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Volume 17 No 4 | September 2021

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

THE FUTURE IS NOW: ACTION IN DIGITAL HEALTH AND CLINICAL RADIOLOGY

Also Featured in this edition The Story of JMIRO

Research and Hard Work Honoured

Practising Radiation Oncology in Dunedin, NZ

Cultivating a Sense of Purpose:

the Benefits

Your calling. Your career. Your life. . Advance your career while improving your own quality of life . Choose the location and work patterns that suit your lifestyle and family needs . Join a radiology team trusted to provide critical care to over 1.5 million patients last year

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Editor’s Pick 5 7

A Message from the President A Message from the CEO

9 13 17

Action in Digital Health and Clinical Radiology

23 24 27

Practising Radiation Oncology in Dunedin, New Zealand Research and Hard Work Honoured

Cultivating a Sense of Purpose: the Benefits Tackling Indigenous Excess Cancer Deaths On the Road to Personalised Breast Cancer Screening

What are your thoughts?

The Story of JMIRO

33 34

35 39 40

Chief Censor in Clinical Radiology A Message from the Chief of Professional Practice Specialist IR and INR Range of Practice

From the Faculty of Radiation Oncology

Chief Censor in Radiation Oncology

Quality Corner

RANZCR Workshops, Courses and Events 2021

43 45 47

From the Faculty of Clinical Radiology

50 51 55 57 59 62

On Track: the 2022 Training Programs Ready to Launch in February

Vale Dr George Keith Chapman InsideRadiology New Zealand Branch News Changes to RANZCR’s CPD Program Starting 2022 News from the SIGs Great Savings and Rewards for Members

Radiation Oncology Trainee Matters

If you have thoughts or comments about one of the stories you have read in this issue, we want to hear from you. The submission of letters to the editor, articles and news items is encouraged. Please email any submissions to editor@ranzcr.edu.au

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Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editor Lindy Baker

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

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Introduction

A Message from the President Introducing Our New CEO, Mr Duane Findley Dr Lance Lawler

As we go into the last quarter of the year, I have a mixed bag of news for members. 2021 has proved as challenging as 2020, yet I am still able to applaud the manner in which members and College staff have continued to perform much valued work no matter the circumstances and also to support each other through difficulties as none of us are, nor want to be, machines. In this September 2021 edition of Inside News, I am pleased to firstly announce the appointment of a new Chief Executive Officer for the College, Mr Duane Findley, and secondly to invite you all to join us, virtually, at the ASM starting in a couple of days on 16 September. Before I begin, I would like to thank Mr Mark Nevin who was appointed as interim CEO of the College for one year starting in September 2020. Mark’s expert stewardship has been invaluable in this last—tough—year. Mark provided deep organisational knowledge and a great deal of personal warmth stemming from his long connection with the College, with members and with staff. I can’t think of anyone better able to lead the College in this very singular transition year, and I thank Mark personally and on behalf of the Board and wish him well in his next endeavours. As you probably already know, during the first half of this year, the Board conducted a search for the next CEO to head up our College. We ran a competitive selection process to choose an executive search firm, advertised the role through May and held interviews during June.

It is my pleasure to introduce Duane Findley as the new CEO of the College. Duane is a senior leader with a strong track record of delivery in member associations, not-for-profit organisations, professional services, governance and corporate businesses. Duane has well over a decade of executive experience in sectors such as education, governance, resources, infrastructure, consulting and a major medical college. He served as interim CEO of The Royal Australasian College of Physicians (RACP) from September 2018 to February 2020, taking the helm to resolve some very challenging issues. He has held concurrent directorships, chaired a national organisation, and most recently served as a pro-bono board governance advisor for a major charity. Duane will start with us at the College on Monday 27 September. The Board is very much looking forward to working with Duane. Likewise, he is looking forward to meeting the clinical leadership and College staff to learn more about their roles, our membership, and the clinical radiology and radiation oncology sectors. I hope you will join me in warmly welcoming Duane to the College.

RANZCR2021 goes virtual Many of us had been looking forward to reconnecting in Melbourne at the 2021 Annual Scientific Meeting (ASM). Following receipt of a recommendation from the ASM Management Committee, the Board made a decision to convert

this year’s ASM to a completely virtual event with no in person attendance. Several factors were considered: health and safety of attendees, the likelihood of cross-border travel, community transmission in Victoria at present, and the member experience of a scaled back in person ASM. This decision was not made easily given so much time and effort has been invested by the local organising committee and our convenors Prof Meng Law and A/Prof Farshad Foroudi since 2019. On behalf of the Board, I wholeheartedly thank all concerned— the ASM organising committee, Meng, Farshad, College staff and Encanta— for their hard work and commitment over the last two years to design an exceptional 2021 ASM event. RANZCR2021 will offer all the same valuable scientific program content and speaker presentations that would have been available in person, the program will include invited guest speakers, breakout sessions and the opportunity to determine your own agenda from the live or on-demand content. Importantly, RANZCR2021 will also deliver social networking activities to allow members to engage and connect during the ASM. It is not the connection that we were used to pre-pandemic but in ways, this connection is more important than ever and we look forward to seeing and hearing from you all online very soon. #RANZCRASM21

Volume 17 No 4 | September 2021

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Introduction

A Message from the CEO Leading Digital Health Mark Nevin, CEO

With continued advancements in clinical care, data storage, sharing and interoperability there remain major challenges. I’ve previously lauded how advanced and sophisticated our two specialties are relative to most industries. Notwithstanding this, timely sharing of information across clinical boundaries remains haphazard and frustrating for most specialists, referrers and others involved in multi-disciplinary care. As this is my last Inside News article as CEO, I hope you will indulge me in focusing on a particular passion. Digital health has been an area of interest of mine since the early years of my career in eye care, helping to design and pilot electronic healthcare records for use in domiciliary optometry. My passion for the area grew while working in policy and strategy in the UK and in Brussels, particularly once I comprehended the value of the data itself and stewardship of the information flow. This has continued in my time at the College and last year, my policy and standards work in this area was recognised with a Fellowship from the Australasian Institute of Digital Health. Both clinical radiology and radiation oncology went digital some decades ago. The radiology sector developed the Digital Imaging and Communications in Medicine (DICOM) standard. The College was instrumental in bringing it to our two countries via Integrating the Health Enterprise (IHE), and we integrated DICOM to our practice standards

and training curriculum. DICOM has expanded considerably since then to include domains for other clinical fields including radiation oncology.

solution to resolve these. Regrettably, at the time, this was not seen as a priority for governments and no funding was made available.

The College’s policy work in digital health commenced about a decade ago. Our first major policy publication was a joint “roadmap” paper with the Australian Diagnostic Imaging Association (ADIA) and Medical Software Industry Alliance.

The following years saw enduring competing priorities: the Australian government focused on My Health Record; while the radiology sector sought to advance electronic referral and information sharing relating to diagnostic images. The College advocated strongly for our digital health priorities for radiology via the Medicare Benefits Schedule Review and the government’s work to develop interoperable digital health.

“The College’s policy work in digital health commenced about a decade ago. Our first major policy publication was a joint “roadmap” paper with the Australian Diagnostic Imaging Association (ADIA) and Medical Software Industry Alliance.” The paper, titled Securing Quality Outcomes: Systemised Access to Diagnostic Images articulated the logistical problems for radiologists and referrers in accessing prior images, and associated challenges for clinical decision-making. It proposed a national

The College regularly pointed out the lack of a critical foundational piece: standardised terminology, where we notably lagged the pathology sector. In order to corral alignment between key decision-makers in government, notably the Department of Health and Australian Digital Health Agency, and the radiology sector, the College produced a white paper in 2020 outlining the College’s vision for a fully electronic flow of medical communications between referrers and radiologists, including eReferral, imaging guidelines and access to historic images. This would also involve integration with My Health Record, and in time facilitate the adoption of artificial intelligence. The white paper made abundantly clear that this would not progress without standardised terminology for radiology tests and procedures. continued over... Volume 17 No 4 | September 2021

Introduction

I was delighted eventually to land grant funding in March 2021 for the radiology sector to develop a recommendation for standardised terminology. The downside was a horrendously short timeline of three months to complete the work. Some amazing teamwork between clinical leads, College staff, ADIA and other stakeholders made it happen and a recommendation was delivered to the government on time! While the Australian environment is ahead in this respect, there are principles and learnings which will benefit interoperability with radiology in New Zealand, and radiation oncology in both countries, not least in accessing historic images. The College’s submissions to the Health and Disability Review had a major focus on data, information technology and artificial intelligence. I anticipate that the changes to amalgamate district health boards in New Zealand will bring opportunities for national digital health infrastructure. Conversations on this

Inside News

have commenced within FCR’s Digital Health Working Group. A key next step will be advocating for radiology and radiation oncology to be central to that. The College is uniquely well placed to lead the next phase of digital health in both countries. As a medical college, we have a broad remit including oversight of professional skills, practice standards, a focus on quality care, and have established ourselves to lead policy and advocacy. We have therefore the mix of ideas, credibility and a strong track record of delivering. This is sadly my last CEO piece for Inside News. It has been a pleasure to have worked with members and our valued staff on so many initiatives that have bettered the lives of New Zealanders and Australians. I hope to stay in health care and to see you around the traps. In the meantime, take care and stay safe.

“The College is uniquely well placed to lead the next phase of digital health in both countries. As a medical college, we have a broad remit including oversight of professional skills, practice standards, a focus on quality care, and have established ourselves to lead policy and advocacy. We have therefore the mix of ideas, credibility and a strong track record of delivering.”

Features

Action in Digital Health and Clinical Radiology The College is finalising a white paper on digital health and clinical radiology. This sets out key steps in the application of digital health to clinical radiology to improve the workflow for radiology practices, and the outcomes for patients. Already, there has been action on some of the key proposed steps, building on earlier work by the College and others. At the request of the Federal government, the College and the Australian Diagnostic Imaging Association (ADIA) have submitted a report on the terminologies used for the identification of radiological procedures, with recommendations on how to adopt a standardised “Radiology Referral Set” with minimum disruption to existing systems. The Federal Budget handed down in May 2021 included provision of $7.2 million for work on electronic referrals in radiology. This will build on earlier work by the College on the information content required in referrals, and on the College’s position paper “Building eReferral: Safety and Patient Choice Position Statement.” The original version of the position paper was prepared in 2018, and this is currently being reviewed in the light of recent experience (especially since the outbreak of the COVID-19 pandemic, and the widespread adoption of ‘telehealth’ measures). There will continue to be a strong emphasis on the importance of patient choice of provider. It will also be important to ensure that this great opportunity to improve the quality of referral information is not lost by merely replicating existing paperbased processes. The Australian Digital Health Agency (ADHA) has been working with the providers of secure messaging in health care to define standards and profiles that will allow secure messaging to be

widely available in health care, with seamless access to the clients of other providers, rather than access limited to each provider’s silo. Secure messaging will play a key role in safeguarding patient privacy and confidentiality as digital data exchange becomes ubiquitous, avoiding the potential hazards of email and social media. The Agency has been trialling prototype secure messaging solutions with several of the leading messaging suppliers this year. Much consideration has been given to strategies for improving access to images from previous studies. The best solutions here will build on work from other key steps in the white paper (the Radiology Referral Set and eReferral), and will also be influenced by the infrastructure put in place by State jurisdictions. That said, the white paper recognises that the steps need to be worked on concurrently as much as possible, both to optimise the interplay between them, and to minimise delays.

Radiology Referral Set: a Key Tool for our Digital Future New digital technologies and applications are in the process of revolutionising many fields of activity, including health care and, specifically, radiology. In planning and preparing for this, the College has identified some key tools that will be needed to help improve our processes and outcomes.

Interoperability A plethora of new applications in health are being launched by many different groups, and it is critical that the data from one application can be read and treated appropriately by the next application in the chain. This requires the systems and applications to be not just interoperable (where the output from one application can be read and used by another), but semantically interoperable (where each system attributes the same “meaning” to a

Volume 17 No 4 | September 2021

Features

Priority Interoperability areas for action based on workstreams agreed with CIOs

given output). In radiology, one of the key data elements is the name of the imaging procedure or test that is to be done. We are all familiar with the list of exam names that we use in our own practices—“of course” a “CT brain” means a CT scan of the brain. But when we look to develop applications that will handle procedures done at many different practices, we find that everyone has their own list, and their own “obvious” names for tests. It is critical that test names be interoperable—a referral system must know that the practice RIS will implement the same procedure that the referrer entered into the referral system; a PACS system must recognise that images of test “x”, requested by an image retrieval system, correspond to images obtained as part of tests labelled as “w” in its own system.

Why do we need (another) RRS ? When the American College of Radiology was establishing its Dose Index Registry for CT, they found that data being submitted for CT scans of the chest could have any of more than 20 site-specific descriptors; a similar range was found for CT scans of the brain (CT head, CT cranium, head CT, cerebral CT, Computed Tomographic scan of the head, etc., etc.). Traditionally, the reconciliation of names from different systems has been done by a human—often one in the booking office, with or without assistance from senior radiographers and radiologists. If we are to capture the efficiencies of digital techniques (which are needed to cope with the ever-rising volume of work), the various software systems need to be able to achieve this semantic interoperability with as little human

Inside News

intervention as possible. This can be done by developing a standard set of terms for imaging procedures, each with a clearly defined meaning—an X-ray foot is one procedure, an X-ray ankle another, and an X-ray foot and ankle could be a simple addition of the first two, or a third procedure, in which, say, only a single lateral projection is obtained. This standard set of terms is sometimes called an “orderables catalogue” or an “examination catalogue”; in order to emphasis the consultative nature of our profession we have preferred the term “Radiology Referral Set” (RRS)—the set of procedures that can be requested from radiology practices. Any system referencing an element of the RRS must be able to rely on any other system attributing the same meaning to that element. Therefore, the vision is that systems sending information about tests will always reference terms from the RRS. This does not mean that every existing term has to be converted to a new term from the RRS, with all the legacy terms discarded, extensive changes to existing systems, and the associated disruption and cost. What it does mean is that there will need to be mappings from existing catalogues to the RRS, so that the application can accurately convey what is intended. This could be (but does not have to be) entirely

“We are all familiar with the list of exam names that we use in our own practices—“of course” a “CT brain” means a CT scan of the brain. But when we look to develop applications that will handle procedures done at many different practices, we find that everyone has their own list, and their own “obvious” names for tests.” ‘’under the hood”: a user could enter the same legacy term they always have; the application would then map it to an appropriate term in the RRS, and send that to the next application (with or without the original “legacy” term). Over time, it might be expected that existing systems would adopt the standardised RRS for simpler operations, and that new systems might use the RRS from the outset.

Features

Choosing an RRS Once it is accepted that a standardised Radiology Referral Set would be a valuable tool for interoperability in radiology, the obvious next question is how to choose or produce such a set. To this end, the College and the Australian Diagnostic Imaging Association (ADIA) have been reviewing the existing terminologies for radiology examinations, with a view to making recommendations to the Commonwealth Department of Health. The Australian Digital Health Agency (ADHA) has also been involved. The project has been run on a tight timeline, in order to ensure that its results will be available for the next project in the proposed pipeline, which will look at electronic referral processes in radiology. At this stage, the scope of the project has been limited to that of Category 5 (the diagnostic imaging section) of the Medicare Benefits Schedule, but it is expected that the chosen RRS will be expanded over time to cover all diagnostic imaging procedures. The RRS project has involved a review of existing terminologies for radiological examinations, a practice survey of terminologies in current use, and the construction of some selection criteria, based on feedback from the survey, and on the logical requirements of the applications that may make use of the RRS (electronic referral, image retrieval, clinical decision support, etc.). A key requirement of an RRS is that its terms be logically related to each other, so that applications using the RRS can make valid inferences about them. It should be possible for an application to recognise that a “CT Pulmonary Angiogram” is one of many examinations that will image the chest; and that it is also a kind of CT

“Traditionally, the reconciliation of names from different systems has been done by a human—often one in the booking office, with or without assistance from senior radiographers and radiologists. If we are to capture the efficiencies of digital techniques (which are needed to cope with the ever-rising volume of work), the various software systems need to be able to achieve this semantic interoperability with as little human intervention as possible.” examination (which might be important for, say, applications concerned with radiation doses, or one managing timeslots on a practice’s imaging devices). This is done by structuring the terms in the RRS in a hierarchical fashion, specifying which term is a special case of which broader term. Terminologies that have a logical structure of this sort

are known as “ontologies”. For an RRS to best contribute to the efficiency gains offered by automation of radiology workflow, it needs to have the structure of an ontology.

