Inside News December 2023 by RANZCR

Volume 20 No 1 | December 2023

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

The Last Hurrah

“Be happy with being good at what you do, but above all be happy to do good for others.” —President Sanjay Jeganathan

Also inside

The ASM Special Issue Event highlights from Brisbane

AI Misses How to identify and report adverse events

Equitable Cancer Care Exploring implicit bias in hospitals

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ASM Special Wrap-up

Contents Volume 20 No 1 — December 2023

4 Message from the President Clin A/Prof Sanjay Jeganathan’s final note. 7 Message from the CEO Duane Findley recaps the AMC’s mid-term review.

Features 8 AI Reporting What happens when AI software doesn’t perform as it should? 10

Equitable Cancer Care An interview with Indigenous Health Research Prize winner Dr Ieta D’Costa.

Doctors in Harmony Meet some of the talented members of The Australian Doctors Orchestra.

News 33

Change Before You Have To What you need to know about new Structured Reporting Guidelines.

14 ASM Special Wrap-up A recap of Brisbane 2023 —the biggest event in College history.

39 Group Effort Updates from the College’s SIG Working Group.

Training & Education

Workshops & Courses Event dates to save in your 2024 calendar.

New Horizons A one-on-one with the Editor in Chief of JMIRO.

Chief of Professional Practice Message CTCA Training Guidelines review and CPD reminder.

Radiation Oncology 46

Dean’s Message Updates on new Accreditation Standards and the Biennial Facility Survey.

Chief Censor’s Message A special letter of thanks from Dr Lisa Sullivan.

Clinical Radiology

Resources for Wellbeing Dr Jen Chang recommends books, podcasts and apps for professional growth.

42 Dean’s Message Industry insights shared from the Clinical Radiology Faculty Forum in Brisbane.

Chief of Professional Practice’s Message Details on the launch of the FRO Mentoring Program.

CPD Deadline 2023 Have you started entering your CPD activities yet?

44 Chief Censor’s Message A look back at the achievements of 2023.

Trainee Matters Dr Tracy Lim’s final letter as Chair of the ROTC.

Inside News is published quarterly. For enquiries, feedback or to contribute to Inside News, email editor@ranzcr.edu.au EDITORIAL STAFF Editor-In-Chief Dr Allan Wycherley In-House Editor Arizona Atkinson

RANZCR acknowledges the Traditional Owners of Country throughout Australia. We recognise the continuing connection of Aboriginal and Torres Strait Islander people to the sky, lands, waters and culture and we pay our respect to their Elders past and present and emerging. RANZCR acknowledges Mäori as tangata whenua and Treaty of Waitangi partners in Aotearoa New Zealand. 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. Inside News © 2023 The Royal Australian and New Zealand College of Radiologists® (RANZCR®)

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Volume 20 No 1 | December 2023

President’s Message

The Farewell

In his last letter before handing over to his successor (the esteemed Prof John Slavotinek), President Sanjay Jeganathan reflects on his term.

Clin A/Prof Sanjay Jeganathan

hen I assumed the presidency two years ago, my predecessor Lance Lawler gave me valuable advice: “Don't stuff it up”. Serving as President of our fine College is an immense honour for anyone, and an immense burden too—one to be soon lifted from my shoulders. I am grateful for the honour and relieved for the lighter load. Looking back, I worked hard on behalf of the College and did my best not to stuff it up, and I sincerely hope most of my colleagues concur. My presidency was, much like Lance’s, indelibly marked by the Covid pandemic. As we emerged from the worst and immediate disruptions, it became clear that the College was facing severe financial headwinds with a large and rapidly growing deficit between the fees collected from trainees and the cost of providing the training and assessment platform. While the Fellows have always subsidised the trainee program by 30-35% and most are happy to do so,

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the growing size of the subsidy was becoming untenable. In the interests of the entire membership and for the long-term sustainability of the College, the Board was compelled to make difficult decisions on membership, training, examinations and other fees. The new trainee fee structure introduced in 2022 created some understandable anxiety. Along with the new fee structure, the Board made sure that there were appropriate mechanisms put in place to assist trainees in financial hardship; these mechanisms were used by a number of trainees. We have always been and continue to be an organisation that shows compassion for those in difficulty. When some members questioned these increases, the College took the opportunity to explain the situation that led to the increases, how the fees measured against other colleges and higher learning institutions, and how the Fellows continued to subsidise the program. Most members understood and supported the position taken by the Board and the College. A minority of trainees and a few members still do not agree with this position and that is of course their right to disagree. The Board decision was partially borne out by the Australian Doctor

article from earlier in 2023, that set out just how many colleges were in financial difficulty, with one larger college placed into administration. The article noted that RANZCR was in a sound financial position, among a minority of colleges. Our volunteer members who put their hand up to work for the College often do so at a personal cost, either monetary or time—or both. This often goes unrecognised. When you are the President of the College most complaints are aimed at the individual as if he or she is doing something deliberate to damage the profession. Each of my predecessors and I bare scars from battles with people who wanted to advance their own agenda at the expense of the wider profession. The irony is such members mostly exert pressure on the College to act on their behalf when events that have nothing to do with College’s core business affect their back pocket. It takes a fair amount of time and energy handling these matters, and without such distractions the role of the President would be much more enjoyable. The highlights of my term were professionally and personally satisfying. Among them stands the establishment of a taskforce on diversity, equity and inclusion

“The highlights of my term were professionally and personally satisfying. Among them stands the establishment of a taskforce on diversity, equity and inclusion (DEI), under the leadership of Prof Liz Kenny.”

From left: RANZCR past presidents: Prof John Earwaker, Clin A/Prof Sanjay Jeganathan, Prof Liz Kenny AO, Prof Dinesh Varma, Dr Barry Moore, Dr Gregory Slater.

(DEI), under the leadership of Prof Liz Kenny. I believe the outcomes of this initiative, properly supported by the membership, will ensure the College is more diverse in its representation, impartial in its deliberations and more responsive to the needs and views of all members. As someone who has witnessed violent discrimination and intolerance first-hand in my life, I know that this is the right path for the College to follow and one that I believe will strengthen the organisation and ensure our future. The immediate task is an internal one for RANZCR, but ultimately, we need to use our influence and privilege as professionals to help foster a fairer world where everyone has a chance to succeed. Related to the DEI initiative was the establishment of a nominations committee of the RANZCR Board to oversee Board and Council elections, assess the competencies of directors and councillors, develop succession plans and maintain a balance of experience, expertise

and diversity. The other structural changes made to the Board include the direct election of a member from New Zealand and appointment of an independent chair to the Board. These changes will place the Board in a strong governance position for years to come. During my term, I am pleased we managed to create a regional training program to train Radiation Oncologists and Clinical Radiologists outside metropolitan areas with the hope of addressing the maldistribution of workforce in Australia and New Zealand. This project is in its infancy and will no doubt grow with more government funding. Last year I worked closely with American College of Radiology (ACR) President Howard Fleishon on an ambitious plan to create a multi-society collaboration between RANZCR, ACR, ESR, RNSA and CAR to develop a paper on artificial intelligence in radiology. That important paper is

expected to be in print soon. I am very proud of this achievement. No technological advance looms larger for us than that of artificial intelligence and the various tools derived from machine learning. At the recent AI Safety Summit in the UK, 28 nations, including Australia, issued a communique calling for AI that is “designed, developed, deployed, and used, in a manner that is safe, in such a way as to be human-centric, trustworthy and responsible”1. ‘Human-centric’ is a term that signifies a purpose—i.e., serving humans—in the same sense we medicos use the term ‘patient-centred’, meaning that our medicine has to serve the patient’s interests first. When we speak of low-value medicine we refer to a loss of this purpose, and we need to remind ourselves that the machines have only the purpose and values we build into them. We also need to be able to trust the answers AI generates and that someone is held responsible for those answers, right or wrong. Such is the potential

Volume 20 No 1 | December 2023

President’s Message Clin A/Prof Sanjay Jaganathan with incoming President Prof John Slavotinek.

“Brady’s message for radiologists fearing replacement in an increasingly competitive and commodified workplace was simple and direct: ‘Embrace your inner clinician!’”

power and scope of AI to serve good, we need guardrails to protect us from its potential to do harm. In his overview of the good, the bad and the ugly in 21st-century radiology at our ASM in Brisbane, Prof Adrian Brady, board chair of the European Society of Radiology (ESR), delineated the various implementations of AI in science and medicine, including its use to write and edit text (mostly a good thing), the creation of fake data (surely bad), and research into eliminating key roles in radiology (downright ugly). The antidote, at least in part, for the unwanted side-effects of AI might be with our patients. At present there is a disconnect in patient-radiologist relationships, in particular among our solely diagnostic colleagues. A 2019 survey by ESR found that 74% of patients valued the radiologist being available to explain a

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diagnosis while a third of patients were dissatisfied with the lack of availability2. Contrast that with a 2017 survey in which a minority of radiology trainees considered patient contact very or extremely important and 22% felt it was of little or no importance3. Brady’s message for radiologists fearing replacement in an increasingly competitive and commodified workplace was simple and direct: ‘Embrace your inner clinician!’ I am very grateful to my fellow Board Directors Drs Christian Wriedt, Peter O’Brian, Rajiv Ratten, Gerry Adams, Gabriel Lau, Ms Yvonne Warner and Prof John Slavotinek. Without their unwavering support and encouragement, all that we have achieved would not have been possible. I cannot be thankful enough for the warm and friendly working relationship I developed with our formidable CEO Duane

Findley, who was my comrade in the trenches and helped me along the way to achieve great things. Needless to say, behind him are our wonderful, dedicated and hardworking staff, and I am ever so grateful to them all. I strongly believe the biggest threat to our profession remains within ourselves. We are among the best-paid workers in the healthcare sector—there's nothing wrong with that, nor with being ambitious for yourself in your career. But if we allow the pursuit of money to guide our career decisions, we will impoverish the profession and kill our love for medicine. This is more relevant than ever before, with the expansion of corporate and private equity ownership of radiology and radiation oncology businesses. There is an insatiable appetite to create innovative and at times unethical ways to bill patients. This is damaging our profession and will ultimately cause further decline in the trust placed upon us by our patients. I could scarcely end my last message on a more salient point. As I have argued throughout my presidency, as clinicians we occupy a lofty position in society, one that comes with high-minded responsibilities. By all means be happy with being good at what you do, but above all be happy to do good for others. IN

UK Government, ‘The Bletchley Declaration,’ 1–2 November 2023, https://www.gov.uk/government/ publications/ai-safety-summit-2023-the-bletchleydeclaration/the-bletchley-declaration-bycountries-attending-the-ai-safety-summit-1-2november-2023 2 ESR, ‘Patient survey of value in relation to radiology: results from a survey of the European Society of Radiology (ESR) value-based radiology committee,’ Insights into Imaging, vol. 12, article 6 (2021), https://doi.org/10.1186/s13244-020-00943-x 3 Nassim Parvizi and Shaheel Bhuva, ‘A national UK survey of radiology trainees special interest choices: what and why?’ British journal of radiology, vol. 90, no. 1079, article 20170338 (2017), https://doi. org/10.1259/bjr.20170338 1

CEO’s Letter

AMC Results

Behind the scenes of the AMC’s highly successful August review.

