reflects how ready the clinical supervisor feels the trainee is for independent clinical practice. The level of Supervision Categories are: Level 1

Direct supervision (all reports checked immediately)

Level 2

Direct supervision with a consultant on site

Level 3

Supervision with a consultant on call with online access to images (if available)

Level 4

Reports reviewed by consultant within 12 hours

The Key Conditions Assessment of Competency tool is recorded by DoTs or clinical supervisors online.

Evaluation forms will be circulated to the pilot sites at the end of September with feedback welcome at any time. If you have any questions or require further information about this tool, or if your department is interested in becoming a future pilot site, please contact Julie Blanchard, Educational Developer at the College on julie. blanchard@ranzcr.edu.au

RADIATION ONCOLOGY Work on the radiation oncology arm of the project is progressing well. The learning outcomes and curriculum have been reviewed and updated by each working group with input and advice from various special interest groups. Positive feedback has been received from pilot studies of newly developed assessment tools and learning opportunities. The project is entering the consolidation phase now, with the aim to finalise the curriculum, learning resources/opportunities, assessment framework as well as individual assessment tools in the next few months. We are indebted to all the members of the Steering Committee and Working Groups for their tireless work and effort. Assistance and advice from other members on the curriculum review and pilot programs is much appreciated.

If you have any question regarding the project, please contact Legend Lee, Educational Developer at the College on legend.lee@ranzcr.edu.au.

Face-to-face feedback is provided and if the trainee has not reached an appropriate level of competency, areas for improvement will be identified and more intensive mentoring and supervision arranged. Once this has occurred the trainee will re-sit the assessment. Volume 14 No 4 I September 2018

Education

Our Place In The Universe: Where Are You In The System? CLINICAL RADIOLOGY Plans for the 2018 ASM are shaping up with one of the largest faculties of dynamic, thought-provoking international speakers from across the planet. In addition, there are a number of new sessions including the Women in Medical Leadership seminar to be held as a breakfast on Thursday 25 October, and the clinical radiology inaugural ‘Battle of the Branches’ quiz. Registration is available at www. ranzcr2018.com

Clinical Radiology Program Highlights • Dr Clyde Helms, world-leading MSK expert with updates on the latest imaging techniques as well as casebased talks • Dr Mary Roddie doyenne of the UK RCR Radiology Error and Discrepancy programme moderating an international case-based symposium on Radiological error • Prof Tanveer Syed-Mahmood worldleader in Artificial intelligence from the US IBM research centre presenting our future (via videoconference); • Dr Elizabeth Dick, President of the British Society of Emergency Radiology and next President of the European Society of Emergency Radiology presenting the latest in trauma and emergency imaging; • The amazing Dr Claude Sirlin from San Diego who was a sell-out draw at the Gold Coast will be presenting the cutting edge of liver radiology.

Inside News

We welcome back Dr Claude Sirlin to the 2018 ASM International Guest Speaker Faculty

Dr Elizabeth Dick, President of the British Society of Emergency Radiology will be presenting the latest in trauma and emergency imaging.

Let’s get ready to rumble….Battle of the Branches Quiz The heats of the inaugural Battle of the Branches Radiology Pub Quiz will be held in a famous Canberra watering hole (with drinks and nibbles) on the evening of Thursday 25 October 2018. There will be 14 Australia and New Zealand teams: one trainee and one consultant team from each of the seven branches. Each team will be comprised of three or four members. There will be invitations to the US and UK faculties to each enter a team (potentially making this the Clinical Radiology “World Cup”).

morning. There is a magnificent perpetual Battle of the Branches Trophy commissioned by Siemens for the winners, as well as medals and other fabulous prizes generously donated by Q Scan. The trophy will be engraved to stand as a lasting testament to clinical Radiology excellence. The compere is the legendary, fearsome, acerbic, radiology savant A/Prof Ross O’Neil who can be trusted to maintain a firm grip on the febrile proceedings. Interested radiologists are encouraged to contact their local Branch Education Officers as soon as possible to book a place on a Branch team. Only one team of trainees and one team of consultants per Branch is permitted.

BREAST Workshop BreastScreen Reader Assessment Strategy (BREAST) workshops have been part of RANZCR ASM and BIG meetings since 2011. These sessions, where readers test their proficiency on a set of 60 mammography cases and receive immediate feedback on their performance, have been very popular among delegates with fully-booked sessions at each meeting.

Clinical Radiology Trainee Learning Day: Preparing tomorrow’s radiologists today.

The format of the quiz is a displayed matrix of numbers from which team members can choose. The first team to answer a lead-in question chooses a number on the matrix. Behind each number is a radiology image/images and the team is required to answer questions about the image.

The Clinical Radiology Trainee Learning Day will be held on Saturday 27 October. The day will consist of International expert vivas, an inaugural symposium on “I’m a newly qualified consultant clinical radiologist. What are my options?” presented and moderated by recently qualified specialists with input from private and public hospitals and an inaugural mock MCQ on the trainee learning day to sharpen your skills.

The four top teams will proceed to the semi-finals and final being held in the Convention centre on the Sunday

Thanks to Pacific Radiology as the Clinical Radiology Trainee Learning Day Sponsor.

Education

RADIATION ONCOLOGY

FALCON Workshops

The theme of this year’s ASM “Our Place in the Universe” will focus on how our speciality is positioned in a world of rapidly developing systemic treatments and disruptive technologies, how we manage geographically with the challenges of servicing remote and regional communities, and how we manage the pressure of delivering modern treatments in a timely, cost effective and high-quality way. Expect to see mind-blowing presentations from the following speakers.

ESTRO will hosting two FALCON EduCase Contouring Workshops during the meeting. The Breast workshop aims to explain the principles of breast contouring. Participants are given the possibility to contour and then compare their own structures with the guideline structure contours with the expert and teacher Prof Birgitte Offersen.

Radiation Oncology Program Highlights • Prof Birgitte Offersen - Hypo vs normofractionated loco-regional radiation therapy of high risk breast cancer in the randomized DBCG Skagen Trial 1 • Dr Christopher Crane - From palliative to curative – The role of image guidance and adaptive planning in GI cancers. • A/Prof Heiko Enderling - Individual patient tumour growth dynamics to personalise radiation dose and fractionation. A/Prof Heiko Enderling has several presentations included in the ASM program including Individual patient tumour growth dynamics to personalise radiation dose and fractionation.

The workshop on lung cancer is a comprehensive, interactive and casebased workshop with the aim to acquire and refresh contouring skills and radiation oncology knowledge with the latest evidence in lung cancer. Participants are given the possibility to contour and then compare their own structures with the guideline structure contours. Both workshops are aimed at junior clinicians or radiation oncologists who want to improve their contouring skills or at more senior specialists who want to refresh and validate their knowledge and skills in this field Prof Birgitte Offersen will be leading the FALCON EduCase Contouring Workshop on Breast.

Radiation Oncology Trainee Learning Day This year sees the Trainee Learning Day placed on a Saturday to bring this packed and exciting programme to as many trainees as possible!

Radiation oncology trainees can look forward to interactive sessions on Leadership in Radiation Oncology, Demystifying Private Practice and the annual Trainee Forum. Trainees considering life after exams should attend the overseas fellowship session and hear about University of Toronto opportunities and past experience. Continuing the conference theme of “Our Place in the Universe”, Dr Chrishanthi Rajasooriyar will share her experiences of being a Radiation Oncologist in Jaffna, Sri Lanka. Invited international experts, ProfBirgitte Offersen, Dr Christopher Crane and Prof Bruce Minksy, are set to deliver traineefocussed education on locally advanced breast, pancreatic and rectal cancer. Our thanks to Cancer Institute NSW for their continued support of the Radiation Oncology Trainee Learning Day. For all the latest updates and hot off the press information on the ASM, don’t forget to follow the College on Facebook, Twitter and LinkedIn using #RANZCR2018 or visit the meeting website ranzcr2018.com for more information. We look forward to welcoming all radiologists and radiation oncologists to Australia’s capital in October! A/Prof John Cockburn A/Prof Rajeev Jyoti Clinical Radiology Co-Convenors A/Prof Hany Elsaleh Dr Angela Rezo Dr Farhan Syed Radiation Oncology Co-Convenors

Volume 14 No 4 I September 2018

exhibitors scientific Program international sPeakers WorkshoPs

RANZCR CANBERRA 2018

25 - 28 October National Convention Centre

6 9 t h A N N uA l S C i e N t i f i C M e e t i N g

netWorking events 1000+ delegates social Program There’s still time to register

www.ranzcr2018.com

Clinical Radiology

Shaping The Future – Where is the Faculty of Clinical Radiology heading? Prof John Slavotinek A key function of the Faculty of Clinical Radiology Council is to identify opportunities and risks for our profession and to meet those by prioritising deployment of finite resources to best effect. Risk mitigation must always be a first concern, but it is important that we look forward, are pro-active and lead and shape the debate rather than being shaped by it. I would like to share with you some of the current priorities and activities of the Faculty.