The Options for an RRS Most “orderable catalogues”/request sets currently in use (including the Medicare Benefits Schedule) are simply lists of terms, with no defined relationships to each other (even though it is usually possible to at least identify the relevant imaging modality from such terms). The Radiological Society of North America (RSNA) recognised the need for a more structured and standardised vocabulary in radiology in the 1990s. After a review of the then-existing general medical terminologies, the RSNA decided that none of them adequately supported the needs of radiology, and commenced on the development of the “RadLex” set of terms for radiology. This is not limited to names for examinations—it includes many other terms relevant to radiological procedures, anatomy, imaging findings, and radiological diagnosis. Much of this work was originally done by expert consensus, however the need for a logical structure was later recognised, with RadLex restructured and then formally recognised as an ontology. A subset of terms specifically used for naming procedures was developed, and referred to as the “RadLex Playbook”—a structured list of radiological procedures (or “plays”, in the American sporting sense).

continued over... Volume 17 No 4 | September 2021

Features

Recently, the US National Institutes of Health (NIH) sponsored a mapping project between the RadLex Playbook and one of the more general structured medical terminologies, LOINC (Logical Observations, Identifiers, Names and Codes—widely used in some pathology applications). Many other medical specialties have recognised the need for controlled terminologies, in which the terms have strictly defined meanings and logical inter-relationships. Pathology has been a pioneer in this field, and was the original source of SNOMED (Systematized NOmenclature of MEDicine), which has since been broadened into “SNOMEDCT” (SNOMED-Clinical Terms), by the incorporation of clinical terms from a British terminology, the Read codes. SNOMED-CT is now the dominant general medical terminology worldwide, and was adopted as a national standard by Australia (on advice from the then National E-Health Transition Authority) in 2005. The Australian “localisation” of SNOMED-CT is managed by the National Clinical Terminology Service, an arm of the ADHA, under license from the International Health Terminology Standards Development Organisation (IHTSDO).

Next steps The RRS project has completed its review of the existing terminologies that could be used as the basis for an RRS, and submitted its report to the Federal Government at the end of June. It was clear that adapting an existing set of terms would involve much less effort than attempting to build a new one from scratch. The requirement that the standardised RRS have the structure of an ontology sharply limits the number of possible candidates.

Inside News

It was noted that existing terminologies for procedures, such as that in the Medicare Benefits Schedule, and the various ad hoc lists developed inhouse, are deeply embedded in current workflows, and that these will continue to have key roles in practice. In other medical fields, the introduction of standardised terminologies has been gradual, and often behind the scenes, with little change to the terms employed by clinical users. In some cases, an application may present the result of its mapping from the legacy term submitted to a proposed standardised term, and seek user confirmation that the mapping has been appropriate. Synonyms for, or definitions of, the standardised terms can be provided, to make this easier for the user. There will be a substantial amount of work required to map the existing terms to whichever new set of terms is adopted. An appropriate funding model for this will be required, along with access to suitable software to assist the mapping process (purpose-designed software tools are available for all of the major candidates).

It is also well recognised that no terminology is ever perfect, that new terms will need to be introduced, and later refined, and old terms retired (or even deprecated). Such maintenance of a terminology is a substantial task, for which ongoing resources and expert support will be required. The adoption of a standardised RRS will allow the unambiguous identification of any radiological procedure. This will help to ensure that the test performed is the one that best matches the patient’s clinical need. It will also help to enable the accurate retrieval of the specific test report and/or images whenever needed. The RRS will thus be a key foundation for e-Referral, image exchange, and clinical decision support. Dr Nick Ferris Digital Health Working Group Chair, eHealth Reference Group

“The RRS project has involved a review of existing terminologies for radiological examinations, a practice survey of terminologies in current use, and the construction of some selection criteria, based on feedback from the survey, and on the logical requirements of the applications that may make use of the RRS (electronic referral, image retrieval, clinical decision support, etc).”

Features

Practising Radiation Oncology in Dunedin, New Zealand An Interview with Dr Tivanka Senanayake

Dr Tivanka Senanayake

What brought you to regional practice? Opportunity and timing. I had undertaken all of my radiation oncology training in Wellington, worked as a consultant for a year or so there, and spent a year in Princess Margaret Hospital in Toronto, Canada. I was ready to find a position that would suit my young family. There were no consultant posts available at Wellington and I was looking into options in Ireland and Australia when both a colleague and my recruitment agency let me know of a locum job at Dunedin Hospital. I had very little knowledge of the set-up at the department but the short-term nature of the post appeared to be a good way of getting a feel for the hospital and the city. I must say, I never thought I would be staying for long, but here I still am two and a half years later… and I like it!

Why practise outside of metropolitan centres?

Are there limitations or challenges in regional practice?

Practising in a regional setting has a number of nuances. The downsides, for example, might be that simple processes that you may have taken for granted (such as using standardised protocols) may not be established. In my opinion, however, the benefits can be great.

Yes, the infrastructure you expect may not be present. That may be a simple health pathway, resources for treatment or investigation, or some supports for patients. One of the biggest challenges has been caring for patients from small distant communities. At Dunedin, we cover one of the biggest geographical catchment areas in New Zealand with patients from very small towns. Many lack specialist care in their region and this can influence decision-making on management.

You have an opportunity to truly play a part in shaping the direction of the department that you just wouldn’t have in a larger metropolitan setting. New processes can be decided by the few people inside one room rather than a number of committees having to sign off. New techniques can be discussed and fast tracked. I have felt particularly valued and appreciated for my role. There is no space for a lack of enthusiasm and a there is a spirit to make things work which means that you are surrounded by passionate and driven people.

I would also say that the draw for trainees and qualified radiation oncologists is not as great as compared to bigger centres and we have had a particular problem with staffing.

continued over...

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Features

What has been the overall effect of the pandemic on the regional experience? Have there been any unexpected upsides? Issues to be confronted now? Like most departments, we have not been unaffected. When all non-urgent treatment was delayed during the lockdown period our waiting lists were naturally impacted and they have grown, which is not ideal. We continue to address this through staff taking on additional work, a recruitment drive, and outsourcing treatment to other centres. Upsides have included being able to do some work from home, for example, admin or treatment planning which is nice. Being in a small city like Dunedin means that even if I’m working from home I can be in at the department within ten minutes if necessary. The flexibility in this regard has been good.

How do you see the next 10 years for the specialty of radiation oncology in the region? I see us as being a growing specialty and department. Naturally, demand increases as the population grows and ages, and our population is definitely growing. We are actively recruiting to increase staff numbers in the department to service that demand. We are already the only centre in the country licenced for stereotactic radiosurgery, which is a treatment modality we plan to continue to offer and grow. Within the last two years we have increased our funding for registrar numbers from one to four, and hope that we become an important training centre for future radiation oncologists. We also look forward to collaborating with Christchurch in moving towards a single South Island cancer service as per the national restructuring of the health service.

What needs to change for patients? One of the main challenges for regional centres like mine is recruitment and retention of permanent staff. When this is an issue, we are understaffed which has significant knock-on effects on patients. Waiting lists are long, and some patients end up with negative impact on their disease progression. Some patients also face travelling long distance to other centres if we outsource treatment to reduce waiting

lists. Ideally we would have a fully staffed department so that waiting lists are not an issue, patients get the treatment they need in a timely manner and in the department and with the clinical team they know.

What needs to change for clinicians? A similar issue to above—we need more of the whole team; doctors, radiation therapists, physicists, nurses, allied health and admin staff! We are a regional department but we have a large catchment area similar in size to some of the city departments in New Zealand. Being short-staffed means we are stretched thin. It is frustrating not being able to deliver ideal treatment or timing for our patients due to staff shortages.

“We are already the only centre in the country licenced for stereotactic radiosurgery, which is a treatment modality we plan to continue to offer and grow.” We do, however, come together to support each other and being a small team means we work hard to optimise the work we do for our patients. Management has been working with the clinical team to improve things in this regard and we all now share an aligned vision of how we want to grow and develop the department.

What training pathways are available in your region? In the radiation oncology department in Dunedin we currently have two Part 1 registrars, but will have places for two more from February 2022 taking our registrar number to four. Our aim is that over the next couple of years overall registrar numbers will increase and that we will also be able to accommodate advanced trainees.

Is there a particular story you have encountered in regional practice that stays with you? One of my colleagues was on a flight to a satellite clinic on a small 10-seater aeroplane. In poor weather these flights can be quite scary. On this one occasion the door opened mid-flight and my colleague had to hold it closed until they landed. Thankfully I did not have this experience when on these flights, but I have now decided to drive to satellite clinics…I am unsure which mode of transport is more dangerous.

What would you say to someone considering leaving the city behind? Having lived and worked in larger city departments in the past, I know the thought of moving to somewhere relatively small may not always be enticing. After the past two and a half years in Dunedin, however, I must say I really enjoy it here. Being part of a small department is lovely from a team and relationship perspective, and it feels like we have real scope and prospect for development of our service. On a general life front, being in a smaller city is great for work-life balance because commutes are short, and overall I can be anywhere I need to be in the city with family in 10−15 minutes. Dunedin is a really friendly city, and my family has settled well here and schools are generally of a high standard. Add to that the real beauty of the surrounding countryside and coast, and proximity to central Otago, it offers something for everyone, no matter what their interests. So, come and give it a try!

Volume 17 No 4 | September 2021

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Research and Hard Work Honoured Professor Makhan Khangure Receives the Hippocrates Award by AMA “I’m very much delighted to receive this award as a radiologist. Radiology is the cornerstone of diagnosis and treatment, and many medical practices rely on innovations in the radiology field. It is a great pleasure to raise awareness of radiology as a medical profession which is very often under-recognised,” said Professor Khangure. Professor Khangure has made significant contributions to medical education, government policy and towards the advancement of interventional neuroradiology in Western Australia.

Prof Makhan Khangure

On 19 June 2021, Professor Makhan (Mark) Khangure was honoured with the Hippocrates Award by the Australian Medical Association (AMA) at the MEDCON21 Conference held at the Perth Convention and Exhibition Centre.

He has received a multitude of accolades, including a Gold Medal from the Australian and New Zealand Society of Respiratory Science and an Order of Australia in the 2017 Australia Day Honours.

Previously, Professor Khangure was the College President (2008–2009), Chief Accreditation Officer for radiology at the College (2010–2015) and was elected as a Councillor Federal and State AMA. He currently serves as member of the College’s WA Branch Executive Committee. He was also Head of Department and Divisional Director of Imaging Services at Royal Perth Hospital, Director of Interventional Neuroradiology as well as a former consultant neuroradiologist at Royal Perth and Sir Charles Gairdner Hospitals.

continued over...

The Hippocrates Award, commonly referred to as ‘the Hippo’, honours doctors who have made a significant contribution to medicine. Professor Khangure is a pioneer of interventional neuroradiology, over the course of his career, he has dedicated himself to serving patients and the broader community as well as nurturing future radiologists.

Image credit: Professor Khangure receives the Hippocrates Award at the Gala Ball in the Perth Convention and Exhibition Centre, during AMA (WA)’s MEDCON21 Conference. [Images used with permission, courtesy of AMA (WA)]

Volume 17 No 4 | September 2021

Features

Associate Professor Frank Gaillard FRANZCR Awarded an Honorary Fellowship of the Royal College of Radiologists (RCR) diagnose stroke, cancer, Alzheimer’s Disease and other neurological conditions. In addition to his work as a neuroradiologist, A/Prof Frank Gaillard has active research interests in neurodegenerative diseases, imaging of central nervous system tumours and computer-aided MRI interpretation.

A/Prof Frank Gaillard The international recognition is awarded by the UK-based College to those who have promoted the interests of clinical radiology or clinical oncology and made notable contributions to either. It is the most prestigious award given to a nonFellow of the RCR, with just 71 Honorary Fellows in total. A/Prof Gaillard joins Prof Lizbeth Kenny (RANZCR President 2005–2007) as Australian Honorary RCR Fellows. A/Prof Gaillard trained as a radiologist at the Royal Melbourne Hospital (RMH) after graduating from the University of Melbourne. He completed two additional years of neuroradiology fellowship training, a form of diagnostic radiology that focuses on the head, brain, spine and neck to

A/Prof Gaillard is the founder and CEO of Radiopaedia.org, an online collaborative radiology reference resource for radiologists and other health professionals. The Royal College recognised this work as a “cornerstone of medical education throughout much of the world”, in particular recognising the contribution in developing countries.

"I am genuinely thrilled to accept this honorary fellowship and I do so not only for myself but on behalf of the entire community that has grown around Radiopaedia. Any success and renown I may have achieved in radiology is entirely due to the thousands of individuals that have contributed to the site. I see this award as a recognition by the college of a belief that I have long held: that access to the knowledge that is necessary for the accurate diagnosis and care of our patients should not be contingent on one's personal, institutional, or regional wealth. Thank you" @Radiopaedia

ASNR Appointments and Certificate of Merit Award go to Professor Sandeep Bhuta In 2021, Professor Sandeep Bhuta has been appointed to two American Society of Neuroradiology (ASNR) committees: the International Collaborations Committee and the Educational Exhibits Subcommittee. Prof Bhuta is Professor in Neuroradiology

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at the School of Medicine, Griffith University, Gold Coast Campus, and Menzies Health Institute, and a neuroradiologist at Gold Coast University Hospital. “It is a massive honour to be selected for these positions and to be the only

person from Australia or New Zealand to represent our region," he said. He was also awarded the ASNR Certificate of Merit award for the project “Imaging of Cervical Spine Ligamentous Injuries: Bridging the Gap between Neuroradiologists and Neurosurgeons”

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conducted together with Mitchell Stanton, PHO Neurosurgery and Ananya Prabhu, PHO Orthopaedics. The topic is very relevant to the management of significant spinal trauma from motor vehicle accidents, sports injuries etc. With the introduction of new AO classification of spinal injuries there was a need for a paper which will influence and streamline the management of spinal injuries as they are time critical. We hope this will be a good educational resource in management of spinal ligamentous injuries. ASNR is the biggest and most prestigious organisation in neuro, head and neck imaging and it is unbelievable even to get an abstract accepted, “This year there were 467 accepted

educational papers, getting an award, with tough competitors like Mayo, Harvard, Hopkins, UCSF, Yale, etc. is something one can only dream of”, he said. “I would like to thank the Department of Neurosurgery and my co-authors for their hard work.” @neurossb

Ananya Prabhu and Prof Sandeep Bhuta

"It is a massive honour to be selected for these positions and to be the only person from Australia or New Zealand to represent our region."

Professor Paul Parizel awarded the 2021 Gold Medal from the European Society of Radiology early days of my career, computed tomography (CT) scanning was still in its infancy, and magnetic resonance imaging (MRI) was just entering that transition phase between a research tool and clinical application. I found it fascinating how X-rays, ultrasound waves, and radiofrequency signals could be translated into specially encoded anatomical images.

What has been the most rewarding part of your career?

Prof Paul Parizel

What attracted you to radiology in the first place? Radiology is fascinating, challenging, and it is a somewhat unusual medical specialty. It sits at the crossroads of clinical diagnosis, minimally invasive treatment, applied anatomy, and medical technology. I was always very much interested in mathematics and technology, and I loved anatomy (especially of the human brain). In the

That is a tough question, since I have really enjoyed all aspects of my career. Perhaps I should try to provide chronological answers for the three stages of my career. In the beginning of my journey into radiology and neuroradiology, the highlights were: my fellowship in neuroradiology in Boston at Massachusetts General Hospital / Harvard Medical School; the years spent as a consultant in neuroradiology at Hopital Erasme / Université Libre de Bruxelles; my PhD in medical physics on the influence of magnetic field strength on MRI signal behaviour. In mid-career, I was fortunate to spend 16 years as professor and chair of the

Department of Radiology at Antwerp University Hospital and University of Antwerp. Together with my team, we created a completely digital workspace with a state-of-the-art RIS/PACS system, introduced a dose-management and registration system, implemented integrated AI reading assistance for radiologists, pioneered a waiting room management system to reduce waiting times and facilitated work experiences for medical imaging technologists. In the latter part of my career I am most proud of my European commitments, first as President of the European Society of Neuroradiology (ESNR), later serving the European Society of Radiology (ESR) in a variety of roles, culminating in my election as President of the ESR and of the 2017 European Congress of Radiology (ECR 2017), and later as Chairman of the Board of Directors of the ESR. I have always enjoyed radiology, and I strongly believe that people who enjoy what they are doing can convey their positive energy to provide the best service to their patients and at same time encourage students, registrars, fellows, and young colleagues. continued over... Volume 17 No 4 | September 2021

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What does receiving the 2021 Gold Medal from the European Society of Radiology mean to you? It was a humbling experience to receive the ESR Gold Medal Award 2021, it is a very great honour. The European Society of Radiology (ESR), today with more than 120,000 members across the globe, has been a very important part of my professional life, for many years. It has been my privilege to serve the ESR in a variety of roles, and to influence and improve the standards of radiology practice, education and research.