Duane Findley, CEO

uring 2023, the Australian Medical Council (AMC) conducted a mid-term review of RANZCR’s training and assessment program. RANZCR delivers its trainee selection, training, education, assessment, IMG and CPD program under a set of AMC standards that apply to all specialist medical colleges. As the regulator, the AMC will require the College to meet specific Conditions (which must be satisfied by the College within a specified timeframe) and Recommendations (which only need to be considered by the College) against the AMC standards. The AMC liaises closely with the New Zealand Medical Council (NZMC) for those colleges operating across both countries. RANZCR provides a detailed annual written report to the AMC on its progress against each of the Conditions and Recommendations. At intervals, the AMC subjects each college to an interim or full review, which consists of surveys, stakeholder feedback, site visits across Australia and New Zealand, and extensive in-person interviews

with staff and member committees. RANZCR fully supports the aims of the AMC and NZMC and has built a professional and respectful working relationship with both regulators at multiple levels. The AMC review is an excellent opportunity to check the College is moving in the right direction and to hear insights on how other colleges are delivering their training and assessment programs. Preparing for, and participating in, this midterm review involved months of preparation from the RANZCR Specialty Training Unit, Standards Unit and other teams, as well as a huge amount of effort from many member volunteers. The AMC applies a user-pays philosophy for these reviews and invoices RANZCR for the costs incurred. The direct financial cost of an AMC review to RANZCR is considerable, as are the opportunity costs as College resources are directed towards preparing for and satisfying the requirements of the review. The outcomes of an AMC review can be momentous. The AMC could close, re-write, extend, or impose new Conditions and Recommendations. It could extend or reduce the timeframes for another interim or full review. In a worst-case scenario, the AMC could withdraw college accreditation for its program. Following the August visit, the AMC produced a draft report and met with RANZCR. The report was then assessed by an internal AMC committee to ensure it was consistent with reports from other colleges, and the outcome has been shared with RANZCR. While this report needs to be formally endorsed by the AMC’s parent body, the Medical Board of Australia, the results are excellent.

The AMC noted the solid progress RANZCR has made towards satisfying its remaining Conditions from the 2019 AMC report. The review closed a number of full Conditions and Recommendations; and parts of other Conditions. As a result of RANZCR’s strong performance, the AMC has deferred our scheduled full AMC review until 2027 subject to satisfactory annual reports. If these reports demonstrate continued progress towards satisfying remaining Conditions, then the AMC will invite RANZCR to apply for this full review to be deferred until 2030, which is the 10-year maximum between full reviews. The review of our CPD program also resulted in the program being accredited through to 2030. This is an outstanding result and confirms the quality of RANZCR’s program. It is also a reflection of the commitment of our staff and members in delivering a world-class training and assessment program. Due to the size and scope of an AMC review, large segments of our staff and membership worked closely together towards a common goal. The buzz in the office was palpable during this time and one senior Fellow commented that it felt like “being part of a family”. There was certainly an energy and sense of purpose in the air! The AMC review has identified areas that it requires RANZCR to deliver against, especially around selection into training and programmatic assessment. Thank you to everyone, members and staff, who contributed to this highly successful AMC review. IN

Volume 20 No 1 | December 2023

Feature

Reporting Artificial Intelligence Devices

What happens when AI software doesn’t perform as it should? Here, RANZCR’s AI Committee, together with the TGA, offer guidance on identifying and reporting adverse or near-adverse events in clinical practice.

he use of artificial intelligence (AI) is growing rapidly and may transform medicine by improving care for patients. Radiology and radiation oncology are at the forefront of medicine, and our specialties have been early adopters of technology, and now AI. During recent communication between the Therapeutic Goods Administration (TGA) and RANZCR, the importance of reporting AI adverse events and near misses was discussed. This article, a collaboration between the TGA and RANZCR’s AI Committee, is intended to provide our members with information to help them manage and report any concerns about Software as

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a Medical Device (SaMD). The use of AI is not without risks. Responsibility to ensure safe patient outcomes rests with the medical team and they must be aware of the potential hazards of working with AI. This burden falls mostly on the reporting radiologist or treating radiation oncologist who may have incomplete knowledge when deciding whether to integrate output from AI software into patient care. The radiologist or radiation oncologist may not know the origin or quality of the data used by the AI software, the patient demographics used in its training data, or other technical issues associated with the software such as automation bias.

Bias is a known issue in many AI products. Therefore, the process of selection and implementation of an AI system must have appropriate governance oversight, and information on the AI system must be acquired and disseminated to ensure that users are adequately informed about any limitations. The accuracy of AI is highly dependent on the population, type and volume of the data used during its development (this includes training, testing, tuning and validation). The target population for the AI may be dissimilar or completely different from the training population. In such situations, AI performance can

deteriorate and lead to potential patient mismanagement and poor patient outcomes. This can occur if the AI software is applied to a different population or if the existing population characteristics change (population drift, for example, as the population ages). Internationally, medical devices using AI technology are often regulated under the umbrella of SaMD (i.e. medical device software that runs on a PC, smartphone or tablet), but it can also be regulated as software that controls or is part of a medical device—this is the case in Australia and NZ. While regulators approve the initial use of a device in a certain country, they will also manage post-market surveillance. In Australia, the use of SaMD is overseen by the TGA. The New Zealand government has passed the Therapeutics Products Bill which extends the scope of a “medical device” to include the new concept of “software as a medical device”, and this bill is expected to come into effect from mid-2026. While this article focuses on the Australian perspective, the same monitoring and reporting principles should be considered when using AI in New Zealand. When AI technology works as expected, it may alleviate workload or transform workflows, but what happens when AI does not perform as it should? Or if the reporting radiologist or treating radiation oncologist is concerned about whether the AI software program is performing as it should? The RANZCR Standards of Practice for Clinical Radiology (with Practice Standards for AI in Radiation Oncology due to be published in the near future) consider it important that the practice has systems in place to monitor AI outcomes, and when they are sub-optimal, to take appropriate action. Additional actions, if the radiologist or radiation oncologist is concerned,

may include the reporting of adverse events and near-misses. This may include indirect harm resulting from any clinical decision or action taken or not taken based on information provided by the SaMD. The TGA advises that individual radiologists, radiation oncologists, practices, hospitals or health services do not need to identify causality between a medical device and an adverse event (or near-miss), or to recognise a pattern of malfunction, before making a report. User errors including user interface issues, and inadequate labelling and instructions for use can also be reported.

What is an adverse event?

Under its “Incident Reporting and Investigation Scheme” (IRIS) the TGA can investigate cases where AI has failed to act appropriately and take action to ensure that the situation does not repeat itself. The TGA defines an adverse event as an event that led to: “the death of a patient, user or other person; or a serious injury or serious deterioration to a patient, healthcare provider, user or other person”. A near-miss adverse event is an event involving a medical device that, in this instance, did not lead to death or serious injury, but such death or serious injury could have occurred if there had not been an intervention. For an event to be defined as “near adverse”, it is considered by the TGA to be sufficient that: an event associated with the device happened if it occurred again, it might lead to death or serious injury testing or examination of the device or the information supplied with the device, or scientific literature indicated some factor that could lead to a death or serious injury. Circumstances could include: The AI findings being incorrect, but the radiologist detects the error and corrects the diagnosis

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A radiologist independently evaluates images and reaches a different conclusion to the AI. A second opinion delivers different diagnoses to the AI leading to a review of the findings. Any of these may have led to delayed or no treatment if the AI findings are not reviewed in a timely manner by the radiologist.

Why do you need to report?

The TGA engages in post-market monitoring and surveillance of medical devices on the Australian market and has powers to act when they do not perform appropriately. Reporting malfunction or underperformance of devices to the TGA can lead to increased patient safety and continuous improvement of systems and quality control. The TGA is a central repository for all reported issues, enabling it to recognise patterns of malfunction that might not be evident within individual practices, hospitals or health services. As well as collecting and analysing adverse event information, the TGA can communicate safety alerts, recalls or educational resources to the sponsors, manufacturers, health professionals and consumers concerning devices of concern. IN

How to report events: If you witness an adverse event or near miss you should report it to the relevant regulator. In Australia, this can be done via the online form on the TGA’s IRIS webpage: www.tga.gov.au/ resources/resource/guidance/ medical-device-incidentreporting-investigation-schemeiris In New Zealand, you can submit via the online form on the Medsafe website: www. medsafe.govt.nz/regulatory/ DevicesNew/9AdverseEvent.asp

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Feature

Indigenous Health Research

Equitable Cancer Care

RANZCR Indigenous Health Research Prize winner Dr Ieta D’Costa shares insights into the issue of racial bias in healthcare.

T Dr Ieta D’Costa email: dcosta@ monash.edu

he purpose of the RANZCR Indigenous Health Research Prize is to promote research and publication as an incentive for excellence and recognition. The Prize has been offered to College members since 2019 in order to promote and recognise excellence in Indigenous Health Research. This year, the prize has been awarded to Dr Ieta D’Costa. Her Australian Health Review article, published within a special section on Aboriginal and Torres Strait Islander Health, is titled ‘A racial bias test with tertiary cancer centre employees: why anti-racist measures are required for First Nations Australians cancer care equity’. In this article, she examines implicit bias in employees at a Victorian hospital, using an Australian race Implicit Association Test, in an attempt to understand a potential factor for inequitable outcomes of First Nations patients. Dr D’Costa has recently retired, having worked as a radiation oncologist at the Peter MacCallum Cancer Centre in Melbourne. She is continuing research to better understand how bias and prejudice affect health outcomes. We sat down with Dr D’Costa to talk about her research.

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How did you begin the project? My initial plan was to research the high rates of incarceration among Aboriginal youth. As is now customary, prior to starting any research involving Aboriginal and Torres Strait Islander Peoples, I spoke with members of the Aboriginal community to see what they considered important to look at. I met with six Elders and leaders at the university and in southeast and central Melbourne. They noted that cancer is a major and growing problem for Aboriginal peoples but that despite this, they do not generally attend major metropolitan and regional hospitals for treatment. It was suggested to me that with my personal and professional experience of having lived and worked in both colonised

Indigenous Health Research

and colonising nations, the most beneficial research may be in exploring why Aboriginal peoples tend not to attend hospitals for illness including cancer. One of the leaders told me of a young Aboriginal woman, who was misdiagnosed at a regional hospital ED despite 18 visits in seven months. She died on the final visit, with sepsis. Such deaths are not rare events for Aboriginal peoples. At that inquest, for the first time, the question of racism as a contributing factor was raised. These invaluable yarns were instrumental in determining my PhD research topic—racism in healthcare.

Why is this research important? Health outcomes for Aboriginal people in Australia are desperately poorer than for other Australians. This is not something that is ‘just the way it is’, it is a consequence of the systems and policies of settler colonisation. We know that Aboriginal peoples in Victoria experience racism—four times more than other groups. In another study, nearly 30 per cent of people surveyed described racism in a healthcare setting that led to high or very high distress. Racism affects the health of individuals and communities. This is not unique to Victoria. I think that as health workers, we like to believe we provide equal care to everybody irrespective of who they are. However well-meaning our intentions, equitable care should be our aim. And to deliver that, we need to understand the history and socio-political context of how healthcare was set up and continues to run in Australia. Settler colonialism exerts effects on all of us: Aboriginal peoples, healthcare workers and our society. So, while this paper documents the presence of racial bias in employees at one hospital in Australia, it is really important to stress that this is not unique to Melbourne, or Victoria, or Australia. Of over 20 million race-

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“However well-meaning our intentions, equitable care should be our aim. And to deliver that, we need to understand the history and socio-political context of how healthcare was set up and continues to run in Australia.” based Implicit Association Tests, worldwide, all show bias towards Aboriginal peoples and/or people of colour to about 68 per cent, and 14 per cent towards white people. What I hope readers take from the paper is not the score of bias. It is that bias and discrimination are not something that affects bad, nasty people, but a systemic effect, the result of an imposed settler colonial worldview. That worldview can lead to learned behaviours for individuals and societies, and plays a role in the inequities faced by Aboriginal peoples.

How can RANZCR continue to support this research?

The effects of colonisation are very much in the present. Associations like RANZCR can open up discussions by having, for example, sessions at conferences

allocated to measures of equity and assessments of such measures in rectifying health injustice.