Funding Given the increasing dependency of modern healthcare upon imaging, appropriate funding of clinical radiology is critical to the health system from both a patient access perspective as well as for the sustainability of radiology practice. With the Australian Diagnostic Imaging Association (ADIA) we have been advocating for the Australian government to meet its original commitment made at the 2016 election to index all of radiology funded under Medicare. The backtracking to index only a portion of items from 2020 was disappointing and we continue to put pressure on the government to increase its commitment for additional funding. Another aspect of funding that we wish to reform is the artificial constraint on MRI which has been a great frustration for members and patients for many years. The College’s advocacy work during the recent Senate inquiry into the availability and accessibility of diagnostic imaging equipment around Australia has

A Message from the Dean elevated MRI to being a ‘hot topic’. We anticipate that leading up to the next Australian Federal Election, MRI and radiology funding will be key campaign issues with commitments expected from both sides of politics.

Artificial Intelligence There is much hype around artificial intelligence and machine learning. As a profession we want to be prepared to transform with such technological change rather than be marginalised by it. Faculty Council recently established an AI Working Group to consider the implications of artificial intelligence and machine learning, plan a response that includes appropriate education for members and trainees, ensure that this technology is applied appropriately and judiciously in the best interests of patients and consider maintenance of ethics, standards and appropriate regulation. I was very pleasantly surprised by the large volume of high quality applications for the working group by members that are already engaged in this space.

Teleradiology Teleradiology is rapidly advancing across Australia and New Zealand, particularly in the setting of out of hours services. We support teleradiology being used, but only to complement and support on-site radiology. The College has recently published new Teleradiology Standards to ensure the provision of safe, high quality teleradiology services for patients.

In New Zealand we have been advocating that doctors located overseas and providing teleradiology services must be registered in New Zealand. The President, Dr Lance Lawler recently presented this position to the New Zealand Parliament’s Health Select Committee and this was received positively.

Acute Stroke Recent advancements in stroke therapy have the potential to provide substantially improved outcomes for a select number of patients. The Faculty has been deliberating about the need to set standards for this small number of practitioners whilst balancing the safe delivery of acute stroke intervention against the need for adequate patient access to services. The Acute Stroke Working Group has developed a Framework for the Recognition of Training in Percutaneous Stroke Intervention, a draft of which was recently published for consultation by member and stakeholders. Once feedback has been received and considered, it is intended that this framework will provide a training pathway specific to percutaneous stroke intervention that complements the existing CCINR guidelines.

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Volume 14 No 4 I September 2018

Clinical Radiology

Digital Health

Quality and Safety

Digital health is an actively evolving arena that has the potential to provide great benefit to patients and healthcare providers. It is imperative that the College advocates for systems and solutions that work for radiology rather than accepting the imposition of illfitting systems by governments.

The Quality Framework proposes a range of regulatory reforms for Australia to support the delivery of high quality radiology services. We have been disappointed with ongoing delays around implementation of the first phase of the quality framework that is principally about professional supervision rules for CT. We will continue to negotiate with the Federal Government showing that we are a committed stakeholder who will pursue our goals in the interest of patient safety.

We have been working with the Australian Digital Health Agency and ADIA regarding a range of digital health issues and at the moment the focus is on uploading radiology reports to My Health Record. There are many issues yet to be worked through including adequate funding for radiology practices and departments to undergo this transition, ensuring that systems deployed are workable and secure and deployment of a practical process for consumers to withdraw consent for reports being uploaded. We will continue to advocate strongly in this space.

Inside News

As clinical radiologists it is important that we set the quality and safety benchmarks for the practice of radiology. Under the leadership of the Safety Quality and Standards Committee (SQSC) the Standards of Practice for Diagnostic and Interventional Radiology have been reviewed and have undergone a process of member and stakeholder consultation. I look forward to version 11 of the standards being published later this year.

If you have any questions or comments about this article, please contact Melissa Doyle, Executive Officer on fcr@ranzcr.com

Clinical Radiology

Training Program News Chief Censor in Clinical Radiology

A/Prof Dinesh Varma

Our approach to well-being needs to be a collaborative one and I would like to encourage all members to take the time to consider their own well-being and contribute to that of their colleagues. The issues associated with trainee wellbeing has been a consistent focus of the Clinical Radiology Education and Training Committee. It has been and will remain a central focus of training policy development. The College has implemented various approaches to allow more flexibility for trainees to address factors influencing their well-being including Training Pauses, Breaks in Training, Part-Time Training, Consideration of Special Circumstances and Trainee Progression. Our College and our training program will continue to seek new approaches and adhere to the standards of the Australian Medical Council, Medical Council of New Zealand and consider initiatives by the Federal Department of Health, state and territory Jurisdictions on this important issue. I would also like to use this opportunity to briefly discuss the training program, our achievements and the work that has been completed on core projects.

Specialist Training Program The Commonwealth Department of Health (DoH) is preparing a new Specialist Training Program (STP) Expression of Interest (EOI), which is set to take place in late September 2018 and will be open for six weeks on the DoH websitei. The EOI aims to identify training sites who are seeking to

increase training numbers, or undertake training as a new site, with the support of the STP funds. Sites approved by the DoH will be placed on the College’s reserve list, which will be utilised to fill posts when vacancies become available. Placement on the reserve list does not guarantee funding, and therefore unaccredited sites are also eligible to apply. Sites are encouraged to engage their branches to discuss network training opportunities and will need to meet necessary accreditation standards and become accredited, prior to being awarded any funding. Funded training sites must ensure that trainee rotations in the STP position are for a minimum of three months and comply with the DoH STP Operational Framework. For more information please contact Chloe Visser, Senior Project Officer STP at chloe.visser@ranzcr.edu.au.

Director of Training Workshop – Queenstown ASM The August New Zealand Annual Scientific Meeting (ASM) Director of Training Workshop was very productive and I would like to thank the New Zealand Branch for their hospitality. It was very pleasing to see such a high attendance and engagement from the New Zealand Directors of Training (DoTs) and participation from Australian based DoTs added to its success. Our guest presenter, Dr Deborah Powell from the New Zealand Residents Association offered a comprehensive insight into the broader issues of training in New Zealand. We also covered updates on

Examinations, Training and Assessment Review and facilitating DoT Networking. Our DoT Workshops are vital to the success of the training program and once again I would like to remind all DoTs that participation in a minimum of one workshop per year is mandatory. I look forward to seeing you all in Canberra on 24 October 2018 prior to the commencement of the ASM. We welcome topics and program ideas for upcoming workshops and I would encourage you to contact Chris Bartley, Trainee Liaison Officer via chris.bartley@ ranzcr.com to discuss ideas for future workshops.

Training and Assessment Reform The Clinical Radiology arm of the TAR project has been a hive of activity as it enters the consolidation phase of the project. The final two of the eight working groups (Non-Medical Expert and Procedures) have held their first meetings and made significant progress in refining their recommendations to the Steering Committee. The Key Conditions Assessment Tool pilot study is well underway with largely positive feedback received to date. Further information on the pilot can be found on page 21.

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Volume 14 No 4 I September 2018

Clinical Radiology

The current challenge facing the Steering Committee is the significant task of consolidating and integrating the recommendations of each of the eight program areas while maintaining a holistic view in order to produce a world-class Clinical Radiology training program. The remainder of the year promises to be a busy time ahead as work on the reform ramps up towards the

implementation phase of the project. As always, I would like to recognise the important contribution of our dedicated volunteers who are vital in moving the College forward.

References i http://www.health.gov.au/internet/main/publishing. nsf/Content/work-spec

If you are interested in volunteering on this, or any other training project please contact Pamela Spoors, Head of Specialty Training at pamela.spoors@ranzcr.com

Radiologists Must Act as One They say a week is a long time in politics, and the health portfolio has certainly had its share of disruption in recent times. The Health Minister has bowed to public pressure and health sector concern about My Health Record, and he’s also had to order his department to stop paying social media influencers. It demonstrates how public pressure can make a difference in a government’s decision-making. And therein lies the lesson for radiology.