How do you see AI changing the future of clinical radiology? There is no doubt whatsoever that AI will become integrated across the entire range of existing radiology workflows: using clinical decision support to optimise imaging requests, streamlining the scheduling process, datamining electronic health records with natural language processing, helping the radiologist to make an accurate diagnosis (especially in detecting subtle abnormalities and processing large data sets), standardising image acquisition in follow-up studies, quantifying disease process with imaging biomarkers, providing image-based follow-up, patient management and prognosis, improving communication with referrers, and everything in between. I always compare the role of AI in radiology

to what a GPS sat nav system does to help and guide the driver of car (without replacing the driver). But it is the radiologist who ultimately makes the decision, taking into account the information provided by AI, in combination with all other elements of the equation. The AI genie is here to stay, and, as radiologists, we do have the power to determine the future: tomorrow belongs to those who prepare for it today. As George Bernard Shaw said: “we are made wise not by the recollection of our past, but by the responsibility for our future”. AI provides a wonderful opportunity to the radiological community to make a new beginning, to re-invent what we do, to boost productivity and accuracy. We must take charge of our own future, and embrace it with confidence, courage and determination.

What areas of research do you plan to focus on next? As a clinical academic, working at Royal Perth Hospital (RPH) and at the University of Western Australia (UWA), it has been my good fortune to be appointed as the Director of the West Australian National Imaging Facility (WA NIF) node in Perth. I think I am one of the only radiologists in such a position in Australia. The WA NIF node is undergoing a major transformation, with the addition of a ‘human imaging expansion’ project, which will consist of a dedicated, research-only human

3.0T MRI and a digital PET/CT. This is a huge project, which has been occupying most of my spare time, almost to the exclusion of everything else. I am also happy and proud that I have been able to introduce a series of imaging seminars in the curriculum of the medical students at the UWA. In terms of pure research, I have contributed to a number of grant applications, always with a focus on integrating scientific research with patient-oriented clinical applications.

What advice would you give to a current trainee studying radiology or radiation oncology? Two things. First, your future’s so bright you gotta wear shades (that is a paraphrased quote from an old Timbuk 3 song lyric). With the advent of AI, radiology is undergoing the most exciting change process since several decades. A wonderful new world of opportunities is opening, it is all there for the taking, but I see that all too often, radiologists are hesitant to step up to the plate. My second advice to young trainees would be to remember that life, and indeed a medical career, is a journey, a metaphorical pilgrimage, in search of wisdom, while helping others along the way. Each stage of the journey is not an end in itself, but an opportunity to help, to serve, and to learn.

"But it is the radiologist who ultimately makes the decision, taking into account the information provided by AI, in combination with all other elements of the equation. The AI genie is here to stay, and, as radiologists, we do have the power to determine the future: tomorrow belongs to those who prepare for it today."

Volume 17 No 4 | September 2021

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Cultivating a Sense of Purpose: the Benefits (enough that I got a PhD in it), but throughout my professional career, I have found myself constantly seeking out opportunities to mentor others both within my field and external to it. This has led to the realisation that, for me, mentoring and helping others succeed is profoundly important to me and shapes the decisions I make in my professional and personal life. This acknowledgement of purpose has helped me keep the even keel Dr Burrow describes during the ups and downs of living, especially during a pandemic.

Life in a pandemic can feel like many things, and sometimes all at once, but life in a pandemic can also help us cultivate habits to carry us beyond the crisis. I use the word cultivate intentionally, as does Dr Anthony Burrow, a Cornell psychologist who has spent the last decade researching the role of purpose in our lives. Dr Burrow defines purpose as “an ultimate life aim, or direction for one’s life ... that guides one’s goals.”1 A purposeful life can be defined simply as one in which your daily activities progress you toward those ultimate aims or directions. Psychologists measure sense of purpose by asking people if “they regularly engage in non-trivial, personally meaningful activities in their daily life.”2 Speaking about his research, Dr Burrow explains that people who score high on purpose tend to keep a more even keel in times of stress and in times of joy. Emotions, even good ones, can have negative impacts and purpose seems to be a mitigator to those impacts. Which leads us to the question, how do we cultivate purpose?

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Three ways of finding purpose Dr Burrow shares three ways in which people find purpose. The first is through what he terms “proactive pathways”, in which people gravitate toward purpose by way of gradual and sustained interest

"Life in a pandemic can feel like many things, and sometimes all at once, but life in a pandemic can also help us cultivate habits to carry us beyond the crisis." in something. While this pathway is proactive, people may not realise at the beginning of their interest that they have found something which gives them purpose.3 I would identify with this pathway; I have always been interested in space and science communication

A second way of discovering purpose is through what Dr Burrow refers to as “reactive pathways”, where something happened that “calls you into it.”This pathway comes with clarity—you know what seed was planted that cultivated your purpose. Perhaps it was the diagnosis of a loved one with cancer or the joy of a first time you took a new class. Whatever the catalyst, your life begins to orient around that purpose. The last way in which people generally uncover their purpose is through what Dr Burrow terms the “social learning pathway”, where you watch another cultivate purpose and this can lead you toward your own. I immediately think of the late Dr Randy Pausch, a professor at Carnegie Mellon University, who gave a moving 'last lecture' when he was dying of pancreatic cancer. The talk “Really Achieving Your Childhood Dreams” is a moving tribute to living a life with purpose, when you know that life is about to end. Dr Pausch says that life isn’t about achieving goals, but about how you live life because “if you lead your life the right way … the dreams will come to you.”4 Dr Pausch’s words live on today, and are echoed by Dr Burrow who encourages us to ask ourselves: “If a goal can be accomplished, what becomes of you once you’ve accomplished it?”

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During this pandemic, there has been a push to use the unexpected time at home and away from others as a time to accomplish goals, but the reality is that for many of us the pandemic has meant more responsibilities and less time. Dr Burrow tells us that in his research, he has found that goals can become obstacles and “decouple” us from our purpose and a lack of purpose can increase feelings of loneliness and isolation.Therefore, if we shift our thinking away from accomplishment and toward cultivating purpose, we can benefit in ways that serve us beyond the pandemic. The question then is: How do we cultivate a sense of purpose/how do we cultivate purpose?

"Purpose may seem like an abstract concept, but research tells us it is important to our daily and long-term wellbeing. People who live purposefully may experience more healthy lives and aging and have more positive economic circumstances. People with purpose may even be more desirable friends." meaning? Or in what circumstances6 do you feel that what you are doing has an impact beyond the immediate?

aging and have more positive economic circumstances. People with purpose may even be more desirable friends.7

“Do you feel your daily activities are engaging and important?”5

Remember that your focus should be on cultivating purpose, not finding it. Purpose is something which we nurture, not what we seek; purpose is aspirational. As Dr Burrow puts it, purpose tells us what to do next once we accomplish our goals. Purpose is about what is inside; even outwardly successful people can feel lost if they lack inner purpose.

Even if purpose just helps us cope better with the uncertainty of life in a pandemic, it is certainly worth spending time cultivating your own. Personally, I know the time I have spent cultivating my own purpose has given me certainty that regardless of my external circumstances, I have a reason to look forward to whatever comes next.

Depending on your answers to these questions, you can take steps to continue your cultivation of purpose. If neither of these has a clear answer, try asking yourself what gives your life

Purpose may seem like an abstract concept, but research tells us it is important to our daily and long-term wellbeing. People who live purposefully may experience more healthy lives and

Dr Burrow says this process does not have to be difficult, in fact, it can be as easy as asking yourself these simple questions: “Do you feel your life has a clear direction?”

Dr Kat Robison @katrobison

References 1 Youth Research Update: Anthony Burrow, "What is Purpose?" – YouTube www.youtube.com/watch?v=2Lljvmt572M 2 Great, purposeful expectations: predicting daily purposefulness during the COVID-19 response (tandfonline.com) www.tandfonline.com/doi/ epub/10.1080/17439760.2020.1832251?needAccess=true 3 Cultivating Your Purpose | Hidden Brain Media https://hiddenbrain.org/podcast/cultivating-your-purpose/ 4 Randy Pausch: Really achieving your childhood dreams | TED Talk www.ted.com/talks/randy_pausch_really_achieving_your_childhood_dreams 5 Cultivating Your Purpose | Hidden Brain Media https://hiddenbrain.org/podcast/cultivating-your-purpose/ 6 (PDF) The Value of a Purposeful Life: Sense of Purpose Predicts Greater Income and Net Worth (researchgate.net) www.researchgate.net/publication/308006037_The_ Value_of_a_Purposeful_Life_Sense_of_Purpose_Predicts_Greater_Income_and_Net_Worth 7 Meaning as Magnetic Force | Request PDF (researchgate.net) www.researchgate.net/publication/240287793_Meaning_as_Magnetic_Force

Volume 17 No 4 | September 2021

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Tackling Indigenous Excess Cancer Deaths A webinar from Cancer Australia and the South Australian Health and Medical Research Institute (SAHMRI) In a comprehensive webinar which ‘travelled’ broadly across country, Julie McCrossin, Targeting Cancer Ambassador and neck and throat cancer survivor, together with Prof Jacinta Elston, Pro Vice Chancellor Indigenous at Monash University, spoke to a crosssection of healthcare professionals working to close the gap between Indigenous and non-Indigenous life expectancy in Australia. The Close the Gap campaign had its genesis 14 years ago in 2005, with an annual report produced by the Federal Government since 2007. The gap remains intransigent and cancer overtook cardiovascular disease in 2019 to become the leading cause of Indigenous deaths. Indigenous populations experience a significant excess death rate and work is being done to address the divergence. The ongoing and significant work of Indigenous health professionals, such as Annie Taylor, Lynne Thorne, Denise Karpany, Megan Clayton and Fiona Bradbury, feeds policymaking and provides support to patients on the treatment journey, offering informed care in language and a culturally contextualised framework. The health professionals spoke of the importance of connection, language, trust, continuity of care and identified a need for male health workers to support men’s business related to cancer as well as acknowledging the impact of cancer in their own families and communities subject to excess death rates from cancer. Kar Giam outlined the case for an Aboriginal cancer unit to scaffold the treatment journey from primary care to acute care and back again with continuity. Ricky Williams, as a long-term client of the Albury Wodonga Aboriginal Health Service (AWAHS), underscored the importance of this continuity, saying, “You get to know everybody. You know most of the doctors and you know most

Inside News

pointed to the need to address systemic failure, “Racism and systemic bias in our care systems and in our structures means we have got work to do on an anti-racism agenda.”

Archie Roach, singer/songwriter and lung cancer survivor

of the people.” Prof Tom Calma laid out a number of factors leading to a greater prevalence of cancer in a population where government wages were once paid in tobacco and cigarettes and gave evidence of the success of counter campaigns such as Tackling Indigenous Smoking, Quitskills and Quitline which have seen a decrease in smoking from 50 per cent to 37 per cent over the last 15 years, with approximately 23,000 lives saved. Although Dr Craig Underhill, Director of Cancer Services at Albury Wodonga Health, pointed out that while Indigenous smoking has peaked the consequences in increased cancer rates will still be seen for another decade or two, as in the lag time for post-peak smoking rates in other populations. AWAHS has been instrumental in the development of resources to counter smoking rates such as Let’s Yarn About Cancer with lung cancer survivor, Archie Roach. Julie also spoke to FRANZCR A/Prof Michael Penniment who is active in advocating for Indigenous patients to have equivalent cancer outcomes to the rest of the population. His experience in rural settings led to the establishment of the Alan Walker Cancer Centre in Darwin, which has significantly increased the utilisation of radiation oncology treatment in the Northern Territory since its inception, from around 22 per cent to 48 per cent of cancer patients. All practitioners emphasised the need for more work to be done on the multi-faceted issues causing excess Indigenous deaths from cancer and Prof Elston recognised the complex work of health professionals in communities and

The College is pleased to announce that five junior doctors and medical students will receive the inaugural ASM Grant, four of whom identify as Aboriginal and one as Māori. The inaugural RANZCR ASM Grant Program, launched in July this year, supports Indigenous junior doctors and medical students to extend their knowledge and interest in the professions of clinical radiology and radiation oncology. Watch the full webinar here: https://www.youtube.com/ watch?v=2kfbeDPgtkI

Prof Jacinta Elston, Pro Vice Chancellor Indigenous Monash University, Chair of Cancer Australia’s Leadership Group on Aboriginal & Torres Strait Islander Cancer Control

Prof Tom Calma, Cancer Australia’s Leadership Group on Aboriginal & Torres Strait Islander Cancer Control National Coordinator, Tackling Indigenous Smoking Member

Annie Taylor, Cancer Navigator, Borroloola Cancer Council, Northern Territory

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Healthcare professionals working to Close the Gap

Megan Clayton, Chronic Disease Outreach Worker, Albury Wodonga Aboriginal Health Service

Ricky Williams, Cancer Survivor & Long-term Client of Albury Wodonga Aboriginal Health Service

Lynne Thorne, Aboriginal Cancer Health Practitioner, Royal Adelaide Hospital

Kar Giam, Clinical Executive Director, Alan Walker Cancer Centre

Dr Craig Underhill, Director of Cancer Services at Albury Wodonga Health, Clinical Director of Hume Regional Integrated Cancer Services

A/Prof Michael Penniment AM, Radiation Oncologist Alan Walker Cancer Centre, Icon Cancer Centre & Royal Adelaide Hospital

Denise Karpany, Strategic Project Officer, Central Adelaide Local Health Network

Fiona Bradbury, Chronic Care Coordinator, Albury Wodonga Aboriginal Health Service

Targeting Cancer The Targeting Cancer website has been performing steadily, serving as the main asset and channel through which we communicate and connect with our consumer audience in a bid to raise awareness of radiation therapy. In June 2021 alone: • The website has attracted good traffic, with a total of 14,793 visits, up 17 per cent compared to the same time last year. Eighty-two per cent of these visits account for organic traffic through Google searches to the website, which is a strong indication of high website visibility. • There were 29 pdf downloads, up 32 per cent year on last year, in a clear indication of an engaged audience for the website. • The website keeps gaining new visitors, with 88.5 per cent of total visitors new to the website.

• The key web pages that drive year-onyear increases in traffic are: - Benefits and Effectiveness of Radiation Oncology, up 37 per cent - Treatment Process (Radiation Oncology), up 249 per cent - Brachytherapy for Cervix Cancer has gained 805 visits from zero last year. The website is demonstrably the primary communication channel for the Targeting Cancer Campaign. The Targeting Cancer Committee has kicked off the website review process, gathering feedback from our stakeholders and relevant members to ensure the website offers the best user experience with up-to-date, relevant, and engaging information and content. A new short video about radiation therapy side effects is currently in the making. Expected to be released later this year, this video features three patients’ personal experience

of side effects from their treatments, including skin irritation and fatigue. We are pleased to have Helen, Lee, and Dominic who will share personal stories and their helpful tips. We hope to build understanding of radiation therapy through sending clear key messages: as with all other cancer treatments, radiation therapy can cause side effects. Check with your treatment team for suggestions and ways to ease these short-term side effects. Join our Targeting Cancer Campaign by helping us promote the Targeting Cancer website: www.targetingcancer.com.au

We’d love to hear back from you if you have any feedback and suggestions to help us improve the website via email: info@targetingcancer.com.au

Volume 17 No 4 | September 2021

What’s in Issue 5? Medical Imaging Review Article: Deep learning applied to automatic disease detection using chest X-rays Corresponding author: Daniel A. Moses, Department of Medical Imaging, Level 0, Campus Center, Prince of Wales Hospital, Barker Street, Randwick, Sydney 2031, NSW, Australia. Introduction: Deep learning (DL) has shown rapid advancement and considerable promise when applied to the automatic detection of diseases using CXRs. This is important given the widespread use of CXRs across the world in diagnosing significant pathologies, and the lack of trained radiologists to report them. This review article introduces the basic concepts of DL as applied to CXR image analysis including basic deep neural network (DNN) structure, the use of transfer learning and the application of data augmentation. It then reviews the current literature on how DNN models have been applied to the detection of common CXR abnormalities (e.g. lung nodules, pneumonia, tuberculosis and pneumothorax) over the last few years. This includes DL approaches employed for the classification of multiple different diseases (multi-class classification). Performance of different techniques and models and their comparison with human observers are presented. Some of the challenges facing DNN models, including their future implementation and relationships to radiologists, are also discussed.