What are you working on now? I am currently writing up the qualitative part of my PhD on how racism is perceived by hospital staff. This has been quite illuminating. I have come to see that racism is not an uncommon experience for staff of colour, from patients and also other staff. There appear to be policies in place for patient-to-staff racism, though it seems that much goes unreported. Staff-to-staff racism is more invidious, often in the guise of supposed humour. That is something I would very much like to explore further. If there are people who are interested, either because of what they have experienced or witnessed, I would welcome an email. It would be confidential. IN

Interaction Institute for Social Change | Artist: Angus Maguire

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Feature

Music and Medicine

Doctors in Harmony

Music and medicine unite The Australian Doctors Orchestra, a non-profit organisation that donates its concert proceeds to charity. We find out more from some of the RANZCR members involved.

Dr Yvonne Ho AM

Dr Xavier Yu

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he Australian Doctors Orchestra (ADO) is a unique national fellowship of medical professionals who are also classically trained musicians. We have more than 700 members and aim to perform at least once a year in a different capital or regional city. Since our first concert in 1993, the orchestra has played a concert every year (with the exception of 2021) and in every Australian state and territory, using each occasion to raise funds for charity. Up to 100 medical professionals from all around Australia share two days of final rehearsals culminating in a performance on a Sunday afternoon, featuring acclaimed soloists and providing exciting orchestral performances. This year, four of its players included RANZCR Clinical Radiology members Dr Xavier Yu (violin and also the incoming ADO President-Elect), Dr Yvonne Ho (piano and percussion) and Dr Shu Su (violin), as well as Radiation Oncology member Dr Kendrick Koo (French horn). In October, we celebrated our 30th anniversary with a concert in Melbourne under the baton of upcoming conductor Ingrid Martin, who was also previously a

Music and Medicine

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The Australian Doctors Orchestra with conductor Ingrid Martin.

practising medical doctor. ADO performed several Australian contemporary music pieces for the event, including works by composers Nat Bartsch and Maria Grenfell, and the Graeme Koehne “Inflight Entertainment” concerto with emerging oboist Briana Leaman. The concert concluded with a more traditional classical work, the iconic Saint-Saens Organ Symphony featuring organist Roslyn Carolane. As well as playing to a near-capacity audience of about 400 people, the ADO undertook its inaugural virtual presence via the Australian Digital Concert Hall (ADCH) across the country. Proceeds from concert ticket sales go to charity, and we have overall raised approximately AU$600,000 for many worthy organisations since our inception in 1993. This year’s charity was the Hush Foundation, founded by Professor Catherine Crock, with a vision to transform the culture of healthcare through music and the arts. The anniversary concert raised approximately AU$12,000, representing the largest amount Hush has raised at a single fundraising event.

We depend on our members to organise concerts, and are planning for future performances in Toowoomba in June 2024 and Sydney in 2025. Further information is available on our website www.ado.net.au. IN

Members of RANZCR who played at the 30th anniversary concert this year. From left to right: Dr Kendrick Koo (radiation oncologist, French horn), Dr Xavier Yu (radiologist, violin), Dr Yvonne Ho (radiologist and nuclear medicine specialist, piano and percussion), Dr Shu Su (radiologist, violin).

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ASM Special

The Wrap-Up

Missed the 2023 ASM? Here are just some of the highlights from the action-packed, three-day event in beautiful Brisbane.

Clockwise from top: President Sanjay Jeganathan’s address; Prof Elizabeth Dick; the Hollywoodthemed Gala dinner; a clinical radiology session in action; Dr Emmeline Lee and Dr Lucinda Morris.

Wrap-up

ASM Special

n Thursday 19 October, the stately Brisbane Convention & Exhibition Centre opened its doors for RANZCR’s 2023 Annual Scientific Meeting (ASM). More than 1,500 delegates descended on South Bank over the three-day event, which featured 350 exhibitors and sponsors and more than 80 exhibition booths—the biggest ASM in the College’s history. The official program kicked-off with an opening address by RANZCR President Clin A/Professor Sanjay Jeganathan. The President’s address was followed by Li Cunxin AO; this year’s Nisbet Orator. Li, Queensland Ballet’s Artistic Director and author of autobiographical bestseller Mao’s Last Dancer, delivered a heartening speech focused on the theme of ‘resilience’ as he recounted his journey from poverty-stricken Maoist China to international ballet stage. The College’s two faculties were well represented in their dedicated streams. Clinical radiology sessions included: ‘AI in Radiology Practice’; ‘Why Young Athletes Die (Cardiac)’; ‘Nuclear Medicine in the 21st Century’; and ‘Wellness, Diversity and Breast Cancer Screening’. Meanwhile, radiation oncology sessions included ‘Ageism in Cancer Care’; ‘Training Radiation’; and ‘Therapists in Papua New Guinea’. This year’s ASM was the first to also have a separate stream dedicated to interventional radiology/interventional neuroradiology (IR and INR). Prof Andy Adam from the University of London presented ‘A Faculty of Interventional Radiology: Dreamtime or Primetime’ as part of the new stream. Other renowned international speakers included Prof Elizabeth Dick (Consultant Radiologist and Professor of Practice at Imperial College NHS Trust), who spoke on post-partum emergency imaging, and physician-scientist Prof Sean Collins discussing SBRT for retreatment of radiation failures. A well-attended Women in Leadership Breakfast heard from Silvia Damiano (Scientist, Founder and CEO of

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ASM Special

Wrap-up

Clockwise from top: Prof Dinesh Varma with Prof Liz Kenny AO and Prof Andy Adam; co-convenors Dr Angela Allen and Dr Tuan Ha; the Board of Directors at the 2023 Annual Ceremony.

About my Brian Institute), A/Prof Catherine McDougall (Chief Health Officer Clinical Excellence Queensland) and former RANZCR president Prof Liz Kenny AO. An all-star female panel discussed the importance of wisdom, resilience, vision and authenticity. Attendees also heard from Prof Kenny about focused efforts RANZCR is making to enhance diversity, equity and inclusion—more on this in the coming year. This year’s Clinical Radiologist Faculty Forum saw a panel of four debate the latest international developments in the specialty, including the role of AI and international collaboration, while a debate on whether brachytherapy is a better investment for the future than SABR was the focus of the Radiation Oncology Faculty Forum.

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The ASM closed in style on Saturday night with a Hollywood-themed Gala Dinner. Black-clad paparazzi snapped attendees as they arrived on the red carpet before heading into the Plaza Ballroom for an Oscarworthy three-course meal. President Jeganathan’s address highlighted the overwhelming success of the Brisbane ASM and encouraged delegates to come to next year’s conference in Perth. A preview of the 2024 ASM was delivered by our new organising committee, who have given it the theme of ‘A Gathering Under the Stars’. We are grateful to all our speakers, sponsors, exhibitors and, of course, our Brisbane organising committee for contributing to a fantastic 2023 ASM. See you in Western Australia next year! IN

Wrap-up

ASM Special

2023 ASM Sponsor Grant Winners

ore than 1,500 delegates attended the 2023 Annual Scientific Meeting in Brisbane recently. Among the crowds were an unprecedented number of ASM Sponsor Grant recipients. This year, nine young First Nations medical students from across Australia and New Zealand attended the conference thanks to their College grants, which assist with covering the costs associated with their registration, travel and accommodation. This initiative is part of our long-term commitment to achieve equitable health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples and increase representation in our future workforce. The ASM Grant has been a great incentive for First Nations Peoples at the start of their professional journeys, and the winners were exposed to three days of clinical radiology and radiation oncology sessions at the event. They also met with RANZCR President Clin A/Prof Sanjay Jeganathan, CEO Duane Findley and College staff, and joined in a lively discussion about the professions and their future specialist choices. RANZCR’s vision is for equitable health and workforce outcomes for Māori and Aboriginal and Torres Strait Islander Peoples. To encourage more First Nations doctors to consider a career in radiation oncology or clinical radiology, the ASM Grant was established in order to provide an immersive experience to learn more

about our professions and provides insight into recent advances and the latest research. It also provides an invaluable networking opportunity to connect with RANZCR Fellows. Sponsor Grant winner Eddie Richardt is a fifth-year medical student at the University of Auckland, and a member of Te ORA, the Māori Medical Practitioners Association. “I believe that attending the 2023 RANZCR ASM in Brisbane is an essential step towards my professional growth and IR career aspirations as it offers a unique platform to engage with leading experts who understand the field’s direction and potential impact in healthcare and can showcase the diverse procedures available,” said Mr Richardt. “Discussions with radiologists can help to clarify my career path, identify research opportunities, and help me learn about training programs. Additionally, it may also provide me with the chance to gain a mentor.” Mr Richardt suggested a forum “in which RANZCR could promote radiology medical practitioners as specialist doctors to increase public awareness and respect among colleagues as to our role. It’s important to note that it is all about how RANZCR and the profession is framed by us and thenceforth, how it is perceived by the general public and others.” For enquiries about the ASM Sponsor Grant for the 2024 ASM, email gaps@ranzcr.edu.au

Volume 20 No 1 | December 2023

ASM Special

Wrap-up

2023 College Honour Recipients College Honours celebrate the significant contribution clinical radiologists and radiation oncologists make to the health of patients across Australia, New Zealand and internationally. We’re proud to showcase some of the 2023 College Honour recipients here.

The Roentgen Medal The Roentgen Medal is awarded to Fellows of the College who have made a valuable contribution to the College over a significant period of time. In 2023, the Roentgen Medal has been awarded to Dr Sean Brennan of Townsville, Queensland and Prof Alan Coulthard of Brisbane, Queensland.

review of the Phase 1 and Phase 2 examinations as a component of the Curriculum Assessment and Reform process. Dr Brennan has practised in regional areas since arriving in Australia and has been intensively involved in trainee education, assessment and mentorship throughout his practice.

Dr Sean Brennan

Dr Brennan is a graduate of the University of Zimbabwe, where he worked for several years before training as a clinical oncologist at Groote Schuur Hospital, Cape Town, South Africa. He emigrated to Australia in 2009 and received his Radiation Oncology Fellowship in 2011. He immediately became involved in education and training, joining the College Phase 2 examiner team under the mentorship of A/Prof Sandra Turner. Dr Brennan works for the College as an examiner, Chief of Examinations, and has served as Chief Censor of RANZCR Faculty of Radiation Oncology (FRO). Together with the examiner team he assisted with the

18 Volume 20 No 1 | December 2023

Prof Alan Coulthard

Prof Coulthard graduated MBBS from the University of Newcastle upon Tyne, UK in 1982. He received FRCS in 1987 and FRCR in 1991. After 10 years as a Consultant in the UK he relocated to Brisbane in 2003, obtaining FRANZCR the same year. He has served the College over the past two decades, locally as

a Director of Training and Branch Education Officer, and nationally as member or Chair of numerous committees, including the Faculty Research Committee, Education Committee and Curriculum Advisory Committee. He was Acting Chief Censor, after which he served as a Faculty Councillor for two terms, before being elected to the Board of Directors. He is currently a senior Part 2 examiner, member of the DEIT Taskforce Committee and the SIG Working Group, and a Trustee of the JP Trainor Trust. Outside the College he has undertaken many senior leadership roles, notably as President of the Australian and New Zealand Society of Neuroradiology (ANZSNR) and as founding Chair of the Conjoint Committee for Recognition of Training in Interventional Neuroradiology (CCINR). He has over 130 peer-reviewed publications. At Royal Brisbane and Women’s Hospital he recently stepped back from interventional neuroradiology and continues as a diagnostic neuroradiologist and Director of Research.

Wrap-up

The Gold Medal

ASM Special

The Annual Ceremony, Brisbane 2023.