Then it announced it was cutting Medicare access to GP-referred MRI of the knee for over 50s. This decision is the result of a recommendation from the MBS Review panel, despite there being no clinical evidence. We can expect this Government will use the current MBS Review to justify additional restrictions and reductions. Yet the savings it has already made through the Review could fund indexation now. ADIA is standing up for our profession and our patients.

For 20 years, successive governments have ignored Medicare rebates which have remained frozen at 1998 levels. During the same time, the Consumer Price Index has risen 65 per cent*. It’s demonstrable proof that radiology has been – and is – treated unfairly by Canberra.

We are lobbying the Department and the Minister. We are running TV commercials nationally – the latest focusing on ultrasound – and we have a constant social and digital media presence.

The clearest example of this is that, prior to the last election, the Turnbull Government promised to end the indexation freeze at the same time it did so for GP rebates on 1 July. Then it broke its promise.

Inside News

We are prepared to campaign all the way up to the election - but we have to act as a united body. I encourage you to get involved with ADIA’s campaign. You can make a difference by displaying brochures and posters in your practices, engaging with

ADIA’s social media content, and talking to your local Member of Parliament about how radiology needs to be funded properly. The situation is startlingly clear. We are being short-changed as a profession. We must react as a profession. *Australian Bureau of Statistics

Clinical Radiology

Clinical Radiology Trainee Matters Medicine is a profession that is steeped in hierarchical traditions (the Hippocratic Oath includes ‘To hold my teacher in this artIfequal to interested my own parents’). Whilst this you are in is less evident in radiology compared volunteering on this, or any toother othertraining specialities andplease has been vastly project improving over the past decade contact Pamela Spoors, Head it is still there in the background culture of Specialty Training at pamela. of spoors@ranzcr.com our profession. It is easy to see the College as the top of this hierarchy, particularly given its role in overseeing our training. For some trainees it is simply a faceless institution that dictates our requirements, often seemingly without rhyme or reason. However if you stop to think about what the College is and what it does a very different picture emerges. The College is us. It’s you, me and all the consultants. It is pretty much every doctor in radiology. It’s a member organisation, run by the members. The College staff are there to assist us, to assist the members, and act at the direction of the members. Hundreds of radiologists and trainees across the country are actively involved in the College on various committees and working groups. They work to further our profession and in the interest of the members. They work on various issue ranging from training and exams, quality and safety, diagnostic economics, and everything in between. And all of them volunteers. Did you know the College has a large policy and advocacy unit that engages with government and political parties about issues relating to radiology? Recently they have had an active role in the senate inquiry into MRI licences. The College also engages with other medical Colleges and professional groups. Recently with the cardiologist regarding cardiac MRI, and the sonographers regarding sonographer performed MSK injections, both important issues regarding our profession.

All the committees in the College are comprised of members volunteering their time and who have gone through a thorough application process to ensure they are suitable for their committee positions. Often decisions also included broader member consultations, allowing all members the opportunity to weigh in on issues. Current issues open for member consultation can be found on the College website. Issues relating to training pass through a very rigorous process often involving passage through 3 or more committees. There is often lots of debate and careful consideration before any changes are made, and in particular retrospective changes are avoided so that most changes only effect trainees commencing training in the future. At present a large amount of College resources are being dedicated to improving the training curriculum and assessments through the training and assessment reform project. The College has a large amount of staff in the speciality training unit which is dedicated to the task of training and guiding trainees through the training program. They are more than willing to assist you with any inquires, particularly Chris Bartley the Trainee Liaison Officer. The trainees committee plays a pivotal role in the College, providing trainee member representation on near all College committees. The trainee’s committee allows us to come together to hear the various issues raised pertaining to trainees in the various committees, and also to discuss new issue relating to trainees so that we can determine how best to address them and advocate for trainees within the College structure. In my experience over the past three years the trainee view point is valued and given considerable weight.

to train to become a clinical radiologist. Indeed it is no small feat to even get accepted into training and we should all be proud of our hard work and commitment to becoming clinical radiologists. However it’s also important to recognise that there are things more important than training. Mental and physical well-being, family, relationships, and pursuing interest and activities that nourish and fulfil us are essential. Radiology training, particularly around exams can become all consuming. It’s important to maintain our wellbeing and perspective during this time and not lose sight of the other important things in our lives. It’s also important that we look out for each other, provide support to other trainees when we can and nurture the collegiate and encouraging environments we all want to work in. It’s important that we as a profession maintain balance in our training, assessments and workload. Every decision effecting trainees requires us to be cognisant of this and the College has a key role in ensuring this balance. Dr Anthony Cardin Chair, Clinical Radiology Trainees Committee

Often at the forefront of our discussions is trainee wellbeing. It is no small task

Volume 14 No 4 I September 2018

Clinical Radiology

New Technology: MARS Spectral X-ray Scanner Further trials and testing is under way after researchers scanned the first human being with a new colour medical imaging device. The MARS Spectral X-ray scanner produces 3D colour images of body parts and allow greater detail of the body’s chemical components than black-and-white imaging allows to be seen. The scanner, which has been in development for more than a decade, has already attracted global interest from millions of people since it was publicised in July. Radiologist Professor Anthony Butler from the universities of Otago and Canterbury in New Zealand, who led the team which invented the scanner, said seeing the first colour images was an amazing experience. “Seeing the internal structure of the bone and the tendons and ligaments was incredible – a staggering moment,” he said. “It’s required a lot of work to get to this moment, so to see these images in front of us was a huge thrill for all the team.” Using algorithms to take the energy information from the colour of the X-ray and small pixels and accurate energy resolution techniques, the scanner creates separate image layers for each ‘material’ scanned. It measures the X-ray spectrum to produce colour images instead of blackand-white ones and shows different components of body parts such as fat, water, calcium and disease markers. Professor Butler’s father Phil, a physicist working at the University of Canterbury, was the ‘guinea pig’ for the first scan, with images of his ankle and wrist being taken. “Because of all our testing and the work we’ve put in, I expected to get quality images,” Prof Butler junior said.

Inside News

Professor Anthony Butler (left) with his father Professor Phil Butler, and their MARS scanner. (Photo credit: University of Canterbury)

“When I saw the images, though, my reaction was – ‘wow, this actually works’. “It was an exciting moment for all the team.” Researchers have been using a small version of the MARS scanner to study cancer, bone and joint health and vascular diseases that can cause heart attacks and strokes. Early results from the tests have suggested that the spectral imaging enables more accurate diagnosis and personalisation of treatment. The scanner has been featured throughout media outlets across the world and has also attracted dozens of millions of views on social media. “I was flabbergasted by the level of interest,” Professor Butler, who works as a clinical radiologist at the Canterbury District Health Board, said. “I think it shows how people care deeply about something that could tell them something about their health and their life.

“On one level there’s the scientific achievement, but on the other it’s seeing something that could potentially help advance humanity in some way.” Professor Butler said the development also underlined the continual developments being made in imaging processes. “I guess it’s like moving from traditional cameras and film to digital,” he said. “Any changes in medical technology are unpredictable, but – just as MRI developed in the 1980s and is still maturing – it’s going to be fantastic to watch. “There were a few times when we hit problems and I felt like giving up, but I always remember a former dean at a medical school telling me that one of the most important ingredients in any research was persistence.”

Clinical Radiology

A clinical trial which will allow the MARS team to compare images of orthopaedic and rheumatology patients with current technology currently used in New Zealand is now planned. “We’ve had so much support from the RANZCR and the radiology community over the years, which has been fantastic,” Professor Butler said. “Now we are keen to find more research partners that have their own ideas and research for how they can take this idea forward. “It’s a hugely fascinating time.” For more information, visit www.marsbioimaging.com Professor Phil Butler’s ankle (Photo credit: Mars Bioimaging Ltd) For more information, visit www.marsbioimaging.com

Professor Phil Butler’s wrist (Photo credit: Mars Bioimaging Ltd)

Volume 14 No 4 I September 2018

Unleash your ability to deliver high-precision SRS treatments HyperArc™ high-definition radiotherapy technology is designed to simplify even the most complex non-coplanar SRS treatments. Experience leadingedge features that allow you to treat multiple metastases simultaneously, enhancing your ability to treat more patients, reduce treatment times, increase throughput and maximise efficiency. Learn more at: Varian.com/HyperArc Safety information: Radiation may cause side effects and may not be appropriate for all cancers. © 2018 Varian Medical Systems, Inc. Varian and Varian Medical Systems are registered trademarks, and HyperArc is a trademark of Varian Medical Systems, Inc.