Medical Imaging Review Article: Artificial intelligence in clinical decision support and outcome prediction – applications in stroke Corresponding author: Melissa Yeo, Ground Floor, Medical Building, Cnr Grattan Street & Royal Parade, University of Melbourne, Vic 3010, Australia. Artificial intelligence (AI) is making a profound impact in healthcare, with the number of AI applications in medicine increasing substantially over the past five years. In acute stroke, it is playing an increasingly important role in clinical decision-making. Contemporary advances have increased the amount of information—both clinical and radiological—which clinicians must consider when managing patients. In the time-critical setting of acute stroke, AI offers the tools to rapidly evaluate and consolidate available information, extracting specific predictions from rich, noisy data. It has been applied to the automatic detection of stroke lesions on imaging and can guide treatment decisions through the prediction of tissue outcomes and long-term functional outcomes. This review examines the current state of AI applications in stroke, exploring their potential to reform stroke care through clinical decision support, as well as the challenges and limitations which must be addressed to facilitate their acceptance and adoption for clinical use.

Radiation Oncology Review Article: Artificial intelligence and imaging biomarkers for prostate radiation therapy during and after treatment Corresponding author: Annette Haworth, Institute of Medical Physics, School of Physics, The University of Sydney, Physics Road, Camperdown, NSW, 2006, Australia. Introduction: Magnetic resonance imaging (MRI) is increasingly used in the management of prostate cancer (PCa). Quantitative MRI (qMRI) parameters, derived from multi-parametric MRI, provide indirect measures of tumour characteristics such as cellularity, angiogenesis and hypoxia. Using Artificial Intelligence (AI), relevant information and patterns can be efficiently identified in these complex data to develop quantitative imaging biomarkers (QIBs) of tumour function and biology. Such QIBs have already demonstrated potential in the diagnosis and staging of PCa. In this review, we explore the role of these QIBs in monitoring treatment response during and after PCa radiotherapy (RT). Recurrence of PCa after RT is not uncommon, and early detection prior to development of metastases provides an opportunity for salvage treatments with curative intent. However, the current method of monitoring treatment response using prostate-specific antigen levels lacks specificity. QIBs, derived from qMRI and developed using AI techniques, can be used to monitor biological changes post-RT providing the potential for accurate and early diagnosis of recurrent disease.l complications to standard sequencing.

Radiation Oncology Original Article: Implementation of the Australian Computer-Assisted Theragnostics (AusCAT) network for radiation oncology data extraction, reporting and distributed learning Corresponding author: Matthew Field, : Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia. Introduction: There is significant potential to analyse and model routinely collected data for radiotherapy patients to provide evidence to support clinical decisions, particularly where clinical trials evidence is limited or non-existent. However, in practice there are administrative, ethical, . technical, logistical and legislative barriers to having coordinated data analysis platforms across radiation oncology centres Methods: A distributed learning network of computer systems is presented, with software tools to extract and report on oncology data and to enable statistical model development. A distributed or federated learning approach keeps data in the local centre, but models are developed from the entire cohort. Results: The feasibility of this approach is demonstrated across six Australian oncology centres, using routinely collected lung cancer data from oncology information systems. The infrastructure was used to validate and develop machine learning for model-based clinical decision support and for one centre to assess patient eligibility criteria for two major lung cancer radiotherapy clinical trials (RTOG-9410, RTOG-0617). External validation of a 2-year overall survival model for non–small cell lung cancer (NSCLC) gave an AUC of 0.65 and C-index of 0.62 across the network. For one centre, 65% of Stage III NSCLC patients did not meet eligibility criteria for either of the two practice changing clinical trials, and these patients had poorer survival than eligible patients (10.6 m vs. 15.8 m, P = 0.024). Conclusion: Population-based studies on routine data are possible using a distributed learning approach. This has the potential for decision support models for patients for whom supporting clinical trial evidence is not applicable.

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!

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On the Road to Personalised Breast Cancer Screening Knowledge about breast cancer risk factors and medical imaging technology has advanced enormously over the past 20 years. However, our system for breast cancer screening has remained essentially unchanged since the mid-1990s, with most women over 50 being offered biennial mammographic screening unless they are in a defined high-risk category. Cancer Council Australia is undertaking a large, Australian Government funded project to investigate how to potentially personalise screening to help optimise the early detection of breast cancer. The breast cancer Roadmap for Optimising Screening in Australia (ROSA) project, established in 2018, is conducting modelling, systematic reviews, assembling evidence and working with stakeholders to help identify the best way forward. Leading the project is Associate Professor Carolyn Nickson from the Daffodil Centre (a joint venture between NSW Cancer Council and the University of Sydney) and the University of Melbourne. The project is guided by an Expert Advisory Group including radiologists, policy-makers, consumers and researchers with an extended panel of experts available for specific input.

Associate Professor Michelle Reintals, Chair of the College Breast Imaging Advisory Committee and Clinical Director of BreastScreen South Australia, and Dr Jill Evans, Clinical Director of Monash Breastscreen and Chief Radiologist at BreastScreen Victoria are members of the advisory group. The ROSA project is answering key questions such as • Which screening technologies and intervals should be offered to different risk groups? • How and when should risk be assessed, and which health professionals should be involved? • Which age groups should be included in risk-based screening? • How would risk-based screening relate to other services in primary care and family cancer centres? There are several different elements to the project, as Associate Professor Nickson explains, “We are analysing existing breast cancer risk tools, the role of breast density in both risk and screening accuracy and the latest evidence on new technologies in breast imaging. The goal is to recommend options that would safely and economically improve breast screening services for Australian women at all levels of breast cancer risk.”

The project is producing detailed summaries of evidence on the following topics: • Risk assessment tools • Mammographic density assessment tools • Risk-based screening modalities • Overdiagnosis by risk group • Critical appraisal of current trials of risk-based screening • Modelled estimates of risk-based screening • BreastScreen Australia participation and outcomes by risk group. In 2021−2022, the ROSA research team’s activities include comparing the expected benefits, harms and costs of different risk-based screening approaches and mapping out how screening and clinical health services could work together as smoothly as possible if more risk-based screening protocols are trialled in Australian healthcare settings. This project is guided by a five-year roadmap that includes horizon-scanning for emerging technologies and innovations. Video presentation: www.mdhs.unimelb.edu.au/centre-forcancer-research/our-research/seminars/ external-speakers/the-rosa-projectoptions-for-risk-based-breast-cancerscreening-in-australia Further details are available on the Cancer Council Australia website: www.cancer.org.au/about-us/policyand-advocacy/early-detection-policy/ breast-cancer-screening/optimisingearly-detection/early-detection-ofbreast-cancer-roadmap To be kept up to date with the ROSA project, contact Amanda Tattam rosa@nswcc.org.au

Dr Jill Evans

Associate Professor Michelle Reintals Volume 17 No 4 | September 2021

Education

The Story of JMIRO

‘The life so short, the craft so long to learn.’ Hippocrates (460–c. 370 BC) ‘Father of Medicine’. Integral to medicine is the continual research and development of advancements to help patients. The Journal of Medical Imaging and Radiation Oncology (JMIRO), RANZCR’s peer reviewed journal, is committed to this life-long learning through publishing articles of scientific excellence in clinical radiology and radiation oncology. The outstanding services of voluntary peer reviewers to assess and judge the contribution of original data, ideas or interpretation reflect the commitment of the College in making invaluable contributions to medical literature. Established in 1957 as the Journal of Australasian Radiology, it was later renamed the Journal of Medical Imaging and Radiation Oncology (JMIRO). Initially two issues of the journal were published per year. Today JMIRO is an internationally respected journal with plans by its Editorial Board and publisher Wiley to publish eight issues in 2022. It attracts submissions from around the world and publishes articles of scientific excellence, case studies, original papers and commissioned reviews in radiology and radiation oncology. In 2020, the journal was widely read with more than 300,000 article downloads from 185 countries around the world. The journal reflects the commitment of the College to the dissemination of excellence in medical research and ideas.

Inside News

This could not happen without the dedicated team of committed member volunteers. The Editor in Chief, Deputy Editor Clinical Radiology and Deputy Editor Radiation Oncology, Associate Editors, Social Media Associate Editors and 14 Trainee Reviewers volunteer their time and expertise to rigorously assess submitted manuscripts that showcase original ideas, data, or interpretation.

“We are incredibly grateful for the expertise the JMIRO Editorial Board and all reviewers bring to each manuscript they review. Their passion and ongoing commitment inspire us. We are proud to see a volunteer-led journal continue to grow and shape the future of research in radiology and radiation oncology.” In the past year, JMIRO’s Editorial Board introduced new initiatives supporting timely reviews and launching the exciting Trainee Reviewer program, a pathway for trainees to be involved in research while studying. Dr Verma also highly commended new initiatives of learning. “The real beauty is the way clinicians guide new initiatives to take JMIRO to the next level. We want to create emphasis on the importance of research and upskill future clinicians as Associate Editors. It enhances the trainee experience and provides excellent insight into research, while allowing them to develop their research skills and knowledge. We look forward to seeing more trainee reviewers join the program, and thank everyone for their work so far.” The 2020 Journal Citation Report (JCR) announced the 2020 Journal Impact Factor score of 1.735, an increase from 1.283 (2019). The Impact Factor is the average number of times articles from the journal published in the past two years have been cited in the JCR year. The score marks not only the critical role research plays to shape the future of medicine but also attests to the quality of JMIRO.

Education

QUICK FACTS ABOUT JMIRO

Professor Michael Barton

Q&A with Editor in Chief, Professor Michael Barton

What makes it different to other scientific journals?

JMIRO’s Editor in Chief, Professor Michael Barton, was asked what makes JMIRO different to other scientific journals.

JMIRO is unique in providing a publishing platform for medical imaging and radiation oncology. It has successfully met the challenge for these two disciplines of working together to provide content that is of interest and importance to College members.

What do you admire about JMIRO? JMIRO is a volunteer enterprise. I admire the commitment of the Deputy Editors Dr Gabes Lau and Associate Professor Belinda Campbell to deal with more than 600 submissions each year. I am very grateful to the Associate Editors and reviewers who work so diligently to ensure excellence in JMIRO. I value the innovative ways the Editorial Board have broadened our reviewer pool and provided incentives for timely review. It is satisfying to see our growing presence on social media and the broader reach of the medical knowledge of the journal.

What is next for JMIRO? We have brought in important innovations this year; registrar reviewers, a reviewer incentive scheme and launched our first two special issues. We plan two special issues each year and I am very interested in proposals for upcoming issues. Next year we will have feature special issues on quality and on immunotherapy.

1. An international journal, with more than 70 per cent of the online readership from outside of Australia and New Zealand 2. More than 300,000 article downloads from 185 countries around the world in 2020 3. 6,592 articles published over 64 years 4. 253 editions published since 1957 (excludes supplemental issues) 5. 2020 Impact Factor 1.735 (Highest to date. Up from 1.283 in 2019) 6. Ranked 106/134 from 110/134 in 2019 7. 32 Associate Editors in 2020 8. Two Social Media Editors in 2020 9. 14 Trainee Reviewers in 2020 10. Available in print, online and via the Wiley Online Library app.

GET FREE ACCESS TO JMIRO College members receive full free access to JMIRO. It is one of your membership benefits accessible in print, online and via the Wiley Online Library App.

@JMIRO_Journal continued over...

Volume 17 No 4 | September 2021

Education

Q&A with JMIRO Deputy Editor Radiation Oncology, Associate Professor Belinda Campbell

Associate Professor Belinda Campbell

How do you determine the quality of a journal article?

What are your priorities in STEM and science communication?

A very important question! For advice and hot tips, I encourage readers to look up the fantastic webinar that JMIRO hosted earlier this year entitled "How to be a Good Reviewer", and please check out the JMIRO training scheme for new reviewers.

I think it’s important that STEM professionals can clearly and concisely communicate what they do and why it is important to colleagues, supervisors, policymakers and the public. Often, communication is seen as less of a priority in the STEM fields, or something better left to professional communicators. While there is value to engaging scicomm experts, it shouldn’t replace the need for everyone to develop basic scicomm skills. When we learn to communicate effectively about our expertise, it empowers us to be better advocates for our own work and its importance.

Five Minutes with Kat Robison, PhD

What do you love about JMIRO? I genuinely love the peer review and editorial process—for me, it has become a passion! As Deputy Editor at JMIRO, I truly enjoy reading the manuscripts that cross my desk: they cover a broad range of topics within radiation oncology, which makes for fascinating reading (and learning!). I am extremely fortunate to work alongside a fantastic crew on the JMIRO Editorial Board who generously share their time and expertise with genuine enthusiasm. And I sincerely admire the innovative, dedicated and encouraging leadership of our present and past Editors in Chief, Prof Michael Barton and Prof David Ball. Being part of the JMIRO team has been a brilliant experience, and is undoubtedly one of the most favourite parts of my career to date.

What makes it different to other scientific journals? JMIRO is now an international journal but has also managed to retain a unique flavour that appeals to our Australian and New Zealand readers.

Inside News

What does your own research focus on?

Dr Kat Robison We welcome Dr Kathryn (Kat) Robison to the role of Project Officer, Grants, Awards & Prizes and Research, Kat will be working closely with the JMIRO team.

What’s your background, what are you bringing to the role? I am from North Carolina in the United States. I came to Australia in October 2020 and spent hotel quarantine watching the US election and answering all my friends’ questions about politics. I have a PhD in Political Science, along with a MA in Political Science, a MA in American Studies, and BA in Near Eastern Studies and Anthropology (Biological), so I would say my educational background is quite diverse! I also ran a mentoring program for my graduate school during my doctoral studies.

I focus on the role of political communication in the formation and dissemination of space policies at the domestic and international level. This includes everything from what the public thinks about spending money to go to the moon to what happens to our political systems back on Earth when we start mining valuable space resources. Basically, politics make the rockets go boom, but what ripples do those booms have on our lives? Recently, I’ve been focusing on just and equitable access to space, and the potential consequences of un/ underregulated activities in space by private actors. This includes investigating issues such as the impact of mega-constellations of small satellites on ground-based astronomy and the night sky as a cultural resource or what happens if we don’t get control of the space debris issue and lose access to low Earth orbit.

Education

What are you looking forward to in Sydney? I’m excited to be starting this role at the College, and glad to no longer have to worry about finishing a dissertation during a pandemic (or defending it on Zoom at 4am!). I bring a lot of experience with research, publishing, and working with committees and can’t wait to get to know more about the College and its members.

Ethics and standards in the use of artificial intelligence in medicine on behalf of The Royal Australian and New Zealand College of Radiologists The above article, recently published in JMIRO by Prof Lizbeth Kenny, Mark Nevin and Kirsten Fitzpatrick, highlights the efforts undertaken by the College to develop principles and standards of practices for the ethical use of artificial intelligence (AI) and machine learning (ML) in radiology practice and research. The College developed, in consultation with clinicians, researchers, and others, two key documents: The Ethical Principles of Artificial Intelligence in Medicine, and the Standards of Practice for Artificial Intelligence in Clinical Radiology. These guidelines considered the implications of the use of readily available and digital radiological data and makes recommendations to ensure

their use takes into account that big data, without context, can lead to harmful outcomes for vulnerable or traditionally ignored populations. As with any rapidly developing technology, good intentions can lead to negative outcomes, so the importance of early and clear ethical guidelines for their use in the discipline is of utmost importance. The College sits in a unique position to lead these conversations around ethical use of AI and ML in medicine and medical research. The foundation built with these key documents will allow the College to ensure its clinicians and researchers can ethically access, use, and understand the limitations of AI and ML as the technology continues to be more widely available and utilised in diagnosis, treatment, and research.

The College’s CEO Mark Nevin tells us a little bit more about writing and publishing his first journal article

Why did you want to publish in JMIRO? Basically, we thought there was an interesting scientific story to tell which others could learn from. Although our ethics and AI standards were available on the College website, they were not being picked up in other academic publications. JMIRO would allow our work to reach a different audience and therefore plug that gap.

How did this idea come about in the first place? Various conversations between the three authors about promoting the work of the AI Committee after we had published the Ethical Principles and AI Standards.

Can you share a hot tip for someone submitting a journal article for the first time? Set aside time to complete from start to finish, particularly for the rigorous peer review.

Who was involved? The core project team who developed the Ethical Principles and AI Standards.

How long did it take to write? A bit over twelve months, but it was stop-start due to COVID disruption and its impact on our day jobs.