The Gold Medal honours a Fellow who has rendered outstanding service or benefactions to the development, teaching or practice of clinical radiology or radiation oncology in Australia, New Zealand and Singapore. The Gold Medal has been awarded in 2023 to Dr Gregory Slater of Clayfield, Queensland.

Dr Gregory Slater

Dr Slater graduated from the University of Queensland Medical School with first-class honours in 1975. He then worked in regional hospitals and general practice before undertaking radiology training at Princess Alexandra Hospital in Brisbane, where he achieved FRANZCR in 1993. Dr Slater completed a clinical fellowship in Abdominal Imaging and Interventional Radiology at Massachusetts General Hospital and Harvard Medical School in 1993 and 1994. He held numerous roles for The Royal Australian and New Zealand College of Radiologists (RANZCR) from 2001 to 2017, and received the Baker Fellowship, Roentgen Medal and Life Membership of the American Roentgen Ray Society. Dr Slater worked as a radiologist at Queensland X-Ray for 27 years and served as a Visiting Medical Officer at Princess Alexandra Hospital for six years. Dr Slater retired in 2022.

Life Membership Life Membership is awarded to Fellows aged 65 and over who have made an outstanding contribution to their profession over the course of their career. In 2023, Life Membership has been awarded to A/Prof Anthony Doyle of Auckland, New Zealand and Dr Arlene Mou of Armadale, Victoria.

Dr Arlene Mou

A/Prof Anthony Doyle

A/Prof Doyle graduated from the University of Otago and completed radiology training in Auckland in 1987. After several years teaching in the US (South Carolina and the University of Utah), he returned to Auckland. With a focus on musculoskeletal and breast imaging, he has published over 100 peer-reviewed articles. For 11 years, he headed the RANZCR training program in Auckland and has been an examiner since 2001. He is currently Associate Professor at the University of Auckland, consultant at Auckland Te Toka Tumai and Astra Radiology, and national clinical lead in radiology for New Zealand Te Whatu Ora.

Dr Mou graduated in 1983 at Monash University. She underwent radiology training at the Alfred Hospital in Melbourne and achieved her Fellowship in 1991. She then worked as a junior consultant at the Alfred Hospital and in private practice, and became a sessional radiologist at North Western BreastScreen. She became a consultant radiologist at the Royal Melbourne Hospital in 1995 and worked there until her retirement in 2023. During her tenure, she was Senior Radiologist at North Western BreastScreen from 2005–2023 and Co-Director of Training from 2011–2018. During her career, she has been involved in several breast research publications.

Volume 20 No 1 | December 2023 19

ASM Special

Wrap-up

Educational Fellowships The College offers a variety of Fellowships each year, to support members in their continuing education and to further their knowledge and expertise. Congratulations to the following recipients of Educational Fellowships for 2023.

ill Hare Travelling Fellowship B for Clinical Radiology This Fellowship supports a clinical radiology Fellow more than five years post-Fellowship for a period of intensive or overseas study (3–12 months) or for attendance at an international short course (two weeks to one month). Its primary purpose is to enable the recipient to further their knowledge of an acknowledged subspecialty or skill, in which there is a recognised shortage. The award is named after the late Prof William Hare AO for his outstanding commitment and service to the College.

2023

Dr Emmeline Lee

Thomas Baker Fellowship The history of the Thomas Baker Fellowship is as long as that of the College itself. The Fellowship enables a clinical radiology or radiation oncology member up to six years post-Fellowship to further their knowledge by studying abroad for between three and 12 months. The College would like to extend its special thanks and appreciation to the Baker Foundation for sponsoring this prize.

2023

Dr Aaron Kent Dr Aaron Kent completed specialist training in radiation oncology in Melbourne at The Alfred and Peter MacCallum Cancer Centre, as well as at the W.P. Holman Clinic in Launceston. He joined the Alfred Health team in 2022 as a Specialist Radiation Oncologist focusing on Genito-Urinary Oncology and advanced techniques including brachytherapy and stereotactic radiotherapy. His major research at Alfred Health investigated the 15-year clinical and toxicity outcomes for a large cohort of men with prostate cancer treated with external beam radiotherapy (EBRT) alone, versus those treated with EBRT and High Dose Rate brachytherapy boost, highlighting the value of this form of dose escalation in this population.

20 Volume 20 No 1 | December 2023

Dr Lee graduated from the University of Western Australia with a MBBS, and then went on to obtain a Diploma in Obstetrics from RANZCOG before specialising in radiology. She then completed fellowships in women’s imaging and breast imaging. She is currently a partner in a specialist O&G imaging practice, Western Ultrasound for Women, as well as in the public sector at Sir Charles Gairdner Hospital and Osborne Park Hospital. Dr Lee is the lead examiner in O&G imaging for RANZCR, and is a keen teacher of radiology registrars and sonographers in Western Australia. She is the current Chair of RANZCR’s Obstetric and Gynaecology Special Interest Group (OGSIG) and serves on the College’s Diversity, Equity and Inclusion taskforce. At RANZCOG, Dr Lee is on the “Screening in Early Pregnancy” Statement Development Group. Dr Lee is the Expert Advisor for Obstetric Imaging for the popular website Radiopaedia, which is the premier reference website for imaging professionals around the world. She is also currently serving as a Director on the Board of the Australasian Society of Ultrasound in Medicine (ASUM). Dr Lee was the recipient of the Professor Turab Chakera Award for Excellence in Radiology Teaching in 2014. She received the ASUM Sonologist of the Year award in 2019. As part of her commitment to education, Dr Lee is Co-Lead in Obstetrics and Gynaecology for Radiology Across Borders, and has done multiple trips supporting sonographers, radiologists, registrars and medical students in developing nations.

Wrap-up

ASM Organising Committee members climbing the Storey Bridge (left) and enjoying the Gala Dinner.

ASM Hall of Fame 2023 2023 ASM Organising Committee

Clinical Radiology Co-Convenor – Dr Liat Barrett Clinical Radiology Co-Convenor – Dr Jennie Roberts Radiation Oncology Co-Convenor – Dr Angela Allen Radiation Oncology Co-Convenor – Dr Tuan Ha Radiology Trainee Representative – Dr Son Do Radiology Trainee Representative – Dr Rachele Quested Radiation Oncology Trainee Representative – Dr Sarah Li Interventional Radiology and Interventional Neuroradiology Co-Lead – A/Prof Nick Brown Interventional Radiology and Interventional Neuroradiology Co-Lead – Dr Grace Aw

2023 Keynote Speakers

Clinical Radiology Prof Elizabeth Dick, UK Dr Christopher Filippi, US Prof Suresh Mukherji, US Prof Mini Pathria, US Prof Mathia Prokop, NED Prof Cornelia M. Schaefer-Prokop, NED Prof Stuart Taylor, UK Radiation Oncology Prof Sean Collins, US Prof Karyn Goodman, US Prof Jeff Michalksi, US

ASM Special

The highest ASM attendance in history!

2023 International Guests

American College of Radiology – ACR American Roentgen Ray Society – ARRS American Society for Radiation Oncology – ASTRO European Society of Radiology – ESR European Society for Radiotherapy and Oncology – ESTRO College of Radiology, Academy of Medicine of Malaysia – MCoR Royal College of Radiologists – RCR, UK Faculty of Radiologists – RCSI, Ireland Radiological Society of North America – RSNA Singapore Radiological Society – SRS

ASM in Numbers

Delegate Numbers: 1,590 Exhibitors: 76 Speakers: 320 Oral Presentations: 437 Sessions: 97 Posters: 123 New Fellows: 90 ASM Prizes Awarded: 11 Targeting Cancer Fun Runners: 101

Volume 20 No 1 | December 2023 21

Mark Your Diary 17-19 Oct

ranzcrasm.com

A gathering under the stars

Wrap-up

ASM Special

Targeting Cancer’s Dr Lucinda Morris and Dr Tuan Ha were up bright and early to take part in the annual Fun Run.

Runaway Success The 8th annual Targeting Cancer ‘Fun Run’ has enjoyed another successful year.

ver 100 sleepy but enthusiastic participants registered for the early morning sprint (or stroll), which took place along the Brisbane River on the third and final day of RANZCR’s ASM 2023. Those taking part in the Fun Run had the choice of a rigorous five-kilometre course following the Brisbane riverbank or a shorter, more forgiving 2.5-kilometre route with friendly marshals guiding the way. Participants donned Targeting Cancer activewear, including the much-coveted Targeting Cancer caps and t-shirts, to raise awareness of radiation therapy as a life-saving cancer treatment. The Targeting Cancer campaign continues to work across Australia, New Zealand and the rest of the world to raise the profile of radiation therapy as a vital, safe and highly effective cancer treatment and to ensure that access is available to people living with cancer. The campaign thanks all our friends in the RANZCR community for your support of this important work. Congratulations to first-place prize winners Justin Whitley and Barbara Laing, who both received JB Hi-Fi vouchers. A special ‘mystery prize’ went to runner and Targeting Cancer enthusiast Dr Emmeline Lee. “This was another fantastic Fun Run, and I was pleased

“We want to ensure all cancer patients get access to this effective, safe and sophisticated treatment.” to get up bright and early to take part,” said Dr Lucinda Morris, Co-Chair of the Targeting Cancer Committee. “We made sure runners had plenty of water and energyboosting refreshments including bananas and sweets. “The purpose of the Fun Run is to celebrate the importance of radiation therapy and to make both clinicians and the general public aware of the important role radiation therapy plays in saving and improving the lives of people with cancer,” said Dr Morris. Dr Tuan Ha, Co-Chair of the Targeting Cancer Committee, said: “Lucinda and I would like to congratulate Justin, Barbara and Emmeline for winning this year’s Fun Run prizes. “The Targeting Cancer team is already looking forward to next year’s Fun Run in sun-soaked Perth,” said Dr Ha. “We want to ensure all cancer patients who may benefit from radiation therapy get access to this effective, safe and highly sophisticated treatment.” IN

Volume 20 No 1 | December 2023 23

Queenstown

2024

RANZCR NZ ASM 2024

August 2 - 4, 2024 Millennium & Copthorne Hotels

INTERNATIONAL INVITED SPEAKERS ARE:

Dr Richard Kinh Gian Do

Dr Giles Maskell

Memorial Sloan Kettering Cancer Center

Royal Cornwall Hospital

New York, USA

Truro, UK

www.ranzcr2024.co.nz

RANZCR Workshops, Courses and Events 2024 24

FEB 2024

RANZCR RECRUITERS EXPO

W Hotel Sydney, NSW

Save the Date!

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VARIOUS DATES 2024

RANZCR/ACR EDUCATION CENTRE COURSES 2024

Millennium Hotel, Queenstown, NZ

Venue TBC

NZASM (www.ranzcr2024.co.nz)

9–11 August: High Resolution CT of the Chest (HRCT)

CPD Hours calculated once program is finalised.

12–14 August: Neuroradiology 16–18 August: Breast Imaging Boot Camp

17-19 OCT 2024

Registration Opening Soon! Save the Dates!

RANZCR ASM

Perth Convention and Exhibition Centre, Perth, WA

Details for these events and many more can be found on our website: www.ranzcr.com/whats-on/events For regular updates, in addition to the website listing, please “like” and “follow” our RANZCR social media accounts:

www.ranzcrasm.com CPD Hours calculated once program is finalised.

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

Volume 20 No 1 | December 2023 25

Research & Grants

Prizes

Outstanding Oncology Research

Dr Therese Kang, winner of the 2023 Bourne and Langlands Prize, discusses the importance of her research and the benefits of international collaboration.

our review by ensuring its relevance to a global audience. Their input strengthened our paper, resulting in a comprehensive review benefiting lung oncology patients.

How has the RANZCR Prize affected your work?