Radiation Oncology

A Generational Change for the Sector A Message from the Dean

A/Prof Dion Forstner

Medicare Benefits Schedule (MBS) Review The Medicare Benefits Schedule Review continues to make progress. The review’s objectives include: affordable and universal access; best practice health services; value for the individual patient; and value for the health system. The once in a generation change is slowly moving closer to significant change. Radiation oncology features in the work of two clinical committees: the Oncology Clinical Committee and the Urology Clinical Committee.

Oncology Clinical Committee The Oncology Clinical Committee’s report was released in late May for stakeholder consultation. I would like to thank all the individuals and groups who submitted a response to the Report from the Oncology Clinical Committee, either to the Faculty or directly to the Department of Health. The Faculty’s response focused largely on justifying the need for such a notable change to the radiation oncology component of the Medicare Benefits Schedule, addressing relevant recommendations, advocating for piloting/modelling before implementation, and providing updates to the proposed descriptors. It was reassuring to see, from other responses that were shared with us, that many in the sector share similar views and there was a willingness to defer to relevant craft group bodies.

We are now awaiting the outcome of the submissions, which are being reviewed by the Taskforce. There will then be recommendations from the Taskforce before being sent to the Minister’s office for consideration. Following a sign off, there will then be substantial work to be done by the Faculty as we seek to ensure adequate modelling and hopefully piloting is performed prior to the implementation of recommendations. Obviously, these changes need to be reviewed as bringing opportunity but also substantial risk.

Urology Clinical Committee The Urology Clinical Committee have completed their report to the MBS Review. We are now awaiting the report’s release. There has been good engagement between the Committee and the Faculty, with A/Prof. Sandra Turner presenting to the Committee in April, and more recently, two meetings with the Chair of the Committee, Prof Mark Frydenberg, including one at the College office with Prof. Bruce Robinson (Chair, MBS Review Taskforce). We hope to be able to push for one significant change, which would see an addition to the explanatory notes for the radical prostatectomy to include reference to men being recommended a consultation with a radiation oncologist—and documentation to be included in the patient notes if they decline. The Faculty is approaching this issue with patient interest front of mind. We continue to heavily involve consumers

and encourage them to the table with us. We are most grateful to Ms Lee Hunt (Cancer Voices NSW) for all her efforts and advocacy, and A/Prof. David Letts for giving up time to present to the Committee. Both presented powerfully the rationale for our suggested changes.

Medicare Benefits Schedule Compliance The Faculty was recently invited to a meeting with the Provider Benefits Integrity Division of the Department of Health, who are meeting with all sectors to provide an overview of the new compliance strategy. The Provider Benefits Integrity Division will be contacting providers whose billing practices are considered out of line with their peers. We understand that this will only be a small percentage of our members. We advised that there may well be a reasonable reason for a small number of radiation oncologists being at variance to their colleagues but this will be for the individuals identified to justify. It is therefore a timely reminder to monitor your billing practices. The Department provided some useful resources for provider education. I urge us all to have a look at these resources. For some, there may be new information; for others, a refresher. If any member has concerns, I am happy to discuss it with you.

continued over...

Volume 14 No 4 I September 2018

Radiation Oncology

Medicare Provider Education General www.mbsonline.gov.au – download the latest schedule and subscribe to MBS updates www.health.gov.au – various information found under the “for health professionals” tab eLearning programs www.medicareaust.com/ compliance/Welcome/index.html www.health.gov.au/internet/main/ publishing.nsf/Content/billingaccurately-medicare

Informed Decision Making in Prostate Cancer I would like to thank A/Prof Sandra Turner for her continued tireless work in raising the flag for radiation therapy in the treatment of prostate cancer. In June, the Faculty published a position statement on Informed Decision Making in the Management of Localised Prostate Cancer – A Patient-focused Perspective. Much of the work that went into this statement was driven by A/Prof Turner. The Faculty position is, simply, that all men approaching active treatment for prostate cancer should discuss treatment options with relevant specialists—urologists and radiation oncologists—before deciding on their treatment. It is only when our patients are fully informed that we can be certain that they are making the best decision for their individual situation.

Inside News

With over 1100 downloads of the position statement since its June launch, I am confident that our message is getting out there. An excerpt from the position statement is reproduced on page 36 and the whole statement can be downloaded from the College website at www.ranzcr.com/search/ informed-decision-making-in-themanagement-of-localised-prostatecancer-position-paper

Annual Scientific Meeting Congratulations to the convenors of the radiation oncology program of the New Zealand Branch ASM, Drs Ziad Thotathil and Nichola Naidoo. Although unable to attend, I have it on good authority that members enjoyed ‘Riding the Silver Wave’ and learning more about geriatric oncology. The next big meeting that should be on all our calendars is the RANZCR ASM, this year being hosted in Canberra. Our ASMs provide not only an opportunity to hear what’s going on in terms of research and developments within our sector, but also an opportunity to network with our colleagues. I encourage you to register for this if you have not already done so. Whilst registering, do not forget about the annual Targeting Cancer Fun Run/Walk – limited places, and this year it has been opened to the public.

If you have any questions or comments about this article please contact Philip Munro, Executive Officer, on faculty@ranzcr.edu.au

Radiation Oncology

Training Program News Chief Censor in Clinical Radiology

A/Prof Margot Lehman

Training and Assessment Reform Work continues apace on the implementation of recommendations from the Training and Assessment Reform. The introduction of programmatic assessment is being overseen by a Steering Group comprising myself, A/Prof Sandra Turner, Drs Matthew Seel and Yaw Chin. In addition, significant contributions have been made by members of a variety of working groups led by Drs Tanya Holt, Mark Pinkham, Sean Brennan, Pat Dwyer, Tran Pham, Ben Chua and Andrew Potter. However, this work has relied on the work of many and I would like to extend my sincere thanks to all those who have given so much of their time and expertise in progressing this work. To date, the learning outcomes contained within the curriculum have been reviewed, revised and updated. We are now in the process of collating and editing this important document. In addition, one of the underlying principles of programmatic assessment is the use of multiple sources of assessment which, over the course of a training program, allow a full picture of a trainee’s knowledge and skills to be observed. It is imperative that the assessments are easy to use, mirror everyday clinical practice activities, facilitate feedback between supervisor and trainee and allow the progress of the trainee to be tracked. It is also fundamentally important that these assessment do not overburden the trainee or the clinical supervisor.

To this end, individual working groups are in the process of reviewing, revising and updating the assessments currently in the curriculum. Some assessments have been removed and replaced by newer assessments, with the aim being to not increase the total number of assessments within the curriculum. Specific working groups have developed 3 new assessment tools: a Contouring and Plan Evaluation (CPE) Tool, a Clinical Assessment Tool (CAT) and a modified Kalamazoo Tool to assess communication skills (in place of the mini-CEX). The CPE tool has been piloted in a number of metropolitan and regional sites throughout Australia and New Zealand and the response to date has been favourable. The CAT will be piloted in a number of sites in the latter part of this year. Both of these tools were presented at the recent DOT workshop, again with favourable response.

Thank you also to Drs Clare Hardie and Carminia Lapuz, the co-leads of the Phase 1 group, for organising the Foundation and Phase 1 preexam course. Thank you also to Dr Rahul Mukherjee, Dr Melissa James, Dr Najmun Nahir (Lead pathology examiner), Drs James Chen, Jeremy Ruben, and Sean Brennan for their involvement with the Phase 2 pre-exam course. In closing, I would like to remind everyone about the upcoming DoT workshop to be held at the Annual Scientific Meeting. We will continue with the theme of equipping DoTs and clinical supervisors with the tools and techniques for dealing with difficult encounters with trainees. I would encourage as many as possible to attend.

It is planned that education around the new curriculum and the specific assessment tools will commence through 2019 with full implementation slated for 2020.

Courses and Workshops We were fortunate to host the ESTRO Radiobiology course in May of this year. This course was very well attended and I would like to thank Dr Jonathan Tomaszewski for doing an excellent job as the convenor. I would also like to congratulate Drs Andrew Potter and Eric Hau who were members of the ESTRO teaching faculty.

Volume 14 No 4 I September 2018

INFORMED DECISION MAKING IN THE MANAGEMENT OF LOCALISED PROSTATE CANCER - A PATIENT-FOCUSED PERSPECTIVE SUMMARY OF POSITION • Men considering curative treatment for localised prostate cancer must be actively supported to make informed decisions about management and treatment based on the clinical features of their cancer and their individual preferences and priorities. • Every man must have the opportunity to discuss all available treatment options before treatment decisions are made. Information needs to include potential short- and long-term benefits and side effects, possibility and options for further treatment, logistics, and costs of treatment. • Information should, if at all possible, be given by relevant specialists: best practice is that a man considering curative treatment for prostate cancer sees a urologist and a radiation oncologist to discuss his treatment options.