Volume 17 No 4 | September 2021

Registrations still open For the latest program visit www.ranzcr2021.com

ELYSIUM: DIAGNOSTICS AND THERAPEUTICS (NOW AND THE FUTURE) WITH AI

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Clinical Radiology

The New Hybrid Normal A Message from the Dean

Clin A/Prof Sanjay Jeganathan

COVID-19 response Last year the College responded quickly to the pandemic by forming a COVID-19 Taskforce with the aim of coordinating a whole-of-College response to COVID-19 in a timely manner in the rapidly changing health environment. The Taskforce ensured that the College’s response encompassed all key precautions, information and professional support for members and their patients. This Taskforce was a great success and demonstrated our agility to adapt to challenging circumstances as required. The need for rapid decision-making has decreased significantly and so the Taskforce was disbanded earlier this year. I would like to thank the Taskforce members for their commitment and helping the College through a critical period. We have moved to a ‘new normal’, yet COVID-19 is still with us and will likely continue to impact our lives and our practice for some time. New issues are bound to rise as the pandemic and vaccination program progresses. FCR Council is carrying on the work of the Taskforce and is closely monitoring both the national and international health landscape, in particular as it impacts clinical radiology. We are prioritising all COVID-19 related issues and will develop guidance material where necessary and communicate this promptly with the membership. Recently we have published guidance on Imaging Recommendations for Patients Suspected of VITT and Statement on Steroid Injections and the COVID-19 Vaccine. Please keep your eye on the

COVID-19 page on the website, I will also provide updates on any new resources in the monthly FCR enews.

College examinations The worsening COVID-19 situation in both Australian and New Zealand continues to be a challenging environment to deliver College examinations. We are doing our best to adapt to the changing circumstances and all effort is being made to deliver the exams with as little disruption as possible. Thank you to the staff and members involved for your dedication to supporting our trainees.

Digital health Digital health is a high priority for the Faculty of Clinical Radiology. As radiologists we understand what digital systems need to be put in place to ensure that clinical information can seamlessly flow between radiologist, referrer and patient. We need to continue to be leaders in digital health technology deployment to ensure that any system developed maximises the value radiology provides to the health system. Our priorities, articulated in the white paper titled Towards Interoperability: Clinical Radiology Forging the Path Ahead, are: standardised terminology; the establishment of an eReferral system; access to historic images and development of imaging guidelines. This important work is being managed by our internal Digital Health Working Group (DHWG).

Our vision for digital health has been recognised by the Government and work has commenced on the priorities. With Federal Government funding the College and Australian Diagnostic Imaging Association (ADIA) have partnered to deliver the first project which was to undertake a landscape of current terminology sets in use internationally and within Australia. The recommendation from the project analysis is that SNOWMED CT is the most suitable terminology catalogue for use in Australia. Discussion with the Federal Government is ongoing about how to develop the Radiology Referral Set to the next stage. See page 9 for more detail. You will have seen funding in the 2021/22 Australian Federal Budget to develop an integrated electronic diagnostic imaging referral system. We are talking to the Government about how the College can be a trusted partner in this process. We are equally focused on the New Zealand health landscape and are looking forward to working with the New Zealand Government to ensure the recommendations related to interoperability from the Health and Disability Review are implemented. In addition, the DHWG recgonises that a bespoke approach for digital health is required for New Zealand. Work will soon commence on a white paper to address the unique circumstances in New Zealand. This will support our advocacy with the New Zealand Government on the best way to achieve interoperability. Volume 17 No 4 | September 2021

Clinical Radiology

RANZCR Workshops, Courses and Events 2021 ESTRO School FALCON Workshops for 2021 30 September to 9 December 2021Online The Radiation Oncology Specialty Training Unit has successfully organised with ESTRO to deliver three online contouring workshops on the following topics; Head and Neck Cancer, Breast Cancer and Paediatric Oncology for RANZCR Trainees. These online delineation workshops are aimed at trainees and junior radiation oncologists wanting to improve their contouring skills. Head and Neck Cancer Workshop 30 September (AEST) and 7 October at 18.00 (AEDT) Breast Cancer Workshop 28 October and 4 November at 18.00 (AEDT) Paediatric Oncology Workshop 2 and 9 December at 18.00 (AEDT) For more information please visit: www.ranzcr.com/whats-on/events

RANZCR/ACR Education Center Courses Due to COVID-19 the January ACR Courses have been cancelled. The College is currently working with the American College of Radiology (ACR) on alternative ways to run this course in 2021. Further updates will be provided shortly. We appreciate your understanding during this time, as the situation continues to evolve.

RANZCR Annual Scientific Meeting 16−19 September 2021 Melbourne Convention and Exhibition Centre RANZCR2021 goes virtual! Check out the 2021 RANZCR Virtual Exhibition Space in the Guide to RANZCR2021 Virtual Conference Platform at www. ranzcr2021.com. Recorded sessions will be available on demand on our website for 120 days after the event for anyone unable to attend. All RANZCR2021 ASM abstracts will be published in an online-only supplementary issue in the December edition of JMIRO.

Save the Date: RANZCR WA Branch ASM 2022 19−20 February 2022 Harry Perkins Institute, QEII Medical Centre, Nedlands, WA An update in Neuroradiology and Head & Neck Imaging with Professor Sandeep Bhuta, Gold Coast University Hospital, Griffith University and Associate Professor Marc Agzarian, South Australia Medical Imaging, Flinders Medical Centre

On Demand If you miss any of live RANZCR sessions, you can watch them on demand via the College’s webcast library: webcast.ranzcr.com/Mediasite/Showcase/

Clinical Radiology Trainee Matters Hello Everyone, Unfortunately, this quarter’s message is sent amid lockdowns in multiple states with the situation wildly fluctuating each day. I hope everyone is looking after themselves, each other, and attempting something productive (or not) while at home. I have been very grateful to the Olympics for giving me hours of entertainment and a newfound obsession with speed climbing.

Dr Sarah Robertson

Inside News

The last few months have been busy with the webinars about the curriculum reforms and what they mean for trainees being held. This is an exciting time for the College and I encourage you all to familiarise yourselves with the changes.

Other areas the CRTC has been working on include: • College engagement/communication with trainees • Trainee after-hours workload • Integrated subspecialty training • Artificial intelligence fellowships • Non-medical expert roles • Cultural safety. As always, we would love to hear from you – email us at clinicalradtc@gmail.com. And we are looking forward to seeing you all (virtually) at RANZCR2021, our first (and hopefully last) locked down ASM! Sarah Robertson Chair, CRTC

Clinical Radiology

We are transitioning…. Chief Censor in Clinical Radiology

Dr Meredith Thomas

I’m sure you are all aware that we are transitioning to the new Training Program 2022 in February of next year—much awaited reforms to our training program delayed in 2021 by COVID-19. The new training program comprises updated learning outcomes, new learning activities and experiential training requirements, new work-based assessments, and revised examination format and rules. The principles of the revisions are to better align with contemporary educational practices, to emphasise constructive alignment between learning outcomes and assessment processes, and to introduce programmatic assessment, whereby there are multiple low stakes points of assessment from multiple assessors across multiple training activities over time, allowing better tracking of a trainee’s progress and multiple opportunities for feedback. While there will still be relatively high stakes examinations, work-based assessments will be referenced when making examination-passing decisions for borderline candidates. In recent weeks we have commenced targeted communications, with a series of Training and Assessment Reform webinars outlining the program and, most importantly for current trainees, outlining transition arrangements, noting that all trainees commencing prior to the beginning of February 2022 are transitioning trainees. We have had excellent attendance at the webinars, which have been targeted at various groups, including trainees, Directors of Training, Training Network Directors,

and Clinical Supervisors. While some have been run centrally, others have been run at jurisdictional level, overseen by our local TAR “Champions” and members of the TAR Implementation Working Group.

Migrating to the new e-Portfolio All transitioning trainees must be up-to-date with their experiential training requirements and workbased assessments on the Training Information Management System (TIMS) by 30 September because TIMS will close, and this information will then be migrated onto the new e-Portfolio system. Trainees need to meet with their DoTs prior to this to document completion of any activities not recorded on TIMS.

Phase 1 examinations New examination format and rules apply for all trainees from Series 1 2022, with the opportunity to sit anatomy and AIT exams independent of each other. Any transitioning trainees who have been unsuccessful in a component(s) of either anatomy or AIT must sit the new exam(s).

Phase 2 examinations The Phase 2 examination format will change in Series 1 2023 for all trainees. What examination rules apply depends on where a trainee is at in their training: • Any trainee who has completed 24 months or more of training at the

time of transition will sit with old examination rules, irrespective of format. • Any trainee who has completed less than 24 months of training at the time of transition will sit with new examination rules, i.e. the written examinations can be sat independent of each other, and all written exams must be completed before presenting for the OSCER (Objective Structured Clinical Examination in Radiology). These trainees cannot commence sitting with new rules until new format exams commence, i.e. Series 1 2023.

Exam extra attempt Recognising that transitioning trainees may be disadvantaged in relation to their examinations, all transitioning trainees will be allowed an additional examination attempt if required, either in their Phase 1 examinations or their Phase 2 examinations, depending on stage of training.

Phase 3 Phase 3 is mandatory 12 months after successful completion of Phase 2 exams for new trainees commencing from February 2022, however all transitioning trainees have the flexibility in the duration of Phase 3 depending on when they successfully complete their Part 2/ Phase 2 exams. Transitioning trainees can either do current system focused rotations or subspecialty modules in Phase 3, depending on what is offered at their site. continued over... Volume 17 No 4 | September 2021

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Clinical Radiology

Research requirements

Series 2 2022 examinations

The new training program research requirements are a single Research Project (RP), with a sign-off requirement of acceptance for peer review in a journal with an impact factor of greater than one (1), an oral presentation of that research at a Network level, and six Critical Appraisal of a Topic (CATs). Any transitioning trainee however, must complete old research requirements— while they will have to complete two research projects, sign-off criteria for Project 2 are more flexible, and they have to complete four CATs only, not six.

In addition to transition planning in relation to TAR, COVID-19 continues to challenge us in the way we deliver our current training program, with widespread jurisdictional lockdowns, often at short notice, disrupting normal training activities. Most training sites have transitioned to online teaching, perhaps online clinical and multidisciplinary meeting presentation and attendance. We continue to allow home reporting for trainees in areas where lockdown or quarantine precludes attendance on site, as outlined in the guidelines for decision-making related to COVID-19:

For further information in relation the TAR, I would refer you to the TAR webpage, where you will find access to information about the new program, the previous webinars, and a comprehensive Q&A page. Additionally, there is a future webinar program, which will cover work-based assessments, examination changes, and progression through training.

www.ranzcr.com/our-work/coronavirus/ impact-on-college-activities Examinations have been particularly challenging and I’m enormously thankful to the examinations team, headed by Dr Barry Soans, Chief of Examinations, and Shane Bryan, Manager, Examinations, for their work in continually adapting and adjusting processes to facilitate the running of the exams. In Series 2 we move to digitalised cases in our vivas,

a long-awaited change, facilitating standardisation and blueprinting of cases. Vivas will be run entirely online on the Practique examination platform, across multiple sites in Australia, New Zealand, Singapore and South Africa to facilitate exams for trainees and for overseas IMGs who have already commenced sitting exams. While we cannot predict or prevent every COVID-19 related challenge, we have built what contingency plans we can into the examination to facilitate a successful viva series. My thoughts go to all trainees who are impacted by COVID-19, not only those in lockdown, but all those who have had their training experience impacted by the pandemic. Our more junior trainees know no different to the current state of disruption, and our exam sitters have demonstrated enormous resilience in dealing with the challenges of uncertain exam dates and format, with better than usual results in the last two examination series. We will continue to do everything we can to ensure training remains robust and that trainees are able to progress through training as expected.

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Volume 17 No 4 | September 2021

Clinical Radiology

Powerful Event Platform to Deliver RANZCR2021 ASM First Virtual Experience Despite our hope and determination that this year’s ASM would be delivered as a hybrid event in Melbourne, the ongoing uncertainty and increasing number of cases in our two largest capital cities had the College’s Board approve a decision to switch the ASM to a full virtual experience. Over the past two years, ASM Convenors Prof Meng Law and A/Prof Farshad Foroudi alongside their sub committees have worked tirelessly to deliver a program that would be sure to engage delegates. “While we are disappointed that we cannot come together in person, we encourage our members to support their colleagues by registering to attend the ASM and acknowledging the countless hours of time and effort invested in designing the program” said Professors Law and Foroudi. Under the theme of Elysium: Now and The Future with AI, RANZCR2021 will unveil the emerging trends in artificial intelligence (AI) from multiple perspectives, exploring the power of AI in diagnosis, treatment, and patient outcome in clinical radiology and radiation oncology. Spanning over three and half days, the ASM 2021 will proudly present over 300 thought-provoking presentations across nearly 60 sessions, eight educational workshops and panel discussions, a dedicated Trainee Day for each discipline, as well as a number of prestigious awards and grant programs alongside virtual industry exhibitions.

Senasi, Dr Ferco H. Berger, and more. They will shed light on cutting-edge technology, reveal ground-breaking research findings and new data, tackle challenges in cancer treatment, highlighting future opportunities in radiology and radiation oncology.

• Branch of Origin: the battle of the branches as the brightest clinical radiology trainees from each branch compete for the best presentation prize and a ticket to the Radiological Society of North America scientific meeting 2022 in Chicago, USA.

RANZCR2021 is also an arena of scientific competitions for further learning and education to nurture medical advancements.

Former Victorian Deputy Chief Health Officer Professor Allen Cheng will deliver the Nisbet Oration on the COVID-19 pandemic and vaccine rollout. This year the Nisbet Oration will be given in the opening plenary session, an ASM tradition with previous Nisbet Orators including Prof Fiona Wood, Dr Mike King and Prof Brian Schmidt.

• The RANZCR CLiP Kaggle Challenge: with a total of $50,000 prize and run for three months, the inaugural Kaggle challenge encouraged data scientists worldwide to develop an algorithm which can detect the mispositioning of catheters and lines on chest x-rays reducing human error. It has attracted over 1,500 teams of health professionals and data engineers from around the world with 28,112 solution entries. • The Varian Challenge: established in 1984, the annual Varian Challenge recognises an outstanding student member for the best scientific paper in radiation oncology with the aim of encouraging medical research. This year, twelve trainees from around Australasia will present their research to compete for this highly regarded prize.

The College's 3D virtual conference platform will be visually appealing and engaging for delegates to participate in discussion forums, live question and answer sessions, virtual meeting hubs with fellow delegates, as well as an interactive virtual exhibition with resource and demonstration videos. Register now to join the 2021 ASM conversations and receive 120 days exclusive access to the recordings to watch at your own leisure.

The 2021 ASM has attracted the largest number of international speakers across the depth and breadth of the globe including Prof Ben Slotman on MRI-guided adaptive radiotherapy, Dr Anne Osborn and Prof Paul Parizel on neuroradiology, Prof Andrew Loblaw on prostate cancer, Dr Jonathan Kruskal on post-COVID rebuilding, Prof Cristopher A. Meyer, Dr Heather Moriarty, Dr Ram Sneak peek of your virtual experience

Inside News

Clinical Radiology

Changes to the Continuing Professional Development Program to Commence in January 2022 Chief of Professional Practice A/Prof Dinesh Varma

It is hard to believe we are already into the third quarter of 2021, with the end of the year seemingly coming at an accelerated pace toward us, despite the ongoing disruptions from COVID-19. My thoughts are with those who have been or who are currently affected by the virus. The Professional Practice Committee has continued to work throughout this year on a number of important projects, the most important among those is the changes to the Continuing Professional Development (CPD) program that will commence in January 2022. The Medical Council of New Zealand (MCNZ) released their ‘Strengthened Recertification requirements for vocationally-registered doctors in New Zealand’ in November 2019 outlining the changes to the CPD requirements for MCNZ registered doctors, with the Medical Board of Australia (MBA) releasing their ‘Revised CPD registration standard’ in late July this year. The College will introduce a transition CPD year for 2022, with additional minor changes coming into effect in 2023, to comply with the MBA and MCNZ requirements including minimum requirements in relation to CPD categories. The most noticeable changes will be that professional development plans (PDP) will become mandatory every year, moving from a triennium cycle to an annual cycle and recording CPD activities in hours rather than points, with a minimum of 50 CPD hours required per calendar year.

To ensure our members understand the changes and how to meet the requirements of the new CPD program, there was a presentation at the recent NZ Branch RANZCR ASM in Wellington by Drs Joe Feltham and Ziad Thotathil. This session was very well received and a similar session is planned during the ASM in September. Detailed information regarding the CPD program changes can be found in this edition of Inside News on page 57. We will also hold a separate session at the ASM to present and highlight some key documents developed by the PPC which will affect the work of clinical radiologists across both Australia and New Zealand.

calendar year only, due to the COVID-19 exemptions. Can I please urge you to enter any remaining points for this triennium to ensure compliance as soon as possible. As always, if you have any questions regarding your CPD, please contact the College via CPD@ranzcr.edu.au I wish you all the best for the remainder of this year. A/Prof Dinesh Varma Chief of Professional Practice Faculty of Clinical Radiology

I hope you will be able to attend these sessions.