Being honoured with the Bourne and Langlands Prize has significantly raised the profile of our work, shedding light on the role of singlefraction SABR to the lung and the specific tumour and patient factors that still pose controversies. This achievement validates the relevance of our paper in facilitating guidance on clinical practices to improve the care of lung cancer patients. I hope this award will also inspire other early-career researchers to explore similar lines of innovation to improve patient outcomes.

What advice would you give to trainees who would like to expand their research output?

Dr Therese Kang

he Faculty of Radiation Oncology Bourne and Langlands Prize, established in 2009, is awarded to a trainee whose research submission is deemed to be outstanding. The prize is named in honour of two of the Faculty of Radiation Oncology’s esteemed retired colleagues, Professors Robert Bourne and Alan Langlands. The recipient for 2023 is Dr Therese Kang of Melbourne, Victoria. Dr Kang is a fifth-year radiation oncology trainee at Peter MacCallum Cancer Centre. The winning research submission ‘Practical Considerations of Single-Fraction Stereotactic Ablative Radiotherapy

26 Volume 20 No 1 | December 2023

to the Lung’ provides an overview of the randomised evidence evaluating single-fraction SABR in primary lung cancer and pulmonary metastases, including the common clinical challenges, immunogenic effect, technical considerations and future directions. This paper reports from a multi-national collaboration supervised by Prof Shankar Siva.

What do you think is the importance of this research?

The review provides an overview of the published randomised evidence evaluating use of single-fraction SABR in primary lung cancer and pulmonary oligo-metastases. It addresses the immunogenic effect of SABR, a common clinical challenge, as well as technical and cost-utility considerations. The review also provides practical insights for the implementation of single-fraction SABR to the lung. Additionally, the contributions of international co-authors enriched

Many registrars have limited research experience, and there’s no better time than during training to gain these skills. I believe an important first step is actively seeking out mentors who can guide your research journey, ultimately leading to publishing an impactful paper. They can give valuable insights, networking opportunities and help you navigate the landscape. I was fortunate to be supervised by Prof Siva, allowing me to collaborate with experts both within and outside our institution. I am also grateful to the co-authors for their guidance. Choosing a research project with clear objectives, achievable goals and realistic timelines is key. This is especially important for us registrars, as we often rotate through different hospitals, and frequently balance clinical responsibilities, exam preparation and research commitments. Finally, I was motivated by the clinical relevance of this project, as it was applicable in my day-to-day work. IN

Dr Graeme Anderson receiving the Clinical Radiology Educational Service Award.

Research Awards and Grants 2024

The College is pleased to offer the following research awards and grants next year—applications open in January.

f you would like to apply for a research award or grant, applications will open in January 2024. A variety of opportunities are available to support research projects and foster a culture of research at the College.

RANZCR Research Grants

RANZCR research grants provide financial support for Fellows, Educational Affiliates and student members in clinical radiology and radiation oncology to conduct research. Grants are awarded for sums between AU$5,000 and AU$30,000.

Withers and Peters Grant

This AU$25,000 grant supports Fellows up to five years postFellowship and trainees post-

Phase 2 exams to carry out significant research projects.

Clinical Radiology Early Career Researchers Award

This prize recognises a clinical radiology trainee or junior Fellow who is the first author of a paper accepted for publication by JMIRO or another Medline-Indexed peerreviewed journal.

Faculty of Radiation Oncology Bourne and Langlands Prize This AU$1,500 prize is awarded to a trainee who has written an exceptional trainee research requirement manuscript.

Faculty of Radiation Oncology Indigenous Health Prize

the case of high-quality research in Indigenous health being published in a peer-reviewed journal.

Faculty of Radiation Oncology Quality Improvement Project Prize

This AU$2,000 prize for Fellows, Educational Affiliates and trainees will be awarded in the case of high-quality research in Quality Improvement in radiation oncology being published in a peer-reviewed journal.

Windeyer Fellowship

This is a 12-month position for Fellows up to two years postFellowship or trainees post-Phase 2 exams that provides clinical research opportunities at the Mount Vernon Cancer Centre in the United Kingdom. The position is under the broad supervision of Prof Peter Hoskin. IN

For more information, email gaps@ranzcr.edu.au

This AU$2,000 prize is awarded in

Volume 20 No 1 | December 2023 27

Training & Education

Wellbeing

Meditation Headspace Smiling Mind Study (a free soundscape that is good for blocking out auditory distractions, also available here: www.archive.org/details/ soundscape_201909)

(Vetted) People

Resources for Wellbeing

Dr Jennifer Chang is the Trainee Wellbeing Officer and a former Director of Training. In this column she explores issues that can impact the progression and wellbeing of trainees, based on her own experiences and references.

T Dr Jen Chang

his is my final column as Trainee Wellbeing Officer. Next year, I am moving into the role of Chief Accreditation Officer (CAO) for CR. Accreditation plays an important role in influencing workplace factors that directly impact the wellbeing of trainees, so I am enthusiastic about stepping into the role and I look forward to meeting some of you on site visits. I would like to acknowledge the hard work that A/Prof Michael Bynevelt has done in the CAO role over the last two years. When I speak to radiologists (and radiation oncologists) working across both the public and private sectors, burnout, exhaustion and dissatisfaction are common themes. So, for my final column, I have compiled a list of resources that might be helpful. Some of these are dedicated to DOTs and trainees, with these recommendations containing selected content that I found helpful, either for self-education or as a resource to which I could direct trainees. Others provide a different perspective on thinking and problem-solving to the way that we have been trained to think as doctors. Hopefully there is something here for everyone to facilitate personal and professional growth and wellbeing.

28 Volume 20 No 1 | December 2023

Coaches who work (across jurisdictions) with junior doctors and trainees: Sharee Johnson: www. coachingfordoctors.net.au. Her book is The Thriving Doctor. Patsy Tremayne: drpatsytremayne.com. Her books are Ace Your Medical Exams and Study Less and Still Blitz Your Medical Exams. Tanya Heaney-Voogt: www. tanyaheaneyvoogt.com. A Melbourne-based consultant who also works across jurisdictions, who is dedicated to building mentally healthy workplaces. She also has a book called Transforming Norm: Leading the Change to a Mentally Healthy Workplace. Arbuthnot & Associates: www. arbuthnot.com.au. This one is mostly for the DOTs. Looking at the list of resources and what is missing, a large proportion of the skills that I acquired as a DOT was through course and workshop attendance, many of which were facilitated by Scott Arbuthnot and his colleagues, based in Brisbane and the Sunshine Coast. Women & Leadership Australia (WLA): www.wla.edu.au. One for DOTs and other leaders. Participation in a WLA leadership course is also a great way to meet and learn from women working across different industries.

Wellbeing

Highly Recommended by Others (but not yet road-tested):

Books Self-Management, Wellbeing, Health and Longevity: Your Oxygen Mask First: 17 Habits to Help High Achievers Survive and Thrive in Leadership and Life (Kevin N Lawrence). This one is first for a reason. I loved this book so much that I bought 100 copies to give to my trainees. Its premise is that hard work and high achievement are sustainable over a lifetime with deliberate, active attention to self-management. Atomic Habits: An Easy and Proven Way to Build Good Habits and Break Bad Ones (James Clear) The Third Space: Using Life’s Little Transitions to Find Balance and Happiness (Dr Adam Fraser) The Resilience Shield (Ben Pronk, Dan Pronk and Tim Curtis) Solve For Happy: Engineer Your Path to Joy (Mo Gawdat)

Podcasts Human Behaviour and Related Concepts: No Stupid Questions Cautionary Tales Freakonomics Radio You Are Not So Smart A Slight Change of Plans Hidden Brain Physical and Mental Health, Wellbeing, Longevity and Medical: Freakonomics MD The GP Show Unforgiving 60 Unlocking Us (Brené Brown) The Imperfects The Drive Real Health and Weight Loss

Training & Education

Leadership, Communication, and Teamwork: Any/all books by Brené Brown Presence: Bring Your Boldest Self to Your Biggest Challenges (Amy Cuddy) Never Split the Difference: Negotiating As If Your Life Depended On It (Christopher Voss with Tahl Raz) How to be Heard: Secrets for Powerful Speaking and Listening (Julian Treasure) Good Arguments: What the Art of Debating Can Teach Us About Listening Better and Disagreeing Well (Bo Seo)

Suggested Googling for Self-education The ladder of inference Unconscious bias. In particular, the Harvard Implicit Association Test Box breathing or 4-7-8 breathing SCARF model Immunity to change Andrew May free book 8 Recharge

Books by Prof Craig Hassed (there are 14 of them!). Prof Hassed was an invited speaker and conducted a session on mindfulness at the recent Brisbane ASM. Waking Up app. Apparently this is meditation meets neuroscience meets philosophy. Those Who Listen, Change the World (book from the Nobel Peace Centre). A recommendation from Prof Liz Kenny, mentioned during the women in leadership forum also during the recent ASM. The Diary of a CEO by Steven Bartlett. A book reportedly about the basis of excellence, grounded in psychology and behavioural science. Sounds pearl-abundant and totally my bag. Why We Sleep: The New Science of Sleep and Dreams by Matthew Walker. Another recommendation from the ASM, this time from Dr Melanie Rule, whose talk in the Wellbeing session on longevity and sustainability of a career in medicine (and avoidance of burnout) is one that I recommend watching. In an interview on The Drive podcast, the author makes a compelling case for the physiological importance of sleep and its impact on our physical and mental health.

Who or what would you recommend that will help other DOTs, trainees and radiologists to succeed and thrive? Please send your

recommendations to our recently appointed Trainee Liaison Officers (TLOs) so that they can be shared for the benefit of other trainees and DOTs. There is one TLO each for Australia and New Zealand, respectively Lisa Grayson and Jenna Howell. Lisa and Jenna are energetic and passionate and will be working closely with my successor. You can reach them at tlo@ranzcr.edu.au. See you in the trenches!

Volume 20 No 1 | December 2023 29

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Volunteer

News

Volunteer in the Spotlight RANZCR relies heavily on volunteers, with more than 1,200 members currently offering their time to support the College. This issue, we quiz A/Prof Arian Lasocki about his experiences, insights and motivations.

/Prof Lasocki is a Radiologist in the Department of Cancer Imaging, Head of Radiology Research, and CoHead of MRI at Melbourne’s Peter MacCallum Cancer Centre. He has a particular interest in neuro-oncologic MRI, including for the pre-operative molecular classification of adult intracranial gliomas, detection and characterisation of early intracranial metastatic disease, and improving the diagnosis of intracranial posttreatment effects. His awards include the MSD Hubert Stuerzl Memorial Educational Award from the Cooperative Trials Groups for Neuro-Oncology, and a Discovery Partner Fellowship from the Peter MacCallum Cancer Foundation.

What motivates you to volunteer? I have always been

interested in College activities, and nominated for the inaugural Trainees’ Committee when I was a 2nd year registrar—about 15 years ago now. As a trainee, my motivations were a desire to advocate for trainees and to learn more about the College. Now, it is more about advocating for our patients and the profession, which are inextricably linked. Ultimately, if we aim to provide the best possible patient care, not just to an individual patient but also more broadly, our profession will continue to strengthen. These issues are only

becoming more important, with the advent of AI and the ever-increasing creep of other craft groups into aspects of radiology.

What benefits has volunteering had? Volunteering has given me an

understanding of the vast scope of the College, which I think is hard to appreciate unless you are involved. It has also given me an understanding of the processes and complexities of making larger policy changes.

What achievements are you most proud of as a volunteer?

I am proud of my years as the radiology representative on the Radiation Oncology Research Committee, as I feel I helped strengthen the links between our two Faculties. It was a great opportunity to share ideas and perspectives, and has helped to establish joint activities. The differences between our Faculties provide an opportunity to learn from and harness each other’s strengths.