Every man diagnosed with prostate cancer must be treated as an individual

His decisions will reflect his own circumstances and preferences

Men with localised prostate cancer must be provided with balanced, evidence-based information about all available treatment options before treatment decisions are made

Information must include: • all treatment and management options • potential short- and long-term benefits and side effects of each possibility and options for further treatment • treatment costs • treatment timeframes and logistics.

Treatments have equivalent effects on survival

Balancing pros and cons is important – and a matter of individual choice

Best practice is that information about treatment options is given by health professionals with relevant specialist medical expertise in the different treatments

All men must be informed of all treatments available and suitable for them in both public and private health systems and the differences between these

There is rarely a need to proceed to treatment very quickly

Men must be given time to adequately discuss and consider their options before deciding

Men are best informed about treatment options when the information is given and discussed by the relevant specialist. Therefore, wherever possible, every man considering curative treatment for localised prostate cancer should be actively supported to discuss his treatment options with both a urologist (surgical expert) and a radiation oncologist (radiation therapy expert). * Localised prostate cancer is defined here as non-metastatic cancer with no clinical evidence of spread beyond the prostate and tissues immediately surrounding the prostate gland. The principle of informed choice is relevant for all stages of prostate cancer.

Informed Decision Making in the Management of Localised Prostate Cancer Faculty of Radiation Oncology Position Statement

Version 1 approved June 2018

RadiationAdvertorial Oncology

HyperArc: Radiosurgery Made Simple Last year, Varian’s HyperArc™ highdefinition radiotherapy was used for the first time to treat patients with multiple brain metastases. Early adopters are finding that HyperArc enhances their radiosurgery programs by facilitating and simplifying delivery of complex radiosurgery treatments. “This exciting new technology unlocks the potential of using non-coplanar treatment strategies to usher in a new era of precision in radiotherapy and radiosurgery for cancer patients,” said Kolleen Kennedy, president of Varian Oncology Systems. “HyperArc automates and simplifies the planning and delivery of sophisticated treatments such as stereotactic radiosurgery (SRS) to make them available to more cancer patients around the world.” HyperArc addresses concerns about complexity, patient safety, cost, and human resources that can make SRS inaccessible for many patients and unfeasible for many institutions. It capitalizes on the unique capabilities of Varian’s TrueBeam® and EDGE™ treatment platforms including the PerfectPitch™ couch. “HyperArc uses all degrees of freedom to deliver orchestrated dynamic movements of the gantry and couch for taking optimal advantage of non-coplanar beams,” says Matthias Guckenberger, MD, head of the Department of Radiation Oncology at University Hospital Zürich, Switzerland.

Technological advances benefit planning and safety HyperArc is an end-to-end class solution for frameless, linear accelerator-based intracranial radiosurgery. Everything needed for establishing an SRS program for treatment of both simple and complex intracranial cases is included. A prescriptive workflow is one of the key elements making HyperArc simple to deliver. It includes simulation guidelines, patient immobilisation, treatment planning, patient setup, intra-fraction

imaging and a pre-determined delivery sequence. HyperArc is designed to enable consistent, high quality planning and seamless one-click delivery. HyperArc treatment plans automatically specify the specific arcs and couch positions compatible with patients’ clearance to the machine. “HyperArc addresses patient safety through the fully-automated execution of treatment fields, plus the fact that all of the hardware—the linac head as well as the patient immobilisation device—are digitally modeled in the treatment planning system to ensure that each field is safely deliverable,” explains Filippo Alongi, MD, director of radiation oncology at Sacro Cuore Don Calabria Cancer Care Center in Negrar-Verona, Italy. A HyperArc treatment can be completed within a typical 20-minute timeslot, making it a time-efficient approach compared to other radiosurgery techniques that treat each target individually or separately. According to Dr. Alongi, who was the first clinician to use HyperArc in the treatment of

brain lesions and metastases, HyperArc treatments break down as follows: • 3 minutes for patient setup • 5-7 minutes for cone-beam CT image guidance • 8-10 minutes beam-on time (for multiple non-coplanar arcs and the couch rotations needed between them) Approximately 20 percent of newly diagnosed cancer patients will develop brain metastases. For many, SRS is recommended as a primary treatment option. HyperArc is designed to make it possible to easily target and eradicate isolated brain metastases and eliminate the complications with whole brain radiation. For more information, visit www.varian. com/hyperarc.

Volume 14 No 4 I September 2018

What’s in Issue 5? Medical Imaging Original Article: Measuring radiologist workload: Progressing from RVUs to study ascribable times Corresponding author: Dr Philip L Munro, Policy and Advocacy Unit, Royal Australian and New Zealand College of Radiologists, Sydney, NSW 2000, Australia. Introduction: The need to measure reporting workload in teaching departments remains a current pertinent need. In Australia, the Pitman–Jones reporting RVUs have been in the public domain since 2003 (revised in 2009). These are expressed in arbitrary units. In New Zealand, single‐site Christchurch Hospital reporting times have been validated and placed in the public domain. Concurrently, the RANZCR has been developing a formulaic descriptor lexicon for imaging studies (the Body System Framework). There is a need to bring these three strands of work together into a common public resource. In 2015, under the auspices of the Chief Accreditation Officer, RANZCR convened the Radiologist Workload Working Group. The goal of the group was to develop a robust method of measuring radiologist workload in teaching departments in Australia and New Zealand for the RANZCR accreditation processes of teaching departments as training sites. This paper concerns itself with one aspect of the group’s work, namely reaching a consensus on radiologist study ascribable times for common imaging studies. Method: The BSF examination descriptors were reduced to a smaller, generic dataset of descriptors at the expense of loss of specificity. BSF study ascribable times had been previously obtained by stopwatch observation. The dataset was harmonized with the Christchurch descriptors to ensure commonality of case mix. The two lead authors reached an approximate consensus study ascribable time for each descriptor in agreement with the BSF and Christchurch data. Specifically, the Christchurch reporting times were relied on extensively to validate the new dataset’s study ascribable times. The first draft of descriptors and times was tabled at the meetings of the RANZCR Radiologist Workload Working Group, and was progressively refined by iterative consensus. Results: The output of the Radiologist Workload Working Group comprises a simplified modality‐based table of robust descriptors and ‘best estimate’ corresponding study ascribable times. These can be used with the extant Pitman–Jones methodology in order to estimate the reporting workload of a medical imaging teaching department in units of time. As a first for Australia and New Zealand, nuclear medicine and PET study ascribable times have been incorporated and balanced against radiology study ascribable times. Conclusion: The RANZCR 2016 study ascribable times are ready for use by the Australian and New Zealand radiologist and nuclear medicine specialist community. We hope these times will also stimulate further data collection in our two countries towards a robust, bi‐national study ascribable times database.

Medical Imaging Pictorial Essay: The many faces of lung adenocarcinoma: A pictorial essay Corresponding author: Dr Heather M Pascoe, Level 1 Radiology Department, Royal Melbourne Hospital, Grattan St, Parkville, Victoria 3050, Australia. Lung adenocarcinoma has a spectrum of appearances on CT, many of which mimic non‐malignant processes. The general radiologist has a major role in guiding the management of abnormalities detected on chest CT and an awareness of these appearances is vital. We describe the protean imaging manifestations of lung adenocarcinoma.

Radiation Oncology Review Article: Optimising motivation and reducing burnout for radiation oncology trainees: A framework using self‐determination theory Corresponding author: D Professor Michael Poulsen, Radiation Oncology Princess Alexandra Raymond Tce (ROPART), 31 Raymond Tce, South Brisbane 4001, Qld, Australia. Radiation oncology trainees in Australia and New Zealand have relatively high levels of emotional exhaustion and depersonalisation which are core components of burnout. The stresses of a demanding clinical load, studying for exams as well as family commitments are all contributing factors. Self‐Determination Theory (SDT) provides a framework for optimising motivation which may be intrinsic or extrinsic. The three core components of SDT are competence, relatedness and autonomy. These factors should be addressed at a college level, Institutional and a personal level if the best outcomes are to be achieved. An environment that supports the individual’s experience of competency, relatedness and autonomy will foster motivation and work engagement which in turn will improve performance, energy, resilience and creativity and reduce levels of burnout.