2019−2021 triennium deadline: are you compliant? Complementing the new CPD Program, will be the new College CPD platform which will also be rolled out in January 2022. The new Kaizen e-Portfolio platform will be mobile friendly and is designed to make recording CPD activities more accessible for members. Due to the change in platform, the current CPD platform will no longer be able to be accessed by members in the future. A reminder to members to ensure you have recorded your CPD activities for the 2019−2021 triennium. To be compliant for the triennium, you need to have recorded 125 points, with a minimum of 30 points in the 2019

Volume 17 No 4 | September 2021

Interventional Radiology

Specialist Interventional Radiology and Interventional Neuroradiology Range of Practice The RANZCR Interventional Radiology Committee has committed to pursuing a path to recognition for the specialties of Interventional Radiology (IR) and Interventional Neuroradiology (INR). The committee has been driving this forward through a number of activities, the latest of which is the development of the Specialist Interventional Radiology and Interventional Neuroradiology Range of Practice document. This document is now available for member and stakeholder feedback: www.ranzcr.com/our-work/consultations It is an all-encompassing document that refers to the full range of interventional radiology and interventional neuroradiology practice, rather than an individual specialist’s scope of practice as determined by a local hospital or healthcare facility. Scope of practice, which differs from range of practice, may vary from site to site and is dependent upon factors such as local staffing and expertise, available equipment and other facilities required to support a given clinical practice. Defining the range of practice for a specialist interventional radiologist and specialist interventional neuroradiologist is a critical step in the development of advanced training pathways, and also begins the process of defining these clinical radiology specialties as distinct from other medical specialties. The document summarises the additional advanced knowledge, behaviours, clinical skills and technical capabilities required for specialist interventional radiology and interventional neuroradiology practice. It emphasises the clinical roles that these specialist clinicians need to provide patients with high quality patient-centric care. These include, but are not limited to: contributing to multidisciplinary care; good communication with patients, referrers and other clinical colleagues; pre-procedural assessment; clinical

Inside News

“Defining the range of practice for a specialist interventional radiologist and specialist interventional neuroradiologist is a critical step in the development of advanced training pathways, and also begins the process of defining these clinical radiology specialties as distinct from other medical specialties.”

management and appropriate follow-up of patients. The ranges of practice for both IR and INR are outlined separately and in a broad manner to accurately describe the similarities and differences between the specialties, and to allow for ongoing relevance as the specialties grow and evolve with technology and clinical capabilities. Any and all comments on this foundational document for IR and INR would be greatly welcomed. The consultation closes on 24 September. For any general comments, please email interventional@ranzcr.edu.au The document was developed by the IR and INR Training Pathway Working Group, whose members are: Dr Andrew Cheung (co-chair), A/Prof Andrew Holden (co-chair), A/Prof Dinesh Varma, Dr Nick Brown (IRC chair), A/Prof Laetitia De Villiers, Dr Hamed Asadi, Dr Nicholas Cheung, A/Prof Gerard Goh (IRSA representative), A/Prof William McAuliffe (ANZSNR representative), A/ Prof Julie Ash (Medical Educationalist).

Interventional Radiology

Interventional Radiology Committee Session at the RANZCR ASM As we look forward to the 2021 RANZCR Annual Scientific Meeting shortly, the College is pleased to announce that the Interventional Radiology Committee (IRC) will again host a dedicated session for IR and INR members on Saturday 18 September at 10.30 am. This session has been placed within the main schedule as engagement between the College and practising IRs and INRs is a key component of the program. The session has been designed to be interactive and will include panel discussions on important and contemporary issues. During the event, the IRC will share key aspects of its recent progress and the College’s vision for IR and INR. Chair of the IRC, Dr Nick Brown, will discuss the roadmap for achieving formal specialist recognition for IR and INR, while Dr Cheung and A/Prof Holden will speak about the College’s pathway toward specialist advanced training in both of these specialties. A/Prof Will McAuliffe will present on the role of IRs and INRs Interventional Radiology Committee

as clinicians rather than technicians, and the skills and values that being a clinician brings to the profession and to our patients. Dr Jonathan Tibballs will discuss the value of these specialties, including how achieving specialty recognition will provide higher quality care to Australians and New Zealanders, and how the specialties support each other and allow growth. Dr Terry Kok will present on the importance of academic IR and how being a clinician-researcher will help to grow the evidence base for our craft. This diverse range of talented IRs and INRs from across Australia and New Zealand represents a mix of IRC members and non-IRC members, and we are fortunate to have a such an enthusiastic faculty for the event. The IRC session will also engage with IRSA and ANZSNR, both societies having recently formed a tripartite committee with the College to ensure that the interests of all IRs and INRs are met as we move forward.

IR and INR Training Pathway Working Group

The tremendous work of the College is only made possible because of the valuable input from College members and the dedicated secretariat. This includes not only the IRC, but members of IRC subgroups including the IR Standards working group, IR and INR Training Pathway working group and the IR and INR reference group. There is more work ahead and if anyone wishes to be involved in shaping the future of IR and INR within Australia and New Zealand, I would encourage them to attend the IRC session at the ASM and/or to contact the College to express their interest via email at: interventional@ranzcr.edu.au We look forward to seeing College members, especially many IRs and INRs, on 18 September. A/Prof Warren Clements Clinical Lead, IRC session Interventional Radiologist Alfred Health and Monash University @Warren_IR

Standards Working Group

IR and INR Reference Group

Dr Nick Brown

Dr Andrew Cheung

Prof Winston Chong

Dr Jonathan Tibballs

A/Prof Dinesh Varma

A/Prof Andrew Holden

Dr Nick Brown

Dr Albert Chiu

Dr Sibtain Raza

Dr Nick Brown

A/Prof Gerard Goh

Dr Justin Whitley

A/Prof Dinesh Varma

Dr Jim Koukounaras

Dr Hamed Asadi

A/Prof Andrew Holden

A/Prof Laetitia De Villiers

Dr Con Phatouros

A/Prof Lourens Bester

A/Prof William McAuliffe

Dr Hamed Asadi

Dr Andrew Cheung

A/Prof Laetitia De Villiers

Prof Winston Chong

Dr Nicholas Cheung

A/Prof Ronil Chandra

Dr Deepak Jain

A/Prof Gerard Goh

Dr Martin Dobes

Dr Arockia Doss

A/Prof William McAuliffe

Dr Colin Chong

Dr Nicholas Cheung

A/Prof Julie Ash

Dr Matthew Lukies

Dr Murthy Chennapragada

Mr Murray McLachlan

Dr Kartik Bhatia

Chair

Chief of Professional Practice FCR Council Representative

Dr Andrew Cheung

A/Prof Ronil Chandra A/Prof Warren Clements Dr Amit Lakkaraju Dr Terry Kok

Co-chair Co-chair

IRC Chair

Chief of Professional Practice

IRSA Representative

ANZSNR Representative Medical Educationalist

Chair

Consumer Representative

Chair

Dr Thomas Pearson

Dr Abysinia Sibanda

Mr Murray McLachlan

Dr Wei Che Tsai

CR Trainee Representative Consumer Representative

Dr Sivasubramanian Srinivasan Dr Matthys Van Wyk

Volume 17 No 4 | September 2021

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Radiation Oncology

Safety and Strategy in 2021 A Message from the Dean

Dr Keen Hun Tai

Ongoing impact of COVID-19

New Zealand Branch ASM

Lockdown is still a feature in Australia with three states in that situation recently and the travel bubble between New Zealand and Australia has been suspended. The pandemic continues to affect all of us, and other parts of the world, in so many ways. Reminiscent of the past year, the Phase 2 radiation oncology examinations are affected especially in New South Wales, but it could be in any jurisdiction at any time due to the more infectious delta strain of the virus. Learning from some of the lessons of 2020, proactive efforts in communications to our trainees and examiners plus contingency plans for alternative examination centres have managed to deal with some of the angst. With these actions in place, the 2021 examinations should be adequately managed.

The suspension of the travel bubble has meant that a number of office bearers, including the two Deans and a number of College secretariat have not been able to participate onsite. Apart from the importance of supporting the academic activities, having faceto-face interactions with members at such events is important in a collegiate environment.

However, these do not alleviate entirely the added stress that COVID-19 has caused, particularly with all the restrictions that have been enforced. While the Faculty of Radiation Oncology and the College can make efforts to manage activities around these restrictions, the changing situations in the short, medium and long term are well beyond our control. These management efforts are multi-faceted and so much depends on some stability of the infection controls at any one time. I would echo the words of many others who have advised that our trainees, and indeed all our members and secretariat of the College should reach out to others for help should anyone feel the distress. We do want everyone to be safe.

It was also the intention to meet with officials from the Ministry of Health to continue the dialogue on the NZ Health strategies and organisational and operational changes to ensure that matters of workforce and facilities in a multi-disciplinary approach address the objective of achieving the best outcomes for patients. These efforts will continue, albeit in an alternative environment.

Radiation Oncology Alliance (ROA) The Radiation Oncology Tripartite Committee was formed in 1998 and had a substantial impact on the setting of standards as evidenced by the publication of radiation oncology practice standards via collaboration with the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) and Australian Society of Medical Imaging and Radiation Therapy (ASMIRT). This cohesive collaboration evolved to include Cancer Nurses Society of Australia (CNSA) and this organisation of four peak bodies is now recognised as the Radiation Oncology Alliance. The ongoing work of this group aims to

address matters of common interest and concern by making representations especially to government through consensus statements and strategic documents while advising medical and other bodies. The 10 year (2012 to 2022) Strategic Plan is due for review and the FRO is working with the other members of ROA to revise the directions for 2023 and beyond. It is quite apparent that many of the areas of concern over the past decade remain with us in this decade. Examples of these include the radiation practice standards, appropriate planning and implementation of workforce strategies in all cancer related disciplines and wellsupported, networked and resourced regional centres to ensure equitable access to radiation therapy in all parts of New Zealand and Australia.

Bi-faculty work There are many areas of common interest for clinical radiology and radiation oncology; not just because we are two parts of the College. There are imaging and therapy aspects affecting outcomes of patients and our professions that are of importance to all members. These are most evident in the frontiers of interventional oncology, artificial intelligence and theranostics where we have bi-faculty representation on committees or working groups. The International Medical Graduate Committee is another that has bi-faculty representation. continued over...

Volume 17 No 4 | September 2021

Radiation Oncology

All of these are well supported by a dedicated secretariat. Not many members are likely to be aware of these areas of activity. From time to time, opportunities to be involved will arise and will be publicised particularly via FRO enews. For those who have that special interest, please look out for these instances and register an expression of interest.

Arising from member consultations Almost continuously, there are pieces of work out for member consultation. Recently, there were two major pieces of work that were opened for consultation feedback: the draft Action Plan for Māori, Aboriginal and Torres Strait Islander Health and the draft RANZCR Strategic Plan 2022–2024. These will

significantly influence the work of the Faculty of Radiation Oncology, and indeed all parts of the College once they are approved by the Board. Effectively, this means that the work of Council and the Committees of FRO will need to prepare for the new directions by the end of 2021 to start to address particularly some of the items in the Action Plan for Māori, Aboriginal and Torres Strait Islander Health. There will need to be training for cultural safety and leadership to drive the actions, some of which are ambitiously aimed to be completed by end of 2022. There will be secretariat support for the required work including the formation of a Workforce Unit and employment of additional staff to provide the capacity for the added work.

Similarly, the RANZCR Strategic Plan 2022–2024 will drive our work ahead to maintain and progressively enhance all that we do with the best interests of our patients at the forefront, ensuring that quality and professional standards are always part of the endeavours. Embedded within these strategic directions will be the desired outcomes in the Action Plan for Māori, Aboriginal and Torres Strait Islander Health. We look forward to having these two very important pieces of work formally launched at the 71st Annual Scientific Meeting (RANZCR2021).

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Inside News

Radiation Oncology

Perseverance and Collaboration Chief Censor in Radiation Oncology

Dr Yaw Chin

It was with a sense of cautious trepidation that we headed into examination season this year. With the College staff and our faithful, indomitable examiner panels working hand in hand, we overcame many unexpected hurdles, thinking laterally and nimbly stepping beyond the normal confines of the examination boundaries that we were accustomed to. Although the Phase 2 written examinations were successfully conducted on 6 and 7July, it was with a heavy heart and disappointment that I had to make the difficult decision to not proceed with the Phase 2 viva examinations on the scheduled dates for a second year in a row. The sudden announcement of the New Zealand Level 4 lockdown one week before the viva examinations meant that there was insufficient time to enact any contingency plans and provide adequate notice to candidates regarding the necessary changes. However, despite this setback, I am proud to say that everyone involved in the examination process is wholeheartedly committed and continuing with our efforts to ensure that this year’s viva examinations would still be delivered, albeit at a later date. I want to acknowledge and convey my sincere thanks to the examiners led by the Chief of Examinations, A/Prof John Leung, the Specialty Training Unit, Training Network Directors, Directors of Training and Educational Support Officers in displaying a remarkable spirit of perseverance and collaboration, all working towards the same vision of ensuring that our trainees are able

to sit this crucial assessment that they have trained and toiled for over the last several years. The Phase 1 examinations are still confirmed to proceed on Friday 10 September 2021. Many modifications have been made to ensure their safe delivery, including hosting of the written examinations at individual local sites rather than a single central site, as per the normal arrangement. This has been necessary to minimise candidates’ travel for the exams and negate the requirement for 14-day self-isolation post travelling to designated hot spots. Momentum on the Training and Assessment Reform (TAR) project is also accelerating as we venture into the final phase of the implementation plans for the new Radiation Oncology Training Program, which is commencing in the new academic year, on Monday 7 February 2022. Many of you have already been engaged in the webinars designed to communicate salient changes within the new training program. These have largely occurred during the month of August and have focused both on the Overview and Transition Arrangements, in addition to those which are specifically targeted for trainee transition. The feedback gained from these sessions has been invaluable and is used to further refine and streamline the processes which will come into effect very soon. Further information sessions have been planned to be delivered at this year’s 71st RANZCR Annual Scientific Meeting, to be held in a few days between 16–19 September.

The Radiation Oncology Learning Outcomes document has been made available online since July. This document has been the culmination of many years of hard work, contributed by many Fellows who have generously donated their time and energies. The six sections held within this document represents a significant milestone in the sphere of radiation oncology education and training. Not only does it build upon the Second Edition of the Radiation Oncology Curriculum (2012), it is a truly transformative document. The previous curriculum has now been brought up-to-date and in line with contemporary, evidence-based best practice in medical education. Learning outcomes are meticulously articulated to form the basis of the structured learning activities, work-based assessments and examinations in the new training program. The success of this new training program is highly dependent on the new electronic platform which will be introduced concurrently. The new e-Portfolio platform will be used to monitor and review a trainee’s progress in their training journey and is a crucial tool for trainees, Clinical Supervisors and Directors of Training to gain an indepth understanding of how a trainee is tracking along their training trajectory.

continued over...

Volume 17 No 4 | September 2021

Radiation Oncology

In preparation for the implementation of e-Portfolio, the current Trainee Information Management System (TIMS) will be coming offline at the end of September. Transitioning trainees will have access to the new e-Portfolio system by Monday, 21 January 2022. The intervening offline period will allow for: • data migration of a trainee’s record from TIMS to e-Portfolio • trainees to still complete any workbased assessments in the current training program in hardcopy format.

Phase 1 Examination 2022 • The Phase 1 Examination for 2022 is to be held on Friday 9 September 2022.

Phase 2 Examination 2022 • For Series 1, the writtens will be held on Tuesday 8 February 2022 and Wednesday 9 February 2022 and the vivas will be held from Tuesday 29 March to Thursday 31 March 2022.

• For Series 2, the writtens will be held Monday 4 July and Tuesday 5 July and the vivas will be held on from Monday 23 to Wednesday 25 August 2022. Please note the examination dates are accurate at the time of printing however may change due to COVID-19. Once e-Portfolio comes online and is operational: • trainees can upload their completed hardcopy assessments into e-Portfolio • trainees will be provided with an opportunity to request adjustments to their training record, if there were any changes during the offline period • trainees can commence the new workbased assessments as per the new Training Program requirements. Lastly, I would like to mention that significant work has gone into revising the International Medical Graduate (IMG) Policy, as well as the Area of Need (AoN) Standards by the IMG

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Inside News

Radiation Oncology

Radiation Oncology Trainee Matters As chair for the ROTC of 2021 I have found the experience very fulfilling and would recommend any interested trainees reach out to their state representatives to talk about how to get involved. In this edition of Trainee Matters we will be hearing from Dr Cristian Udovicich to give us some insight into his involvement and updates from the ASM.