Do you have any advice on volunteering in general? Our

profession needs the College, and the College needs radiologists to volunteer so it can best

advocate for our patients and the profession. There is a wide range of opportunities, from those that provide a broader oversight of College activities, such as Faculty Council, to those focused on a more narrow area. So I suggest that all radiologists consider where their interests lie and try to identify an area of the College that fits.

What are the perceived barriers to (particularly younger) Fellows taking on College volunteering activities? I think that nominating for one’s first College role is the hardest step. It is natural to feel that you don’t have the necessary skills and experience. However, all perspectives are important, whether coming from a recent Fellow or someone who has years of experience in clinical practice. It is also important to grow the corporate knowledge throughout our membership. Additionally, younger Fellows may not appreciate the wide variety of opportunities available— their experience with the College at that point will predominantly be through the training side, yet that is only one of many key areas within the College. IN

Volume 20 No 1 | December 2023 31

Training & Education

CPD

CPD Requirements for 2023 Continuing Professional Development for 2023. Have you started entering your CPD activities yet?

s the year comes to a close this means that it’s time to enter your CPD activities for 2023. If you haven’t started yet please be reminded that the deadline is 31 December 2023. Thank you to all the members who have commenced entering their CPD activities. As you will be aware 2023 is the first year of the new CPD requirements so we recommend reviewing the CPD Handbooks available on the College website to familiarise yourself with the new requirements and CPD categories. To record your CPD activities please log into the RANZCR ePortfolio and select the CPD Dashboard (2023). Please also note the 2023 CPD requirements: Completion of a Professional Development Plan (PDP) 50 hours of CPD: • 12.5 hours of Educational Activities • 25 hours of Reviewing Performance and Reflecting on Practice and Measuring and Improving Outcomes (with a minimum of 5 hours for each category, e.g. 20 hours in one and 5 hours in the other) • 12.5 hours distributed across any of the three CPD categories Anaphylaxis training (once every 3 years, clinical radiology members only) MRI and mammography requirements (clinical radiology members only) Structured conversations (MCNZ requirement) Cultural safety and health equity

32 Volume 20 No 1 | December 2023

to be reflected in CPD activities (MCNZ requirement).

How to meet the CPD requirements for 2023

There are a wide variety of CPD activities that can be recorded to meet the CPD requirements. Please also refer to the CPD Handbooks for a more detailed list of CPD activities. You can enter up to 25 hours of CPD under Educational Activities, e.g. conference attendance, webbased learning, journal reading, supervision and/or assessment of trainees etc. To meet the requirements under Reviewing Performance

An example of CPD activities for 2023: Educational Activities:

15 hours for a conference 10 hours of web-based learning. Reviewing Performance and Reflecting on Practice:

2 hours for the Professional Development Plan 2 hours for Cultural Competence Activities 4 hours for Reflective Diary 12 hours of Peer Review. Measuring and Improving Outcomes

2 hours for Audit 3 hours for Multidisciplinary Team Meetings. Please visit the website to find the CPD Handbooks and how-to guides.

and Reflecting on Practice (you need a minimum of 5 hours) we suggest the following categories/ activities: • Review of Cases—peer review activities • Reflective Diary • Professional Development Plan—you can claim up to 2 hours for completing this • Cultural Competence Activities —please refer to the Cultural Safety page on the College website for suggestions • Professional Practice Management—e.g. staff appraisal meetings, staff training, operational planning, equipment compliance, workplace health and safety etc. • Participation in RANZCR Governance—College activities e.g. sitting on Committees • Multidisciplinary Team Meetings To meet the requirements under Measuring and Improving Outcomes (you need a minimum of 5 hours) possible activities include: • Multidisciplinary Team Meetings • Audit—of your own cases • Patient Experience Survey • M & M meetings.

College staff are on hand to assist with entering your CPD activities.

Please be reminded that College staff experience a higher volume of enquiries towards the end of the CPD year and response times may be longer than usual. Please contact Freya or Leanne on +61 2 9268 9777 and select CPD. If your call cannot be answered, all staff may be on the phone. Please leave a message when prompted and a team member will be in touch. Alternatively, you can email cpd@ranzcr.edu.au. Please also note the College will be closed from Friday 22 December and will reopen on Monday 8 January. IN

Reporting

“Change Before You Have To”

What you need to know about RANZCR’s new Structured Reporting Guidelines.

Dr Felicity Pool, Structured Reporting Working Group

“

Change before you have to.” This quote is attributed to Jack Welch, the Chairman and CEO of General Electric between 1981 and 2001. Technologic change, driven by companies like General Electric, is one of the defining characteristics of diagnostic radiology as a medical specialty. We see this in hardware like scanners, but also in the software that runs our equipment and emerging fields like artificial intelligence. Radiology reporting has also evolved from voice dictation, typist transcription and paper reports to digital recording, voice recognition systems and reporting software. These changes have been accompanied by increasing interest in improving the accuracy and clarity of report content and the process of communication, so that imaging can contribute even more effectively to improving patient outcomes. Structured reporting aims to improve report completeness, clinical utility and compatibility with electronic health records by standardising some or all of report content, terminology and format. Increasingly, report templates and software applications are being

developed to help radiologists create structured reports. Professional organisations like the RSNA and ESR are leading initiatives to promote structured reporting. Other specialties, especially pathology, are also moving towards defining the content and format of their clinical reporting. As radiologists in Australia and New Zealand, we need to make these changes work for us. RANZCR established a structured reporting working group in 2020. A survey of members and subspeciality groups in 2020 explored attitudes toward structured reporting and how it is being used in Australia and New Zealand. The results were published in the Quality Issue of JMIRO in March 2022. A clear majority of respondents supported the development of RANZCR structured reporting guidelines. These have now been completed, approved and posted on RANZCR’s website. They are based on current literature, RSNA and ESR materials and the Royal College of Pathologists of Australasia (RCPA) Structured Pathology Reporting of Cancer project. Before discussing WHAT the guidelines are, it is important to stress what they are NOT. They are not intended to prescribe how individual studies are reported; the radiologist must always decide whether and how to use a structured report, depending on the clinical context. Instead, the guidelines outline criteria that radiologists, practices and departments can use to assess the quality and usefulness of existing

News

templates or software tools. These indicators can also be used as a benchmark when new templates or software are being developed. So, how might a radiologist use the guidelines to assess a potential reporting template or system? 1. Content Does the report include all of the required information for the particular study type? Is it tailored to the modality, body system and clinical context? Will it meet the needs of the referrer and other users? 2. Format, brevity and efficiency Does the report input format support efficient radiologist workflow and does the output format communicate clearly with the intended reader? 3. Technical considerations How is report data defined and used? What level of software involvement is there and is it compatible with existing RIS/ PACS systems and anticipated electronic health records, or is other hardware or software required? 4. Evidence of quality improvement Has this report or system improved patient outcomes elsewhere, either in the published literature or in similar practices or institutions? 5. Implementation tools Are there any tools like templates available to help radiologists use the report in everyday practice? The guidelines will continue to evolve alongside the broader digital health system. Hopefully they will help Australian and New Zealand radiologists to not just survive but also thrive in this changing environment. Thanks to Dr Kirsten Gormly, Dr Miranda Siemienowicz and Dr Piyush Siwach for reviewing the draft of this article. IN To view the Structured Reporting Guidelines, scan the QR code.

Volume 20 No 1 | December 2023 33

IR & INR

News

Prof Mayank Goyal, Canada

ANZSNR ANNUAL SCIENTIFIC MEETING

FOUNDATIONS FOR THE FUTURE SAVE THE DATE

Prof Majda Thurnher, Austria

2024 2 - 4 MAY

TE PAE CHRISTCHURCH CONVENTION CENTRE NEW ZEALAND

Mayank Goyal is a Professor in the Department of Radiology and Clinical Neurosciences at the University of Calgary. He is also the Director of Imaging and Endovascular treatment at the Calgary Stroke Program. Dr Goyal is world-renowned for his work in efficiency and workflow in acute stroke intervention.

Prof. Larry Ginsberg, USA Neuroradiologist

Majda M Thurnher is a neuroradiologist at the Medical University of Vienna. She specialises in demyelinating and inflammatory diseases of the central nervous system. She was President of the European Society of Neuroradiology (ESNR) from 2014–2016 and has chaired the European Board of Neuroradiology (EBNR) since 2018.

Call for Abstracts Dr Mayank Goyal, Canada Diagnostic and Interventional Neuroradiologist

www.anzsnrasm.com For more information contact NC Events ncosta@ncevents.com.au

Prof. Majda Thurnher, Austria Neuroradiologist

Call for Abstracts is open, and we welcome submissions from all wishing to submit a paper related to research in neuroradiology. For more information and to submit an abstract, visit www.anzsnrasm.com. Selected abstracts will be presented orally, and all accepted abstracts will be published in JMIRO.

ANZSNR Research Grant 2023

ANZSNR News

Discover some of the international speakers presenting at the ANZSNR ASM.

e are looking forward to welcoming delegates to the Te Pae Convention Centre in scenic Christchurch from 2-4 May 2024 for the ANZSNR ASM. The provisional program is available to view at www.anzsnrasm.com. Here’s some of the international speakers scheduled to present at the event.

34 Volume 20 No 1 | December 2023

Prof Lawrence Ginsberg, US

Lawrence Ginsberg is a Professor of Radiology in the Department of Diagnostic Radiology and Head and Neck Surgery at The University of Texas MD Anderson Cancer Centre, Houston, TX. He is a renowned head and neck radiologist and is a past president of the American Society of Head and Neck Neuroradiology.

The Research Sub Committee has awarded student member Dr Maurice Wu the first ANZSNR Research Grant. Congratulations to Dr Wu, from the Royal Brisbane and Women’s Hospital, who will receive AU$5,000 to assist with the funding of scans for his research on Use of Magnetic Resonance Diffusion Tensor Imaging in the Assessment of Nerve Roots in Cervical Radiculopathy Patients Undergoing Decompressive Surgery (Pilot Study).

For more information on the ANZSNR research grants, visit www.anzsnr.org.au/research.

News

IR & INR

IRSA News

ASM early-bird registrations are opening soon. Plus, a reminder about the Vertebroplasty Registry.

lans are well underway for IRSA’s 2024 Annual Scientific Meeting to be held at the Ta Pae Convention Centre Christchurch from 5–7 August 2024. The program, which includes a mix of interactive sessions, workshops, networking opportunities and didactic lectures, will appeal to interventional radiologists, general radiologists with an interest in IR, radiology accredited trainees and nurses and radiographers. Early-bird registrations are opening in late January 2024. For more information, keep an eye on the IRSA ASM website: www.irsaasm.com. IRSA members are reminded that they receive substantial registration discounts. IRSA offers various categories of membership. If you are interested in joining, please visit www.irsa.com.au/join-us.

The Australian Vertebroplasty Registry

As advised by the Australian Department of Health, IRs that perform vertebroplasty on private in-patients or public out-patients (in both a public or private setting) are required to notify the IRSA secretariat to ensure that site ethics and governance approvals are sought. Patient data must be entered into the Vertebroplasty Registry for the purpose of reporting to the Department of Health. If you perform vertebroplasty but are not yet a registered REDCap contributor, please email secretariat@irsa.com.au. Registry contributors are reminded to enter any outstanding data from vertebroplasties you have performed that were bulk billed (using Item Number 35401). We are accepting data from 21 November onwards. To access the registry,

contact secretariat@irsa.com.au.