Radiation Oncology Review Article: Use of stereotactic body radiation therapy for oligometastatic recurrent prostate cancer: A systematic review Corresponding author: Dr Ricardo Alencar Vilela, Instituto Nacional de Cancer Jose Alencar Gomes da Silva, Praca Cruz Vermelha, 23 - Centro, Rio de Janeiro –RJ, Postcode: 20230-130, Brazil. The purpose of this study is to evaluate the effectiveness and safety of stereotactic body radiation therapy (SBRT) in the management of oligometastatic recurrent prostate cancer (PCa) by means of a systematic review. Six databases were searched (CENTRAL, Embase, LILACS, PubMed, Scopus and Web of Science). Additionally, hand‐searching and grey literature search were performed. The main outcomes were progression‐free survival (PFS) and toxicity rates. Androgen deprivation therapy‐free survival (ADT‐FS), local control, pattern of recurrence, cancer‐specific survival and overall survival were also assessed. Risk of bias and quality of evidence were judged with the aid of specific tools. Fourteen studies were included, involving 661 patients and 899 lesions (561 nodal, 336 bone, 2 liver). Median PFS and ADT‐FS were around 1 to 3 years. Local control rates varied from 82 to 100% among researches with low risk of bias. Acute and late grade 2 toxicity was observed in 2.4% and 1.1% of the patients, respectively. One case of acute and two cases of late grade 3 toxicity were registered. Only one randomized study addresses this topic. Although it does not meet all the eligibility criteria, it is useful for the discussion. A quantitative analysis was not possible, nor were subgroup analyses, due to the significant heterogeneity of the interventions and outcomes reported. Longer follow‐up period is required. SBRT seems to be a safe approach to metastatic lesions that might provide disease control and defer androgen deprivation therapy (ADT). Local control is better when higher radiation doses are employed.

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!

Radiation Oncology

Radiation Oncology Trainee Matters

This Inside News theme is wellbeing. This aligns with the main focus of the Radiation Oncology Trainees Committee (ROTC) this year. As a trainee, it is easy to get fixated on completing the next assessment or studying for exams, and we can forget there is a significant personal cost of caring for patients with cancer. This hit home recently when my mother’s best friend passed away from a long battle with metastatic breast cancer. Thinking I had successfully compartmentalised work and home life, I was surprised to find a lot of the emotions I felt on her passing also related to some unresolved emotions I had felt while experiencing the cancer journeys of my own patients. This reminded me that the core of being a good doctor is self-awareness and self-care.

Within our ROTC we have discussed the strategies each committee member uses to maintain their own wellbeing. We have decided to share these in this article to encourage readers to reflect on their own wellbeing strategies and assess if there are ways that these can be enhanced. Our own strategies include: • Stargazing to remind ourselves of the enormity of the universe • Fine dining with family, friends and other trainees • Laser Tag • Yoga and meditation • Bush walks with the dog • Playing sport • Travelling to faraway places The ROTC have implemented a number of strategies this year to focus on trainee wellbeing. These have included adding a

wellbeing section in our trainee eNews, encouraging engagement with Chris Bartley our Trainee Liaison Officer and ongoing support for the development of a mentorship program. Finally, we would like to take this opportunity to encourage trainees to complete this survey being run by Youth ESTRO to help identify factors that may contribute to burnout amongst radiation oncology trainees. www.surveymonkey.com/r/3FLK57L

Visit www.ranzcr.com/trainees/ general/your-wellbeing for resources and support

Volume 14 No 4 I September 2018

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Radiation Oncology

TROG Cancer Research New TROG CEO Appointed

Successful Cancer Australia Grant

TROG 2019 ASM Dates

The board of TROG Cancer Research is pleased to announce the appointment of Susan Goode as the new TROG Chief Executive Officer. Susan is formerly the Centre Manager for the Hunter Cancer Research Alliance at the University of Newcastle.

TROG Cancer Research has been successful in being awarded a $1.5 million grant (2018-2020) under the Cancer Australia Support for Cancer Clinical Trials Program.

The TROG Annual Scientific Meeting (ASM) 2019 will be held in Melbourne, Victoria from 12-15 March. The ASM will be held at the Melbourne Cricket Ground and will include a number of internationally renowned guest speakers alongside key TROG researchers.

In this role, she was key player in a strategic expansion of the Newcastlebased cancer research infrastructure (such as the biobank). She has also worked to diversify the Hunter Cancer Research Alliance revenue sources from government funding to a mixed portfolio. Susan has more than 12 years’ experience in clinical and health services research and has been providing strategic support to the Hunter New England Clinical Cancer Research Network. In addition, Susan has a strong medical research background having worked as a trial co-ordinator, project officer, program co-ordinator and research manager. The TROG Board was very impressed by Susan’s vision for TROG and willingness to work in partnership with the TROG team and board. Joan Torony resigned from the position as TROG CEO in April due to health reasons. A/Professor Farshad Foroudi TROG President

The funding from Cancer Australia provides essential infrastructure for TROG to build our capacity to undertake cancer clinical trials. TROG’s primary business is the conduct of clinical trials involving radiation therapy to establish whether new cancer therapies or new ways of using existing treatments are effective and safe for patients. The Support for Cancer Clinical trials program will allow TROG to increase the number of cancer clinical trials conducted in Australia and increase the participation in clinical trials by people affected by cancer.

A full program will be presented, including three and half days of collaborative workshops, scientific sessions showcasing radiation oncology clinical trials, discussion of new clinical trials, future research directions and other research developments. Stay tuned for more details.

The program also provide opportunities for more clinicians, researchers and patient advocates to participate in the development of cancer clinical trials. TROG Cancer Research CEO Susan Goode said the grant received enables TROG Cancer Research to continue to develop industry-independent clinical trials, increase the number of trials open for patients and to increase clinical trial participation. “We are very pleased to continue our association with Cancer Australia. All of these activities make a significant contribution to improving patient outcomes and quality of life of people affected by cancer.”

Volume 14 No 4 I September 2018

MASTERCLASS MRI CONTRAST MEDIA

WEBCAST NOW AVAILABLE ONLINE!

International Speaker:

DR YAIR SAFRIEL

Neuroradiologist, Asst. Clinical Professor at University of South Florida Affiliated Programs and Radiology Associates of Clearwater.

Topic: Translating Advances in Brain Tumor Imaging to Clinical Practice

Liver MRI Speaker:

DR MARK GOODWIN

Interventional Radiologist Austin Health, Melbourne

Topic: How I approach difficult liver scans – with real case examples

Returning Masterclass 2017 Speaker:

CHRISTIAN LIENERTH

Head ol Application Service – Bayer Radiology.

Topics: • Liver Specific MRI Contrast Agent Optimal Workflow Protocols • 1.0M Gadolinium MRI Contrast Agent Optimal Workflow Protocols

HTTPS://CONTRASTMASTERCLASS.COM.AU/VID USERNAME: YOUR EMAIL ADDRESS PASSWORD:

radiology14

The Masterclass webcast delivers key points on contrast media workflow optimisation from the Sydney event on Sunday 27 May 2018, including: • 1.0M MRI Contrast Media workflow optimisation1.0M MRI • Liver Specific Contrast Media workflow optimisation Choose from three speaker sessions.

PRIVACY STATEMENT: By accepting this invitation I consent to Bayer Australia Ltd (Bayer) collecting, using, storing and disclosing the information provided by me via the registration portal to third party contractors and service providers for the purpose of arranging my attendance at the “MRI Contrast Media Masterclass” meeting including lunch and to provide me with product related information relevant to my practice. As Bayer is a global business some personal information may be transferred overseas. You may access the information we collect from you, or, you may make a complaint about breaches to the Privacy Act 1988, by contacting the Privacy Officer. Further information about our collection, use, storage and disclosure of your personal information is available on our privacy policy which can be found at www.bayer.com.au. If you no longer wish to receive information from or on behalf of Bayer, please email, mail or fax to Bayer, Fiona Spaziani, Radiology Marketing Manager, 875 Pacific Highway, Pymble NSW 2073; Email fiona.spaziani@bayer.com Bayer Australia Ltd, ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. ® Registered trademark of the Bayer Group, Germany.

AU-GAD-00048-08-2018

News from the Professions

Asia Pacific News

Dr Jayasingham Jayamohan and Dr Poly Bunpa at Crown Mary Cancer Centre, Westmead Hospital.