Dr Chamitha Weerasinghe Here we go again, we are once again facing a new wave of COVID-19. The situation continues to evolve, however I do feel reassured by the efforts of Dr Yaw Chin and his team. I would like to congratulate the College on their successful delivery of the 2021 Phase 2 examinations. So much preparation has gone into establishing contingencies to be in place to ensure the delivery of examinations despite the constant threat of lockdowns. From a trainee perspective, these exams are significant life events. Trainees plan our lives around them, twelve to eighteen months of studying are dedicated to preparing for the written and clinical examinations. For those approaching the possibility of being ready for Phase 2 examinations, we eagerly await the announcement of the 2022 exam dates. This has been a stressful time and many of us have found ourselves reflecting on the difficulties of training. The purpose of the ROTC is representation for trainees, to discuss the difficulties you may be facing and advocate for your trainee experience. Nominations have also opened for ROTC 2022. If trainee advocacy is something you’re interested in getting involved with, I encourage you to apply for the position of trainee representative in your state.

Lastly, it is important to continue to check in with your fellow trainees and stay supported. It has been a somewhat disconnected time, if you would like to connect with trainees across Australia and New Zealand, I encourage you to join the Australian and New Zealand Society of Radiation Oncology Trainees (ANZSROT) on Facebook. ANZSROT is a group for radiation oncology trainees, it’s a source of information, updates and community. Finally, as always, we can only advocate effectively if we know what’s going on. Please talk to your ROTC representatives if you have any ideas for improvement or any training related issues. Dr Chamitha Weerasinghe Chair Radiation Oncology Trainee Committee (ROTC)

ASM Committee Dr Cristian Udovicich is the ROTC ASM representative. The ASM representative is responsible for organising the Trainee Day program. It is a great opportunity to liaise with international speakers directly and network with multiple consultants across Australia. There is also input into the ASM overall and to experience the (very complicated) inner workings of the ASM!

individual stations on the Sunday. Looking forward to seeing you virtually! Speakers include: • Breast: Desiree van den Bongard (Breast Nodal Irradiation) • Prostate: Andrew Loblaw, Sunnybrook Health Sciences Centre, Toronto, Canada (Pelvic radiotherapy in intact and salvage prostate radiotherapy) • Head & Neck: Clifton David Fuller, MD Anderson, Texas, USA (Career development opportunities in imaging informatics) • Lung: Fiona McDonald, The Royal Marsden, UK (Changes in practice of small cell lung cancer) • Gynaecology: PORTEC-3 Investigators, Leiden University Medical Center, Netherlands (High risk and advanced endometrial cancer) • Lower GI: David Sebag-Montefiore, University of Leeds, UK (Total Neoadjuvant Rectal Therapy) • CNS: Anthony Chalmers, University of Glasgow, UK (Molecular biomarkers and their impact on glioma biology and response to treatment). Sessions include: • Fellowship Opportunities • Beyond Phase 2: Navigating Tumour Board, Demystifying Private Practice • Radiation Oncology Research Committee • Trainee Forum. Dr Cristian Udovicich, Trainee Representative, ASM Committee 2021

This year the ASM committee have put together a jam-packed program on the Saturday specifically focused at the registrar level, including clinical lectures from an all-star international line-up as well as professional development sessions. There will also be a questionbased clinical cases workshop with Volume 17 No 4 | September 2021

Radiation Oncology Advertorial

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Inside News

Varian software—the ARIA® oncology information system and Eclipse™ treatment planning—to a cloud-based managed IT environment that is used by both hospitals. Clinicians at the ESNEFT say they are already benefiting from the change, in the form of faster access to new features, better system performance, and improved flexibility.

Reducing risk and managing complexity A key goal of the Trust’s IT strategy was to reduce the risks and management complexity in running the software associated with highly technical treatment delivery systems so that the IT staff could focus their efforts on other infrastructure issues and network requirements across both sites. The Trust was also looking to achieve predictable costs across a 5-year plan. Varian stepped in and coordinated the process of moving the department’s software and historical patient data to the cloud-based, managed-IT environment and managed an ARIA upgrade at the same time. “It was a massive change for us,” said Hayley James, head of Radiation Services at ESNEFT. “Not only did it involve an upgrade, but we were doing it during a pandemic, trying to treat patients and implement all kinds of new guidelines and protocols. The Varian implementation team was especially helpful in setting up the systems to support our workflows and interfaces

with other systems. For example, our patient demographics are fed in through an HL7 link; we have a CT scanner and a PAC system, and all those functions are critical for service delivery.”

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Radiation Oncology

Quality Corner

The role of peer review in radiation oncology is long recognised by the College, the American College of Radiology (ACR) and the American Society for Radiation Oncology (ASTRO) as the process improves plan quality and patient safety. There are multiple facets in the peer review process and the most critical part is in the dose prescription and contouring. It is reported that around 20–30 per cent of prospective peer reviewed cases will require some modification while around 5–8 per cent require major revision. Most of the recommended changes were related to contouring and dose/fractionation. While the process of peer review can be time consuming and potentially impacts on workflow resulting in delay from simulation to the start of treatment, it is proven to improve the quality of treatment planning and likely to improve treatment outcome. The majority of centres in Australia have implemented some form of peer review process particularly for complex cases—the likes of head and neck cancer and cases being treated with stereotactic ablative body radiotherapy. There is currently no standardised peer review format. There is also no standardised definition on the degree of deviation as to what constitutes a minor or major deviation. Furthermore, there may be a lack of feedback mechanism to follow up on whether the recommended consensus changes are adopted by the treating radiation oncologist (RO). It is reported by the literature that prospective daily peer review reduces the rate of plan revision recommendations not followed from 15 per cent to 4.5 per cent compared to retrospective weekly review. Daily prospective peer review rounds were conducted by several institutions overseas and was reportedly feasible.

The constituents of RO, registrars, physicists and radiation therapists are generally regarded as essential as the standard peer review group. Notwithstanding that, it is unclear such a program can be implemented in each and every Australian centre on every patient undergoing curative

“There is currently no standardised peer review format. There is also no standardised definition on the degree of deviation as to what constitutes a minor or major deviation. Furthermore, there may be a lack of feedback mechanism to follow up on whether the recommended consensus changes are adopted by the treating radiation oncologist (RO)” intent treatment. Some centres employ a buddy system whereby two radiation oncologists team up and prospectively review each other’s contours prior to planning. With the pair of RO being familiar with each other’s approach and preference, it is anticipated that the rate of deviations would be lower than

a larger group multidisciplinary peer review process although there is no data to confirm that observation. Common barriers to effective and efficient peer review process including scheduling, communication, and workflow will need to be overcome at the local institution. The College emphasises the fundamental importance of this process. We allocate a great amount of resources to prevent slop in the isocentre; we should also allocate resources to prevent slop on lines we might draw around the isocentre. Explicit and clear guidelines and requirements from the Faculty should act like technical requirements for linac accuracy: it should lead to absolute requirements of the institutions or organisations which resource us to allocate time, money, and people to implement a peer review process that meets standards. There is no current College guideline on the format, frequency, and definition of deviation from consensus peer review process. The other question concerns how much emphasis should be placed on enforcing changes when deviation is raised by the consensus peer review group but the treating RO disagrees with the recommendation. These issues will be further discussed in the Quality Improvement Committee with a view to providing a standard peer review process, adapted to individual organisations, to ensure quality radiotherapy treatment delivery and patient safety. A/Prof Charles Lin, Quality Improvement Committee

Volume 17 No 4 | September 2021

Education

On Track: the 2022 Training Programs Ready to Launch in February

The Faculty’s Implementation Working Groups have continued their work with preparations toward implementation of the new training programs. The College is pleased to confirm that the 2022 Training Programs for Clinical Radiology and Radiation Oncology will be launched from this coming February for all Australian, New Zealand, and Singapore trainees.

Learning Outcomes and Training Program Handbooks In preparation for the February 2022 launch, the two Faculties have released electronic versions of the Learning Outcomes and Training Program Handbooks. These documents have been compiled as resource guides for College trainees and members involved in the new Training Program. The Learning Outcomes and Training Program Handbooks for both clinical radiology and radiation oncology are now available under the Training and Assessment Reform (TAR) section of the College website. The Learning Outcomes document is a comprehensive guide to education and training for the specialty, designed to form the basis of the structured learning activities and formative work-based assessments, and assemble content for examinations within the Training Program. The Training Program Handbooks provide information and guidance for trainees, Fellows and staff in relation to all aspects of the Training Program, from commencement to Fellowship.

Workshops and webinars: Training and Assessment Reform A series of webinars have been developed in preparation of the February launch to inform trainees, Clinical Supervisors, Directors of Training, and Networks about the key changes to the Clinical Radiology and Radiation Oncology Training Programs. The webinar series provides an overview of the 2022 Training Program including learning outcomes, transition arrangements, assessments in the Training Program, and the e-Portfolio system. A webinar resources page has been developed on the TAR page of the College website, in addition to regular updates of upcoming webinars included in the Trainee, DoT, and Faculty enews. We encourage members to register for the relevant discipline-specific webinars to keep abreast of the latest information. For those who missed past webinars, the recordings and presentations are available on the TAR webinar page: www.ranzcr.com/college/tar/webinars

Training e-Portfolio System The training program will be administered in the new e-Portfolio System. The new system will replace TIMS with an online portfolio that utilises online forms to deliver and track trainee assessments. Over the next few months, we will begin the migration from TIMS to the e-Portfolio system, the current transitioning schedule is: 30 September 2021 Trainees and DoTs complete final upload of information to TIMS 1 October TIMS system goes offline 15 October Trainee Transcripts emailed out by the College

Inside News

30 October Trainee Transcripts signed by trainees and their DoT, and returned to the College via email 1–30 November Training Progress Data uploaded into e-Portfolio 1 December 2021–20 January 2022 Quality check of training profiles and actioning of adjustments By 21 January 2022 e-Portfolio System available to members

Policy review The College policies relating to the training program are currently being reviewed to align with the new Training Program. Please refer to the TAR webpage on the College website to view the latest updates on training policies.

Ongoing updates and information Updated information pertaining to the 2022 Clinical Radiology and Radiation Oncology Training Programs will be made available on the TAR section of the College website. The QR code below will link to all future updates and information relating to the programs to allow for quick access to the TAR section on the website.

The Royal Australian and New Zealand College of Radiologists®

QUEENSTOWN NEW ZEALAND ASM AUGUST 5-7 2022

MILLENNIUM HOTEL

KEY DATES 7 April 2022

Registration and Abstract Submission Opens

19 June 2022 Abstract Submission Closes 26 June 2022 Earlybird Registration Closes

www.ranzcr2022.co.nz

News

Vale Dr George Keith Chapman 30.05.1932–30.05.2021

On Sunday 30 May this year, our friend and former colleague and mentor, Dr George Chapman, died quietly at home in Sydney. George had been an important part of the Sydney radiological and orthopaedic world virtually from his time of graduation from The University of Sydney in 1955. He obtained his membership of the then Royal Australasian College of Radiologists in 1960, having completed his resident medical and radiological medical training at St Vincent’s. As a radiologist he practiced as an HMO at St Vincent’s and the Mater hospitals from 1960 to 1969. In that period he helped establish very active and well respected private radiological clinics in Ryde and Chatswood, initially with John Carroll and later with Barry Figtree and Philippe Scamps. He continued in those practices until his retirement in 1995. From 1970 he was a visiting medical officer at Royal North Shore Hospital (RNS), where he remained until his retirement. As a VMO he helped train radiology and orthopaedic trainees as the prime musculoskeletal radiologist at RNS. He was always a superbly thoughtful and innovative plain radiograph ‘bone’ radiologist—always insisting on relating and correlating the pathoanatomy to the radiographic demonstration. He established, with Professor Tom Taylor, the early Friday morning clinical orthopaedic meeting which continued

for over 20 years. This meeting, somewhat feared by the radiology and orthopaedic registrars asked to describe and diagnose the radiographs, was immensely useful as a forum for virtually all interesting and difficult orthopaedic and spinal problems presenting at RNS and adjacent areas in Sydney. He also established with Professor Stan McCarthy, the NSW bone tumour registry weekly meeting at Royal Prince Alfred where he was the prime radiologist for decades. Internationally he was well respected by many of the world-renowned musculoskeletal radiologists of the era, many of whom travelled to Sydney and RNS to visit him and present at meetings there. He was an early member of the International Skeletal Society, often presenting at the closed sessions. George Chapman was universally regarded as an excellent clinician and radiologist and he effectively became the mentor of several generations of radiologists and orthopaedic and spinal surgeons at RNS and throughout Sydney. He was a thoroughly engaging raconteur and had superb timing, which he demonstrated to the end—having an 89th birthday party with Hilde, his wife of 37 years, and his family and close friends earlier on the day he died. He will be missed—a true gentleman. Bruno Giuffrè 03.06.2021

Volume 17 No 4 | September 2021

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 InsideRadiology is a conduit of communication between the College, health consumers, and health professionals; further promoting the role and value of clinical radiology and clinical radiologists in patient care. Place the website link on your referrals and patient invoices to reliably inform consumers and health professionals about radiology procedures.

Get involved! If you have an idea for a topic or would like to help review pages get in touch with us! All authors get credit on the website and any work can be used for CPD points too. Contact us at: insideradiology@ranzcr.edu.au

Web activities Since the beginning of the year we have had a steadily increasing number of visits to the site resulting in the highest volume of traffic in the last year. The angiography page attracted the largest number of visits so far this month followed by computed tomography and nuclear medicine bone scan.

Angiography In honour of our most popular page for August: what a patient will read. Angiography is the X-ray imaging of blood vessels using contrast agents injected into the bloodstream through a thin plastic tube (catheter) that is

Promote InsideRadiology to Patients and Colleagues



placed directly in the blood vessel. The images taken are called angiograms. Angiography provides information about blood vessel abnormalities, such as narrowing, blockage, inflammation, abnormal widening and bleeding, using a liquid contrast agent (known as contrast medium – see Iodinecontaining contrast medium (ICCM). Contrast agents are injected into an artery or vein to make the blood vessels visible on X-rays. Angiography is also used to guide procedures that treat blood vessel abnormalities. If the artery is narrowed, a tiny balloon can be inflated (and occasionally a piece of metal tubing called a ‘stent’ can be inserted) to widen the artery and restore normal blood flow. This procedure is called angioplasty (see Angioplasty and Stent Insertion). Angiography is also used to guide procedures where abnormal blood vessels need to be blocked off if they are bleeding (called ‘embolisation’), or as part of other medical investigations or surgical treatments. Angiograms can also be obtained using computed tomography (CT) by injecting contrast medium into a vein in the arm, or by magnetic resonance imaging (MRI). CT or MRI angiography only show the appearances of the blood vessel, and cannot be used for treatment procedures.

Inside News

Trans-Tasman visitors account for 21 per cent of the total activity on the site, while 40 per cent of visitors are accessing the website from the US, 10 per cent from the UK and 10 per cent from India. The majority of our TransTasman audience are accessing the site from large cities, with eastern Australian capital cities responsible for more than 65 per cent of Australian and New Zealand visitors, however there is still a steady stream of visitors from regional and remote locations.

Supplementing your online resources InsideRadiology encourages its information partners, hospitals, and radiology practices to link directly to the InsideRadiology website so that staff, patients and referrers can access trusted information that can easily be printed into a fact sheet straight from their own website. InsideRadiology continuously updates the items as part of an ongoing review strategy so that radiology sites have up-to-date information for their patients without the extra administration. Please help us promote InsideRadiology by following us on Twitter and Facebook (@InsideRadiology) If you need further information please contact: insideradiology@ranzcr.edu.au

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News

New Zealand Branch News

Dr Gabes Lau Kia Ora. The Olympics have just finished. New Zealand and Australia both represented well—once again, the athletes have represented us exceptionally well on the sporting stage, but also in interviews, especially loved the interview with Ruby Tui on the BBC.

NZ ASM The first weekend in August saw the NZ membership heading to Wellington for a well-attended NZ ASM. The numbers: • total on-site delegates: 235 • total virtual delegates: 73 • total delegates: 308 • of those numbers there were 45 radiation oncologists. It was fantastic to see everyone there enjoying the speakers. Bar a couple of tech issues during Q&A all the virtual presentations from overseas speakers were well done and engaged the audience. And I think attendees learned a few things from their local colleagues as well. Ka pai! I’d like to recognise all the hard work done by trainees on their presentations and posters. They were of universally high quality and I think some senior members were humbled by the quality of the work. The winners were: • Hugh McHugh: Obex Medical Registrar Research Award • Kyle Grabowski: NZRET Poster Prize • April Xu-Holland: FRONNZ Prize. On behalf of the College (particularly the NZ membership), I would like to thank the organisers for all their hard work. Thanks, in particular, to the convenors: Nick Humphries, Nichola Naidoo, Lisa Sweetman and Ziad Thotathil. The 2022 NZ ASM will be

convened by Dunedin and take place in Queenstown 5−7 August 2022.