Executive Team Update

We are very pleased to advise of the appointment of three additional non-office bearing members to the Executive team. We wish to welcome: Junior Executive Member – Dr Caitlin Farmer Executive Committee Member – Prof Warren Clements Executive Committee Member – Dr Phil Chan

IRSA Socials - Follow us: @IRSA_IRs IRSocietyofAustralasia IRSA Australasia @irsa_au

Volume 20 No 1 | December 2023 35

IR & INR

News

Women in IR and INR.

Launch Success

The Interventional Radiology Committee presents highlights from the inaugural IR and INR stream at the 2023 RANZCR ASM.

e are very pleased to provide our colleagues with an exciting update on the first ever dedicated stream for interventional radiology and interventional neuroradiology at this year’s RANZCR ASM, which was a tremendous success. This stream ran across all three days of the scientific program, in parallel to the clinical radiology and radiation oncology streams. The interventional radiology and interventional neuroradiology program was convened by stream

36 Volume 20 No 1 | December 2023

leads Dr Grace Aw, Interventional Neuroradiologist from the Royal Brisbane and Women’s Hospital, and A/Prof Nick Brown, Interventional Radiologist and Chair of the RANZCR IR committee. The theme of the conference was ‘Beyond’; taking you beyond the clinical, beyond the expected and beyond the scopes of our specialties, which provided an opportunity to bring delegates a range of scientific content that promised a vision for innovative quality healthcare. The combined

opening session for interventional radiology and interventional neuroradiology delivered just that. Dr Matthew Mauro, RSNA President, opened with his presentation on “The birth of a specialty: Interventional Radiology in America”. This engaging address provided delegates with an overview of how the specialty of interventional radiology (recognised in 2012) has been driven by the need to provide quality care to patients and the ongoing demand for high-quality training that

News

provides dual trained specialists with their unique skills to offer high-quality radiological care. The highly esteemed panel that followed consisted of an unprecedented collection of key international and national experts: Dr Rajiv Rattan, FCR Council Dean, RANZCR Dr Matthew Mauro, President, Radiological Society of North America (RSNA) Prof Adrian Brady, Board Chair, European Society of Radiology (ESR) and the European Congress of Radiology (ECR) Dr Bill Thorwarth, CEO, American College of Radiology (ACR) Prof Andy Adam, Professor of Interventional Radiology at Kings College London Dr Chris Rogan, President, Interventional Radiology Society of Australasia (IRSA) Dr Con Phatouros, President, The Australian and New Zealand Society of Neuroradiology (ANZSNR) Dr Laetitia De Villiers, Interventional Neuroradiologist, Gold Coast University Hospital. The panel contributed to a thought-provoking and informative discussion on “The rise of IR and INR in modern medicine and the potential to elevate Clinical Radiology”, setting the tone for the remainder of the conference. There were many highlights throughout the program, and too many to mention here, but one standout session was the IR and INR Careers Breakfast Forum. This industry-sponsored event featured hands-on demonstrations of the latest in technology and medical

IR & INR

“This industry-sponsored event featured hands-on demonstrations of the latest in technology and medical innovation, showcased to the future workforce of radiology."

innovation, showcased to the future workforce of radiology—medical students, junior medical doctors and radiology trainees. This session included a summary of what a day in the life of an interventional radiologist is like, and provided a platform for the Women in IR and INR panel to share personal stories on becoming interventional radiologists and interventional neuroradiologists. The IRC Forum was also an opportunity to learn about how the College is advancing interventional radiology and interventional neuroradiology, including seeking specialty recognition and the development

of two specific, contemporary training programs for interventional radiology and interventional neuroradiology in Australia and New Zealand. For registered delegates, all ASM content is now available via the RANZCR Mediasite with your personal log-in, so if you didn’t get to the IR and INR sessions, we strongly encourage you to take a look and hear what is going in the world of IR and INR. The Interventional Radiology Committee looks forward to working with the IR and INR convenors of the 2024 RANZCR ASM in Perth from 17-19 October. IN

Volume 20 No 1 | December 2023 37

SIGs

News

Training Tour

Port Moresby General Hospital specialists visit New Zealand.

hanks to APROSIG (AsiaPacific Radiation Oncology Special Interest Group) and APSIG (Asia-Pacific Special Interest Group), radiation therapists, medical physicists and radiation oncologists from Port Moresby General Hospital (PMGH) in Papua New Guinea visited the Waikato Hospital in Hamilton to receive training for their upcoming radiation therapy centre. The new cancer centre at PMGH will have a Halcyon and TrueBeam linear accelerator and the Bravos afterloader system for brachytherapy; equipment which is already in use at the Waikato Hospital. The aim of this visit was to provide upskilling training to the visitors from PMGH to help them prepare for the opening

of their new centre. The RTs spent a total of two weeks rotating between the Halcyon, brachytherapy and simulation. They were also provided with a lot of information regarding setting up Aria and documentation on processes used for recording patient set-up and other patientspecific annotations they might use when transitioning to a paperless system. The radiation oncologists spent one week learning specially about the ARIA oncology information system and looking at the overall set-up of the department. The medical physicists spent a total of six weeks in New Zealand: one week at the Kathleen Kilgour Centre (KKC) in Tauranga and five

weeks at the Waikato Hospital in Hamilton. The physicists spent a significant amount of time in NZ to learn all about the new systems including the planning for both external beam radiation therapy and brachytherapy and quality assurance processes for all machines. The medical physicists are currently being trained to have recognition by ACPSEM (Australasia College of Physical Scientists and Engineers in Medicine) and the six weeks spent in NZ helped immensely in progressing their training. APROSIG and APSIG would like to extend a massive thank you to the team at Waikato for the time they spent organising and providing training to the team from PMGH. IN

Radiation oncology medical physicists from Waikato and PMGH.

38 Volume 20 No 1 | December 2023

News

SIGs

Group Effort

The College’s SIG Working Group outlines its 2023 achievements and further initiatives on the horizon.

id you know that over one third of the College’s Fellows belong to one or more of the College’s 14 Special Interest Groups (SIGs)? Or that our largest SIG has more than 530 members? Across clinical radiology, SIGs cover areas of practice in abdominal; emergency; paediatric; thoracic; obstetric and gynaecological; and rural and regional medicine, with the College’s newest SIG being recently established in nuclear medicine. In radiation oncology, the SIGs cover a wide range of practice: gynaecological; genito urinary; breast; lung and paediatric oncology. There is an additional special interest group focusing on palliative care and a SIG that furthers training and education in developing countries across the Asia-Pacific region. With the vast and important work that our SIGs contribute to, College staff and SIG representatives have invested in establishing a SIG Working Group to harmonise the working relationship between the College and its SIGs. We would like to thank Prof David Christie (FROGG), Dr Craig Gibson (ANZSPR), A/Prof Stefan Heinze (ANZSTR), A/Prof Tom Sutherland (ARGANZ), and Dr Kirsty Wiltshire (FROPAED) for their time and input to the SIG Working Group, as well as Prof Alan Coulthard as the RANZCR Board representative. SIG Executive members contribute a significant amount of time voluntarily. While much of their time is devoted to the activities of the SIG, including research and organising events, SIG Chairs in particular

have also made administrative contributions. Through the input of the SIG Working Group, the College understands that the administrative burden on the SIGs, as detailed in the SIG Manual, has been a significant area of concern for many of the SIGs. We are pleased to announce that, through the working group discussions, changes to the SIG manual have been made which will reduce the administrative requirements. These changes were agreed by both Faculty Councils at their joint meeting in August 2023 and will be on the next Board agenda for final approval. Commencing in 2024, there will be a new part-time position in the College dedicated to providing some additional administrative support to the SIGs. This will allow SIG Executive members to invest their time where it is most valuable—in research and delivery of educational events for the benefit of all College members. The College believes that having a network of SIGs is a significant benefit to members and is open to establishing new SIGs where a particular area of practice is not already represented. Seed funding is offered to new SIGs to allow them the opportunity to host events, which in time will contribute to their financial independence. As part of the SIG reforms, the seed funding process will be simplified to encourage SIGs to take advantage of this opportunity. As members of the College, the SIG Working Group has shared ideas for areas for reform that may be of

assistance to the broader College membership. For instance, it was reported some members have little knowledge of the governance structure of their organisation and the senior management team that leads it. As a result of this feedback, the website has been updated to provide greater transparency into the leadership team, the responsibilities of each unit and the governance structure which underpins the decision-making process of the College. Further details can be found at www.ranzcr.com/college/about/ structure-governance. The College staff and SIGs have appreciated the opportunity to increase the lines of communication, and this was further increased when the Chiefs of Professional Practice for each Faculty jointly met with all the SIG Chairs at the recent ASM, to build on the outcomes of the Working Group meetings. IN

Get involved Members are encouraged to get involved with SIGs that align with their areas of practice and interest. For radiation oncology SIGs, any enquiries or membership requests may be directed to frosigs@ranzcr.edu.au, and for clinical radiology, the email address format is “SIG name” @ ranzcr.edu.au (e.g. arganz@ranzcr. edu.au). For full details on each of the College SIGs, please see www.ranzcr.com/college/specialinterest-groups.

Volume 20 No 1 | December 2023 39

MQAP

MQAP Update

The below report outlines 2023 results from the Mammography Quality Assurance Program (MQAP).

or over 20 years the College has supported mammography services in Australia and New Zealand by operating the Mammography Quality Assurance Program. MQAP provides quality assurance assessment for mammography sites and participation is open to private medical imaging practice and medical imaging departments of public and private hospitals. The MQAP has been declared under the Commonwealth Qualified Privilege and is required to regularly share de-identified information about the activity. The MQAP Management Panel forms part of this structure and is responsible for analysis reporting under the terms of Qualified Privilege. Pictured right is an update for the participation rate in the Mammography Quality Assurance Program. IN

Clinical Radiology

Summary of participation rate: June 2020

June 2023

Difference

Total number of sites

202

209

Digital Sites – DR (full field digital)

187

206

10%

Digital Sites – CR (computed radiography)

-80%

Accreditation/Re-accreditation Assessment: June 2020

June 2023

Accreditation Assessments

Pass (on first submission)

28 8

Pass with recommendations

Resubmission (on first submission only)

Site replaced or terminated machine

Of those which required resubmission this was due to one or more of the following criteria: Total Resubmissions

Clinical Image Review

Phantom

Monitor (or Printer)

Equipment Assessor’s Report

June 2020

June 2023

Annual Review Assessments

Pass (on first submission)

Pass with recommendations

Resubmission (on first submission only)

Annual Review Assessments:

Of those which required resubmission this was due to one or more of the following criteria: Total Resubmissions

Quality Control Log

Phantom

Monitor (or Printer)

Equipment Assessor’s Report

Volume 20 No 1 | December 2023 41

Clinical Radiology

Dean's Message

The Big Questions

Insights shared from the international panel of speakers at the Clinical Radiology Faculty Forum, held as part of the Brisbane ASM.

challenges in your region and globally, and are there any risks that we don’t discuss?

All panellists agreed that artificial intelligence (AI) will radically change what radiologists do and that we are well positioned to realise the potential of AI and big data.

Dr Rajiv Rattan, Dean (FCR)

he Clinical Radiology Faculty Forum was among the many highlights of the ASM, with a distinguished panel of international radiology leaders sharing their insights on global trends, current challenges and the future of the field. It was my privilege to moderate this fascinating discussion with Prof Adrian Brady, past president of the European Society of Radiologists (ESR); Dr Howard Fleishon, past president of the American College of Radiology (ACR); Dr Matthew Mauro, President of the North American Radiology Society (RSNA); and Clin A/Prof Sanjay Jeganathan. What follows is a synthesis of panellists’ responses to a series of questions, sharing insights which have both national and global significance for current and future radiology practice and reflect the shared experiences across each of the regions represented by panellists—US, Europe, Australia and New Zealand.