Observerships of Cambodian Oncology Professionals in Sydney The Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) FRORANZCR and the University of Sydney’s Office for Global Health partnered to host staff of the National Cancer Centre (NCC) of Cambodia, Calmette Hospital in Phnom Penh for a month’s observership. The Strengthening the Capacities of Cambodian Oncology Professionals through Advanced Immersive Learning program was funded by the Department of Foreign Affairs and Trade’s Australia Awards Fellowship, bringing 8 Cambodian oncology professionals in the areas of: radiation oncology, paediatric oncology, haematology, oncologic surgery, pathology, radiology, cancer registry and health informatics to Sydney. Australian cancer professionals supervised the Cambodian fellows in Westmead, Liverpool, Blacktown and Royal North Shore Hospitals, as well as the Cancer Institute NSW, from February to June 2018. The program aims for the knowledge and skills gained during the fellowship to be applied locally at NCC in the treatment of the Cambodian cancer patient population.

The National Cancer Centre is a newlybuilt comprehensive cancer centre in Phnom Penh, which APROSIG has been helping support with training and education since 2016. External beam radiotherapy has been operational since March 2018 and there is a plan to develop HDR brachytherapy in the coming months. An Australian physicist volunteer, Nikki Shelton and a radiotherapist trainer volunteer, Glen Newman are currently based in NCC training local staff. Further APROSIG visits to NCC, involving a tri-partite team, are planned in September 2018 and March 2019.

APROSIG Annual General Meeting and Global Radiotherapy Session at RANZCR ASM

RANZCR ASM in Canberra on Sunday 28th October from 9-10:30am ‘Our place in the Universe I’. It will feature A/ Prof Surbhi Grover from UPenn, who is leading a team responsible for setting up a public radiotherapy service in Botswana, as well as APROSIG’s Dr Iain Ward. The APROSIG Annual General Meeting will precede this session, held on Sunday 28th October from 7:30-8:30am (room to be advised). Telco facilities will be available for those who cannot attend in person. If you are interested in radiotherapy in low and middle income countries in the Asia Pacific, participate in our AGM at RANZCR, or contact Iain Ward on Iain. Ward@cdhb.health.nz

APROSIG are delighted to be a part of the global radiotherapy session at the

Genito-Urinary News The Faculty of Radiation Oncology Genito-Urinary Group continues to make steady progress. With some great work by Dr Hester Lieng and many others involved in the FROGG meeting in Noosa, we have recently published FROGG guidelines in radiotherapy and oncology on the management of relapsed prostate cancer which we recommend glancing your eyes over. We are also working on a sister paper on the management of node positive prostate cancer which has been stimulated by A/Prof Tom Shakespeare and again Dr Hester Lieng will be the lead author.

The Executives are working hard towards the 2019 FROGG Workshop, to be held in Queensland probably around early August. The workshop will focus on practicing our art for prostate, bladder, penile, kidney and testicular cancer. A survey will be developed and distributed to members in the coming future, to identify what are the current techniques and trends that are used to treat these cancers. It will be greatly appreciated by the Executives, if you can spare sometime to complete the survey. Along with the workshop, the Executives are also developing and updating the

FROGG Bladder Cancer Guidelines, which will be presented at the 2019 FROGG workshop. The committee is always looking for enthusiastic members to be involved in our committees, workshops, guidelines and advocacy programmes. If you would like to be involved or have any enquiries, please email Tan.Nguyen@ranzcr.com A/Prof Andrew Kneebone (Chair), Dr Amy Hayden (Co-Chair), Dr David Christie, Dr Mark Sidhom, Dr Marketa Skala, Dr Tanya Holt and A/Prof Thomas Shakespeare. FROGG Executives Volume 14 No 4 I September 2018

A GLOWING HISTORY - CURIE UNEARTHS RADIUM When Marie Curie discovered the properties of radium, a whole new world of medicine was unearthed. From those early days through to the present, the discovery of radium has illuminated the treatment of cancer and modern medicine alike.

Learn more about Chicotet at the Trainor Owen Archives online here Early uses of radium – Picture of G Chicotet

Radium used for hair removal c.1901

“It is easy to understand how important for me is the conviction that our discovery is a blessing for humanity not only by its scientific importance but also because it permits the reduction of human suffering and treatment of a terrible disease. This is indeed a great reward for the years of our enormous effort”

Radium taped to the face of a patient c.1901 Radium used to treat lupus c. 1901

Marie Curie on the discovery of polonium and radium in rue I’Homond Laboratory, From Sklodowska-Curie M auto biografia (translated 1959)

The Royal Australian and New Zealand College of Radiologists®

General Interest

New Zealand Branch News

Dr Gabes Lau

Annual Scientific Meeting The New Zealand Branch Annual Scientific Meeting (ASM) was held the first weekend in August. As always, Queenstown was an excellent location for a conference and the ASM was an enormous success, with 255 attendees. Congratulations and thanks to the organising committee including the team from Outshine and convenors Drs Adrian Balasingam, Justin Hegarty, Nichola Naidoo and Ziad Thotathil. Thanks also to the sponsors, including: Varian, Radiology DU, I-MED, Pacific Radiology Group, Elekta, DPI, Intelerad, Kiwis STAT and NZRET. Particular highlights included the talks from international speakers: Prof Howard Rowley, Claude Sirlin and Dr Kristen Gormly. I heard lots of positive comments from radiation oncologists about their sessions with Dr Farzan Siddiqui as well. There was an insightful medico-legal session with Dr Jonathan Coates from Claro (firm specialising in health law), Michael Austin from ACC and Anthony Hill (current Health and Disability Commissioner). Hopefully members who attended will have gleaned the following good advice from those presentations: • Be aware of what hat is being worn whilst carrying out responsibilities – for example, are you acting as a representative of the College or the DHB in situations where both might be applicable? • The College is a membership organisation with a constitution – it does not have statutory responsibilities and is, therefore, not responsible for ensuring competence of practitioners

• Clear communication, and having cultures of good communication, within institutions are effective at ensuring high quality patient care and keeping practitioners out of difficulty • Protocols usually exist for a reason and have often evolved in response to incidents – it’s a good idea to follow them. After the medico-legal session, the Annual General Meeting was held. The registrar presentations and posters were robust in number and of excellent quality. The presentation award winners were: William A Cook Award Dr Sheila Oh presented on pelvic ultrasound and whether or not it is necessary to automatically include kidneys regardless the symptoms or the differential. NZRET Proffered Paper Dr Remy Lim presented on changes in management following findings on pre-operative PSMA PET/CT in high risk prostate cancer patients. NZRET Poster Dr Jeremy Bates shared his poster comparing Maori and Caucasian prostate anatomy using MRI images.

FRONNZ Prize Dr Eric Ji reviewed two different fractionation regimens and concluded single-fraction HDR boost of 12.5 Gy is not inferior to the previous two-fraction protocol in terms of disease control and has additional benefits for patients for reduced toxicity and urethral stricture. The conference gala dinner was great fun and I think those who participated in Saturday’s quiz enjoyed identifying frostbite, owning their knowledge of celebrity gossip by identifying Sharon Stone’s brain aneurysm and geeking out while identifying the Delorean from x-ray art. The winner was Dr Gabrielle James, following a tie breaking decision with Dr Graeme Anderson. It was a fantastic weekend and if nothing else, we will all long remember this year’s ASM for our 8:30 wake up call thanks to some burnt toast. The RANZCR combined ASM will be held in Auckland during 17-20 October 2019, with yours truly convening – we hope to see you all there.

Volume 14 No 4 I September 2018

General Interest

HTI Contract I’ve recently sent out some communication to the NZ membership regarding the new High Tech Imaging Contract with the Accident Compensation Corporation (ACC). Members will also have received copies from ACC. In discussions with ACC, we noted concerns about financial relationships between referrers and radiology practices. In response, ACC made changes to the Standard Terms and Conditions, outlining steps

that must be taken where there are “perceived conflicts of interest either through business ownership or similar relationships.” There are a couple of other minor outstanding issues which the MSK Group will raise with ACC when we meet them next. If you notice any anomalies or issues that you would like us to raise with ACC, please send those through to the office by emailing nzbranch@ranzcr.org.nz. Dr Gabriel Lau NZ Branch Chair

Mammography Education Coming to Australia! November 2018

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 a NEW Interactive Unique Course in Queensland led by course director László Tabár, M.D., F.A.C.R. (Hon).

Multimodality Course

Interactive Course

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

Physicians - $1,500 USD Residents/Fellows - $1,200 USD Radiology Techs - $995.00 USD

November 8-10, 2017

November 27-30, 2018

Course will be held at the Gold Coast Hospital 1 Hospital Blvd, Southport QLD 4215 For more information please email Donna Sokolik at donna@mammographyed.com Please visit www.mammographyed.com for course details and to register.