RANZCR’s NZ AGM 2021 and the new Taku Taku At the start of the Annual General Meeting, which takes place at the NZ ASM, Dr Dana Tipene-Hook and I introduced the College's Taku Taku to the NZ membership. The Taku Taku has been shared with the College by Dr Tipene-Hook who is the NZ Māori representative on the College’s Māori Aboriginal and Torres Strait Islander Executive Committee (MATEC). Ngā mihi Dana. A Taku Taku is a chant used to open a meeting. The Taku Taku will be used to open College meetings. I want to thank all the attendees who did the Taku Taku with us. For those who were not there, the Taku Taku and the English translation are below. The AGM was followed by Joe Feltham’s presentation on the new CPD programme. Thanks to the members for

TAKU TAKU | NEW ZEALAND Taki uru Taki uru Taki uru Kare-ao te puru haeata Ki uta noa Kia tau, ka tau Ki te muri-ahotanga O te puna wananga e.....i..... Prepare to activate, ready oneself! Feel the rippling and dawning of understanding approaching, reaching, achieving, connecting, settling down/settled, relaxing in order to connect to the ancestral collective knowledge pool or spring of knowledge

sticking around for that presentation— I’d like to encourage everyone to get familiar with the new requirements. There is information on the College’s website and the College staff will be available to offer support during the transition.

Committee meetings While in Wellington for the NZ ASM, I attended a number of governance meetings including: the NZ Branch Committee, New Zealand Radiation Oncology Executive (NZROE) and the New Zealand Radiology Education Trust (NZRET). • The NZ Branch discussed ongoing member concerns in regards to ethical referrals and the importance of arm’slength referral. The consultation phase on the Ethical Referrals document has recently closed. I understand there have been more than 40 responses— the majority of respondents were supportive of the Ethical Referrals Discussion Paper. • The NZROE was concerned with a number of issues but particularly the RO vivas —the ongoing COVID situation in Australia is jeopardising the running of those exams. • NZRET met face-to-face, and had a good discussion on funding for education and training related projects. The Trust will be introducing a more transparent and formal process for applying for funding but if any NZ members (CR and RO) are seeking funding in 2021 for research or an education project, I would encourage you to email trust@ranzcr.org.nz Kia kaha. Stay safe, vigilant and strong. Volume 17 No 4 | September 2021

News

New Zealand Branch ASM 2021

Inside News

Education

Changes to RANZCR’s CPD Program Starting 2022 The Medical Board of Australia (MBA) and Medical Council of New Zealand (MCNZ) recently announced reforms to the regulatory requirements for registration in Australia and New Zealand, which will be mandated from January 2023. As a result, the College has been working to align our CPD program to meet the new requirements. This will mean 2022 will be a transition year for members, with the introduction of some of the new program requirements and introduction of a new CPD platform. In 2022 members will be transitioning to the requirements of the MBA and MCNZ: • Members will commence undertaking CPD on an annual cycle (rather than trienniums) • Members will complete a minimum of 50 hours of CPD per annual cycle (rather than points) • Members will be able to record CPD activities in any of the 3 broad categories (measuring and improving outcomes; educational activities; reviewing performance and reflecting on practice) • A Professional Development Plan (PDP) is required to be completed annually • If reporting MRI, eight CPD hours will be required (radiology only) • If reporting mammography, four CPD hours will be required (radiology only)

• A structured annual conversation activity will need to be completed by New Zealand members only (MCNZ requirement).

Introduction of Kaizen e-Portfolio (replacing the current CPD Learning Portal in 2022) The Kaizen e-Portfolio will be replacing the current Learning Portal platform at the beginning of the 2022 annual cycle. The Kaizen e-Portfolio will make it easier for members to log CPD hours, download certificates (for example, showing CPD participation) and will include other functions to log MultiSource Feedback and reflective practice activities. The new platform will be mobile friendly, allowing members to log their CPD activities and upload evidence from a smartphone or tablet. The overall contemporary design will also allow members to interact with the platform more easily.

Additional program changes commencing 2023

the minimum) in activities focused on reviewing performance and measuring outcomes, with a minimum of five hours for each category, and • the remaining 12.5 hours (25 per cent of the minimum), and any CPD activities over the 50-hour minimum across any of these types of CPD activity. If you have any questions about the upcoming changes to the College’s CPD program, please contact us via CPD@ranzcr.edu.au In addition, the upcoming RANZCR2021 ASM has a number of opportunities for members to learn more about these upcoming changes including: • Thursday 16 September, 3.30 pm Faculty of Radiation Oncology faculty forum • Friday 17 September, 8.30 am Changes to your CPD requirements from 2022 • Visit us at the College booth to ask a question or see a demonstration of the new CPD portal in action.

Members must meet minimum requirements across the 3 CPD Categories from January 2023: • at least 12.5 hours (25 per cent of the minimum) in educational activities • at least 25 hours (50 per cent of

Volume 17 No 4 | September 2021

IMAGE CREDIT: DESTINATION NSW

MEETING 2022 | ICC SYDNEY 26 - 27 MARCH

HYB RID MEETIN G

The ARGANZ Executive are delighted to announce they are planning a hybrid meeting in 2022, with on-site attendance at the ICC, Sydney and the opportunity to attend the meeting virtually. The program will include virtual presentations from our international experts with live Q&A, and planned on-site presentations by our impressive Australian and New Zealand faculty. We invite you to join us at ARGANZ 2022.

INTERNATIONAL GUEST SPEAKERS Alberto Vargas

Ania Kielar

Michael P Hartung

Perry Pickhardt

Chief, Body Imaging Service Memorial Sloan Kettering Cancer Center New York

Associate Professor Toronto General Hospital Department of Medical Imaging

Assistant Professor of Radiology Abdominal Imaging and Intervention University of Wisconsin School of Medicine and Public Health

ARGANZ Workshop Friday 25 March 2022 Planned on-site only

Scientific Posters All radiologists are invited to submit a poster relating to abdominal imaging. Share your research or present a review topic.

Professor of Radiology Chief of Gastrointestinal Imaging University of Wisconsin School of Medicine & Public Health

Mendelson Research Prize All RANZCR radiology registrars and fellows in training are invited to submit an abstract for the Mendelson Research Prize 2022. Oral presentations will fulfill the requirement for sign off of the RANZCR Project 2.

CONNECT WITH ARGANZ

KEY DATES 9 November 2021: Registration and Submissions Open 23 January 2022: Abstract Submissions Close 14 February 2022: Standard Registration Fee Applies

Search for arganz radiology @arganz_online arganz_online

News

The Australian and New Zealand Society for Paediatric Radiology (ANZSPR) ANZSPR Annual Scientific Meeting

forms can be obtained by emailing anzspr@ranzcr.edu.au

Given the ongoing impact that COVID-19 is having within Australia and across the world, the combined Melbourne and Adelaide ANZSPR 2022 ASM Convening Committee has taken the decision to postpone the ANZSPR ASM which was scheduled to take place in February 2022. Dates and details for the re-scheduled meeting will be made available when finalised.

Brief descriptions of the two roles are listed below:

ANZSPR election The ANZSPR executive committee is currently welcoming nominations from ANZSPR members and current committee members for the positions of President and Secretary of ANZSPR, to commence 1 January 2022. Nomination

ANZSPR President • two-year appointment (with option to continue for second two-year term) • lead the ANZSPR special interest group, with committee assistance, as per the Terms of Reference • chair regular telco ANZSPR committee meetings (two to three per year) • chair ANZSPR AGM (one per year) • promote paediatric imaging in the region • initiate representation to the College when required on paediatric imaging matters

• respond to College requests for clarification, review and guidance on paediatric imaging matters • co-ordinate ANZSPR newsletter, website updates and communication to the membership • liaise with the College regarding financial matters.

ANZSPR Secretary • three-year term • support ANZSPR President and committee • assist in minuting and chairing committee meetings and ANZSPR AGM • assist in production of newsletters and website updates • assist in conducting elections when required.

Obstetrics and Gynaecology Special Interest Group (OGSIG) Intrauterine Devices (IUDs) The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has contacted us asking for advice and assistance regarding the reporting of ultrasound assessment of Intrauterine Device (IUD) placement. They have raised the issue of inconsistent reporting of the placement of IUDs. This has led to unnecessary removals and re-insertions, or, conversely, incorrect reassurance of contraceptive efficacy if the device is low in the uterine cavity. It is also important to consider the type of IUD (i.e. copper or levenogestrol). The Clinical Guidelines on Intrauterine Contraception (see reference below) from the Faculty of Sexual and Reproductive Healthcare (FSRH) in the United Kingdom discuss the efficacy of IUDs when not fundally placed. While there is a lack of clear evidence, studies show that copper IUDs are more likely to result in contraceptive failure if they are dislocated than levonorgestrel-releasing

IUDs, particularly if the IUD is dislocated inferiorly near the isthmus or the cervix. Overall, the FSRH guideline group were of the opinion that contraceptive efficacy of non-fundally placed IUDs cannot be guaranteed, especially if the IUD is more than two centimetres from the fundal end of the cavity when measured with ultrasound. Thus ideally the distance from the fundal end of the cavity should be reported. The decision to remove and replace the device should be a clinical one and based on the type of IUD, and a discussion with the patient.

follow the guidelines in consistent and accurate reporting of IUD placement.

OGISG meeting Plans are underway to hold another OGSIG scientific meeting in 2022 following the success of the 2021 meeting. At this stage, this will be a hybrid meeting, with options to attend in person at the International Convention Centre in Sydney, or virtually. This will take place immediately before the ARGANZ meeting. Please diarise 25 March 2022.

Thus, consistent reporting of the distance from the fundal part of the uterine cavity to the superior end of the device is suggested.

As always—best wishes to all, and please do not hesitate to contact me with any queries related to anything regarding O&G imaging.

This may avoid unnecessary concern in patients, with unnecessary removal and re-insertion procedures, and more contraceptive coverage.

Dr Emmeline Lee emmeline@westernultrasound.com.au

There may also be medico-legal consequences of inaccurate reporting of these. As such, I would urge you to

Reference: Faculty of Sexual & Reproductive Health. Intrauterine Contraception: Clinical Guidance. 02/FSRH/Intrauterine/2015

Volume 17 No 4 | September 2021

News

The Interventional Radiology Society of Australasia (IRSA) 2021–2023 NEW Executive Committee A new IRSA Executive Committee was voted on at the recent Annual General Meeting, held on 30 June 2021. We are pleased to announce the following Executive Committee for a two-year period from 2021–2023. Dr Christopher Rogan – President Dr Brendan Buckley – Secretary Dr Radha Popuri – Treasurer A/Professor Gerard Goh – Past President We would like to congratulate the new Executive Committee members on their appointment. If you would like to contact them, please do so via the IRSA secretariat: secretariat@irsa.com.au

ASM 2021: Gold Coast Following a snap lockdown on the Gold Coast, the IRSA ASM was efficiently converted to a fully virtual meeting for delegates and sponsors. We are pleased to have been able to continue to hold the meeting virtually and deliver a highlevel scientific program. The New Zealand Hub in Queenstown was very well attended, and positive feedback received confirmed it as a success.

ASM 2022: QT Hotel, Queenstown Planning for the 2022 ASM is underway. The ASM will be held from 9–11 August 2022 at the QT Hotel, Queenstown. Please save the date. Convenors, Professor Buckenham and Dr Lau are working with events management and the IRSA secretariat on the program. We look forward to providing you with more information over the coming months and welcoming you to Queenstown next year.

We would like to thank all delegates for their patience as we transitioned to a virtual meeting. The recorded lectures are currently being edited and will be made available to delegates and sponsors shortly. Certificates of attendance are being sent via mail.

Former Past President, Dr John Vrazas, was acknowledged for his dedication, passion and for the corporate knowledge he has brought to the roles of President and Past President over the past four years.

S AV E T HE DATE

PROGRAM HIGHLIGHTS INCLUDE: PARALLEL PROGRAM Neurointervention Diagnostic Neuroradiology/Head and Neck Radiology REVISION COURSES Neurointervention Diagnostic Neuroradiology Head and Neck Radiology

10-13 MARCH

2022 HILTON HOTEL SYDNEY, AUSTRALIA REGISTER YOUR INTEREST Please contact: NC Events ncosta@ncevents.com.au

www.anzsnrasm.com

Inside News

News

~ In Memoriam ~ The College notes with regret the death of the following members: Dr Ross Dwyer, Educational Affiliate, NSW

Cardiac CT Training 2021

2021 COURSE DATES:

We go beyond simply meeting training requirements: ●

●

117.5/67 RANZCR CPD points available for the course

On-line Courses ONLY

NOW OFFERING

Due to Covid

2021 COURSE DATES:

ULAR CT

WATCH THIS SPACE: www.aicct.com.au

Closing date for registrations is: Tuesday 30 November 2021

AS C

TITU

22nd C - 24th October 2021

The course will be of particular value to registrars and candidates preparing for the Part II FRANZCR examination. It will also provide an overview of pathology for practising radiologists who are encouraged to attend.

A I CC AUS T R ALI AN

S UR

12 & 13 FEBRUARY 2022 The Division of Medical Imaging at Flinders Medical Centre will offer a two day Pathology Course, consisting of lectures and “pots” sessions to be held on Saturday 12 and Sunday 13 February 2022 at the Adelaide Convention Centre.

TRAINING

5 Day Level A CourseULL 20th - 24th May 2021 SF

FLINDERS MEDICAL CENTRE PATHOLOGY COURSE

T E OF C A R

For 2022 Face to face and online courses info@aicct.com.au

For registration form and further information please contact Helen Sainsbury: helen.sainsbury@sa.gov.au / (08) 8204 4405

Volume 17 No 4 | September 2021

General Interest

Great Savings and Rewards for Members

Medical Wealth Advisory: Lending and Financial Planning College members across Australia can now receive substantial benefits and discounts in the areas of Finance and Lending, and Financial Planning Services. As a specialist service for medical professionals, Medical Wealth Advisory provides a wide range of innovative and integrated financial solutions.

Finance and lending Medical Wealth Advisory offers a comprehensive range of finance and lending services including: • • • • •

Home Loans Investment Property Loans Commercial Property Loans Business Lending and SMSF Loans.

With loan products available from many lenders, our focus is on selecting and delivering the best solution for each member, rather than offering lending products from just one financial institution. For College members, finance solutions are also available for: • • • •

motor vehicles medical equipment office fit out and business cashflow.

Medical Wealth Advisory provides access to numerous lenders offering bespoke solutions adaptable to individual members requirements.

Financial planning

NobleOak Life Insurance

Medical Wealth Advisory develops and implements specialist Financial Planning advice covering investment advice and management, business advisory and entity structuring, tax planning, personal insurances, superannuation and SMSF management and estate planning.

Did you know our Life Insurance partner NobleOak only offers fully underwritten cover?

What sets Medical Wealth Advisory apart from other firms is their Fusion program. Through multiple complimentary consultations, College members will have the opportunity to explore the specialty advice services available, quantify the value that can be delivered by the service and understand the process involved in implementing them. Members who proceed with these services receive exclusive discounts on any implementation or ongoing advice fees applicable to these services.

Contact To learn more about what’s available and how to access the offers visit www.ranzcr.com/ college/member-rewards or www.medicalwealthadvisory.com. au/ranzcr/ or phone Medical Wealth Advisory on 1300 41 81 61.

This means that they ask a number of health, occupation and lifestyle questions upfront resulting in more certainty at claim time. NobleOak processes claims in 5 business days on average. College members receive your first month free until 31 August.* Plus a 10 per cent lifetime discount on Life cover.*

Obtain a quote here: https:// quote.nobleoak.com.au/ranzcr/ *Terms & Conditions apply. Consider the PDS. AFSL 247302 ABN 85 087 648 708. Visit https://quote.nobleoak.com. au/ranzcr/ for full details including offer details. Other Member Rewards offers We also have unique Member Rewards offers from Tesla, The Accommodation Brokers, Unsworth Legal, BUPA, Mercedes Benz, Europcar, and BMW/Mini. Access our full Member Rewards Program: www.ranzcr.com/college/memberrewards

Inside News

Ingenia Ambition 1.5T

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Discover helium-free MR operations at www.philips.com/ambition

1. Compared to Philips scans without Compressed

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