Inside News

General Interest

Australian Branch News Victoria

Western Australia

Mr Hogan Sharpe is a qualified Radiographer at the Alfred Hospital in Melbourne, and was awarded the VIC Branch Student Prize on 8 May 2018 for his research, titled ‘Predicting Femoral Geometry using an Articulated Statistical Shape Model Constrained to Simulated Motion Capture Markers’. Mr Sharpe’s research was supervised by Dr Matthew Dimmock from Monash University and Dr Desney Greybe from the Auckland Bioengineering Institute. Mr Sharpe investigated whether an articulated statistical shape model of the lower limb could accurately recreate the 3D geometry of the femur. He segmented the femur, together with virtual skinmounted motion capture markers, from a post-mortem computed tomography (CT) data set that he obtained from the Victorian Institute of Forensic Medicine.

The WA Branch congratulates Dr Yi-Jin Kuok on receiving the 2018 Professor Chakera Teaching Award in WA recently. The WA Branch believes one of the most memorable things about Dr Kuok are his tact and sense of humour. When on duty he educated medical and surgical registrars in the correct interpretation of X-rays, ultrasound, CT, and MRI images without denting their ego thus making these junior clinicians feel part of the diagnostic team. He utilises his tact and common sense in his tutorials which has made his teaching sessions extremely popular. Dr Kuok was selected unanimously by his peers as the winner of this year’s Professor Chakera Teaching Award.

He compared the femur geometry predicted by the articulated shape model (based on the virtual markers) to the femur segmented directly from the CT images. On average, there was a 4.0mm mean absolute error in the predicted model. By accounting for skin thickness in obese and morbidly obese individuals, the errors were substantially reduced. The articulated statistical shape model allows musculoskeletal gait models to be customised in a more subject-specific way. Compared to the crude scaling methods that are currently in use, this approach provides a more accurate description of the underlying bone anatomy by considering natural variations in 3D bone shape. This work could improve pre-surgical planning in patients with musculoskeletal disorders such as cerebral palsy. Congratulations to Mr Sharpe on winning this prize for 2018.

Dr Xavier Yu of the Victorian Branch presenting Mr Sharpe with the award

Dr Yi-Jin Kuok and Professor Turab Chakera

WA Branch members at the annual presentation dinner for the Professor Chakera Award

Volume 14 No 4 I September 2018

General Interest

New Guidelines for Digital Mammography and Dr John Heggie’s retirement from MQAP The Faculty of Clinical Radiology has published version 4 of the Guidelines of Quality Control Testing for Digital CR DR Mammography. The main driver for this revision has been the need to produce a set of digital mammography (DM) quality control tests that reflect the technical advances that have been made to DM equipment incorporating Digital Breast Tomosynthesis (DBT) in recent years. These guidelines are intended to assist clinical radiologists, radiographers, and mammography equipment assessors in addressing quality control requirements relating to the Mammography Quality Assurance Program (MQAP).

The Breast Imaging Advisory Committee gratefully acknowledges the extensive work undertaken by Dr John Heggie, alongside the MQAP Management Panel members – medical physicists Jenny Diffey, Lucy Cartwright, Peter Barnes, Lee Collins, John Herley, and the Chair, clinical radiologist Dr Peter Downey. We would also like to take this opportunity to thank Dr John Heggie, who retired at the end of June this year, for his outstanding contribution to the MQAP. He has been involved with the Program for 25 years in the roles of MQAP Management Panel Physicist Chair, physicist reviewer, and

Cardiac CT Training 2018/19 We go beyond simply meeting training requirements: l

Participants eligible to claim 117.5 RANZCR CPD points for the 5 day course and 67 RANZCR CPD points for the recertification course. Maximum allowable course based live and library cases for ANZ credentialing.

Clinician led teaching by high volume operators.

State of the art low dose, High Definition imaging.

2018 - 2019 COURSE DATES: 5 Day Level A Course 8th - 12th November 2018 2nd - 6th May 2019 3 Day Recertification Course 10th - 12th November 2018 4th - 6th May 2019 AICC ULAR CT

Inside News

ASC

TITU

AUSTRALIAN

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

TE OF CAR

as an author of the RANZCR Guidelines for Quality Control Testing for Digital CR DR Mammography. His extensive knowledge and affable manner has made him a pleasure to work with. On behalf of the Breast Imaging Advisory Committee, and College staff, I wish him all the best for his retirement. Michelle Reintals, Chair, Breast Imaging Advisory Committee

General Interest

Australasian Meetings 2018

Professional Documents and Publications

October

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.

ANZSPR ASM Brisbane, QLD – 29-31 October www.anzspr2018.com

International Meetings 2018 September CIRSE Annual Meeting Lisbon, Portugal – 22-25 September www.cirse.org

All College standards, policies and guidelines are available on the College website here: Clinical Radiology www.ranzcr.com/fellows/clinical-radiology/professional-documents Radiation Oncology www.ranzcr.com/fellows/rad-onc/professional-documents All College position statements and submissions are available on the College website here: College Wide www.ranzcr.com/our-work/advocacy/position-statements-and-submissions

RANZCR Annual Scientific Meeting Dates ASM 2018 25-28 October 2018 Canberra, ACT ASM 2019 October 2019 Auckland, New Zealand

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

Westmead Department of Radiology

40th Anniversary Reunion and Seminar Saturday 3 November 2018

College Meetings 2018 Board 22 November Annual General Meeting 26 October Faculty of Clinical Radiology 19 November 6 December (telco) Faculty of Radiation Oncology 19 October

Believe it or not, it has been 40 years since the Department of Radiology at Westmead Hospital opened its doors, and through these doors many staff have come and gone and many changes have occurred.In commemoration of these 40 years of change, we would like to invite you to a reunion and seminar to mark the occasion. This offers an opportunity to meet old colleagues and friends and engage in an interesting educational program featuring invited speakers presenting on some of the technological advancements over this period, case presentations, and historical perspectives, followed by lunch and a chance to catch up with colleagues.

Westmead Education & Conference Centre, John Loewenthal Auditorium & Lecture Theatre 1

Registration for this event is through Eventbrite. You can click on the following URL hyperlink to take you to the registration page. https://www.eventbrite.com.au/e/westmead-department-of-radiology40th-anniversary-reunion-and-seminar-tickets-45544211964 Or go to Eventbriteweb site and search for Events in Westmead.

Volume 14 No 4 I September 2018

General Interest

Cardiac CT Training 2018/19 5 Day Level A Course

8th - 12th November 2018 2nd - 6th May 2019

We go beyond simply meeting training requirements: l

$8,000 +GST

$6,000 +GST for first 3 Fellows

Clinician led teaching by high volume operators.

3 Day Recertification Course

State of the art low dose, High Definition imaging.

Unrivalled venue and catering optimises the learning experience.

www.aicct.com.au or contact us at:

info@aicct.com.au

ULAR CT

For more information and online registration log on to:

AICC

TITU

for previous AICCT students

Dr. Daniel Friedman is a fellow of the Society of Cardiovascular CT, a current member of the ANZ CTCA Conjoint Committee and was the founding chairman of the ANZ International Regional Committee of SCCT. He has been an invited speaker at numerous National and International meetings.

AUSTRALIAN

$4,000 +GST $3,500 +GST

Course Director

ASC

10th - 12th November 2018 4th - 6th May 2019

2018 - 2019 COURSE DATES:

TE OF CAR

He is the Chief Executive of Spectrum Cardiac Imaging and has vast experience in Cardiac CTA. He was instrumental in establishing the collaborative approach to Cardiac Imaging in Australia.

Society for MR Radiographers & Technologists ANZ Chapter –13th Annual Meeting 10–11 November 2018 • Melbourne Convention and Exhibition Centre

Keynote speakers

Professor Keith Thulborn University of Illinois at Chicago, USA

Doctor Lale Umutlu University Hospital Essen, Germany

Inside News

Professor Vincent Vandecaveye University Hospitals Leuven, Belgium

Full attendance at the meeting has been approved for 11.5 RANZCR CPD points

Meeting secretariat: Expert Events Tel: +61 7 3848 2100 | Email: smrtanz2018@expertevents.com.au

13-16 March | Crown Perth INVITED FACULTY International +

Chris Comstock, USA

Fleur Kilburn-Toppin, UK

Australian +

Christobel Saunders, WA

David Clouston, Vic

Andy Redfern, WA

Nick Ferris, Vic

SPONSORS & EXHIBITORS

Kathy Nightgale | Conference Manager Tel. +61 418 51 5090 E. conference@tni-australia.com

www.bigmeeting.com.au

#BIG2019

MADE IN JAPAN