Where will radiology be in 1020 years, what are the major

42 Volume 20 No 1 | December 2023

Key points include: the reliance on AI will grow our role, where radiologists will become data synthesisers and aggregators AI will accelerate innovation, with more patient-specific imaging linked with the correlation of imaging and genetic data the growth and potential of radiomics will enable us to extract much more information from studies performed there will be a convergence among data-rich specialists such as pathology, e.g. merging of traditional pathology and radiology departments to become a diagnostic testing department embracing this technology is a prime opportunity to enhance our role we can demonstrably add value by working more in the clinical space and engaging more directly with patients. Some of the risks and challenges include: dilution of our specialty where some imaging e.g. ultrasound, is becoming routine at pointof-care as part of a physical examination and an ‘extension of the stethoscope’ critical to add value throughout the patient journey to affirm relevance

preserving and enhancing quality of the radiology report counteracting perceptions among referrers using AI that they can do without radiologists fee structures must reflect and demonstrably value radiologists’ clinical work and be balanced against the huge volume of reporting required opportunity to consider how we can scale and bring more services to patients training must keep pace with accelerated technological innovation.

Where is the scope for international collaboration?

Panellists acknowledged the many benefits of international collaboration, agreeing that as a global radiology community we can be very influential in addressing common issues, sharing new science, and raising the quality of radiology worldwide. These include: multi-society statements and position statements to establish principles with global reach population health e.g. screening programs such as mammography for breast cancer economic modelling demonstrating cost/benefit of imaging particularly in underserved countries (and regions) emerging areas of therapy, e.g. theranostics training models of training and education standardised approaches research. Workforce was highlighted as one of the biggest global challenges and limitations in enabling the

opportunities and benefits of fast-paced technological change to be realised. It was agreed that we need global solutions to enable radiology to take the lead in developing and using better-quality data to predict workforce needs more accurately. Also highlighted was the growing need for radiology to articulate the metrics by which our work (and value) is measured beyond those that simply place a value on the turnover of reading and reporting studies.

Dr Howard Fleishon and Prof Adrian Brady. BELOW: The Faculty Forum panel.

Can you speak about the “turf erosion” from other specialties?

There was some concern that imaging is now included in multiple specialties, e.g. cardiac imaging, which while reflecting the critical role that medical imaging has in the practice of modern medicine, carries risks that can potentially undermine both quality and practice. Teleradiology has emerged in recent years, and while improving access and opportunities to scale services, has potential risks including negative impacts on referring relationships, quality and communication. All reiterated that radiologists must undertake more frontline clinical work, engaging in the patient journey so that the contribution is recognised and valued by referrers, patients and funders.

What advice do you have about training in radiology in the future?

When discussing the future, panellists stressed that training is a priority concern and needs to continually evolve. Key points: find new ways to train young doctors adapt to changing practices, including emerging technologies standardise our approaches as an international community include leadership and business acumen as part of a holistic

“Radiologists must undertake more frontline clinical work, engaging in the patient journey so that the contribution is recognised and valued by referrers, patients and funders.” training curriculum create new models that include online learning as well as the traditional apprenticeship model address trainers’ challenges in balancing the competing pressures of service delivery and teaching time, which is not appropriately compensated.

What advice would you give to a young trainee and those interested in radiology?

All panellists agreed that trainees should not expect to be practising the radiology that they learn today

in 10 or 20 years time. And for those just starting out in radiology, these few words were offered. “It’s a very exciting profession which is constantly evolving. If you enjoy innovation and change, are committed and willing to embrace technology, radiology is a great profession,” said Clin A/Prof Jeganathan. All felt that they’d made the right decision in choosing radiology, with Dr Fleishon summing this up for early career trainees, “Congratulations, great choice!” IN

Volume 20 No 1 | December 2023 43

Clinical Radiology

Chief Censor

Year in Review

Another year has flashed by and, on reflection, a few words come to my mind—evaluation, flexibility and collaboration.

s we continue to review and evaluate our new Training Program, I would like to thank all who have provided feedback. You will have noticed throughout the year all the positive changes that have been implemented. We remain committed to listening to our trainees, Clinical Supervisors and Directors of Training (DOTs), so please continue to share your invaluable feedback. I would like to take this opportunity to welcome Dr Ruth Sutherland, our newly appointed medical educationalist, to the College. Ruth will be working closely with the Curriculum and Assessment Committee (CRCAC) as we further review the WBA components of the Training Program, as well as our Exams team as we begin the review of the new examinations in 2024. The AMC and MCNZ together have undertaken a follow-up accreditation visit in August. Many of you were involved in some capacity—thank you all for your collaboration. As I write this, we have received the draft report for our feedback. They were impressed with our new Training Program, and the significant progress we have made in many areas, particularly the new examinations. RANZCR launched a new Regional and Rural Training Pathway (RRTP) Pilot Program in 2023 with funding secured for five pilot positions in Australia for 2024 and 2025 clinical years. This is a pathway complementary to our training programs, applicable to both specialties. RRTP builds on the existing network training model, augmented via the STP-IRTP, and

44 Volume 20 No 1 | December 2023

selects applicants who have an affiliation with rural and regional areas. The College received a very positive response. Four sites have been confirmed with four trainees accepted into the program commencing 2024 clinical year. The Selection Working Group is grateful for the considered responses and feedback to the recent stakeholder consultation on the draft Selection Policy. The Selection Policy will be introduced for the 2024 recruitment. The main changes are that candidates will initially register with the College; equity mechanisms for Aboriginal and Torres Strait Islander candidates; CV weighting; and processes to be standardised in the selection processes across jurisdictions. I would like to recognise and acknowledge the Network Training Director Working Group (NTDWG) for the feedback provided to CRETC, especially during the implementation of the new curriculum. A Working Group is generally of a limited time and the NTDWG has met its objectives. However, in recognition of the value it provides, we are looking to make the NTDWG an advisory committee. Our DOTs and NTDs provide invaluable training and leadership to the next generation, my sincere thanks. It was wonderful to catch up with colleagues at the recent ASM.

Dr Barry Soans, Chief Censor (FCR)

The Director of Training Workshop preceding the ASM was very well attended. Thanks to everyone who attended and added your valuable contribution as you continue your work towards providing the best training opportunities for our next generation of radiologists. The ASM also creates many opportunities for engagement with our trainees and junior doctors who may be looking to pursue a career in radiology. One of my highlights always is the Annual Ceremony—I find it incredibly heartwarming to see our new Fellows capped. I would like to thank Prof Michael Bynevelt, Chief Accreditation Officer. This is a busy and challenging role. For the past three years, Mike has done a tremendous job, navigating the challenges of a post-Covid world, an increase in training sites, and developing the new Accreditation Standards due to be implemented in 2024. I wish you all a restful summer break, a chance to relax and recharge for next year. Stay safe and enjoy the holidays with your loved ones. IN

“RANZCR launched a new Regional and Rural Training Pathway (RRTP) Pilot Program in 2023 with funding secured for five pilot positions in Australia for 2024 and 2025 clinical years.”

Chief of Professional Practice

Clinical Radiology

CPD Deadline Approaching

A reminder to enter your CPD activities now, and a message of thanks to key College members.

he FCR Professional Practice Committee (PPC) has had its fourth and final meeting for 2023. It was a successful face-toface gathering in Brisbane during the ASM. Some of the key pieces of work relating to the PPC worth mentioning at this time include:

support to members in the CPD space; I know the support will be ongoing into 2024. If you have any questions or require support regarding the CPD Program or ePortfolio, please contact the College team at: cpd@ranzcr.edu.au

CPD

CTCA Training Guidelines Review

If you haven’t completed your CPD activities on the ePortfolio for this year, please start entering your activities now. I would like to emphasise that it is an annual process and the requirements for 2023 need to be completed by 31 December—that is only two weeks away. I’d like to remind you that the RANZCR website (www.ranzcr.com/ fellows/general/cpd-overview) has a series of CPD ePortfolio video guides available to assist you in navigating through some of the main processes required for submitting CPD activities. The website also has many other resources to support you in this task including links to FAQs and user guides. The combined CR and RO CPD session at this year’s ASM was another well-received session. We had a very engaged audience and it served as a great opportunity to see a live demonstration of how to navigate the ePortfolio. We appreciated the lively and varied questions we could answer in real time. My only disappointment was that our session ran out of time, and we couldn’t continue the discussion further. I offer sincere thanks to the CPD team and College staff for providing

I would like to make special mention of a substantial and specialised piece of work which has been ongoing throughout this year and that’s the CT Coronary Angiography (CTCA) Training Guidelines review. The PPC oversaw this project as it came to fruition, and it was fantastic to see it approved by Council this year. I commend the CTCA Parent Bodies and associated College staff who have diligently worked together to ensure a best practice rationale is reached for the training pathways. The PPC will continue to support this project’s development as it shifts into the next-steps phase during the first part of 2024. I foresee the roll-out of the updated guidelines being well-managed as the CTCA Conjoint Committee and CTCA Parent Bodies continue to work together to affect a smooth transition for our clinicians.

Special Thanks

Prof John Slavotinek and Dr Tony Chen are both stepping down from their positions on the PPC and, I would like to thank them sincerely for their enormous contributions to the College through their work on this committee. They

Prof Dinesh Varma, CHoPP (FCR)

guided PPC through the new CPD requirements, the launch of the ePortfolio system, the CTCA Training Guidelines review and made significant insightful contributions to many postFellowship projects and initiatives. Their corporate knowledge and skills were of immense value. The PPC members wish John all the best in his new role as our President in 2024. If you have any questions or comments regarding the work of the FCR Professional Practice Committee, please feel free to reach out by emailing the College team at: professionalpractice@ ranzcr.edu.au I’ll take this opportunity to wish you and your loved ones a happy and safe holiday season, enjoy the new year festivities. I look forward to a busy and exciting 2024. IN CPD ePortfolio video guides to assist in submitting CPD activities

Volume 20 No 1 | December 2023 45

Radiation Oncology

Dean's Message

The Year that Was

A look back at the AMC Review, Biennial Facility Survey, new accreditation standards and highlights from the Brisbane ASM.

Dr Gerry Adams, Dean (FRO)

Facilities Survey Report Insights and

Trends TRENDS from 2010–2020 Australia. KEY

INCREASINGLY COMPLEX TREATMENT

30% 2

s we continue to return to, or create, our new ‘normal’ post COVID, this year has had its fair share of challenges which have occurred against a backdrop of continuing global uncertainty and upheaval. Nonetheless, we have also seen some terrific strides in furthering clinical practice through research, technology and innovation. Being able to meet face-to-face again has underlined how important this in-person connection is in facilitating stimulating discussions, offering new perspectives on treatment and practice, and fostering a sense of collegiality. This was especially evident at the recent ASM in Brisbane which showcased the breadth and depth of clinical practice and global trends in radiation oncology. Delegates were treated to the best of cuttingedge research, with presentations from a distinguished line-up of international and local speakers. The ASM was also a valuable opportunity to share and debate

Radiation therapy treatments have become more complex with the use of IMRT and stereotactic treatments increasing by around 30% per year (figure 20, table 1). In 2010 these treatments made up 7.2% of courses, in 2020 it was 72%.

SHORTER COURSE LENGTH

In keeping with changing evidence-based practice in delivering shorter courses (hypofractionation), as well as the uptake in stereotactic treatments – it is not surprising that there has been a reduction in the length of the average course of treatment. What is perhaps surprising is that this was relatively modest falling 18.1 to 15.5 (figure 18).

CHANGING LOCATION OF TREATMENT

2.3 vs 2.8 LINACS PER FACILITY

In 2020 compared to 2010, the average facility was smaller (2.3 vs 2.8 linacs per facility) and more likely to be privately operated (60% vs < 40%). There was also an increasing proportion of treatment delivered outside of major cities (21% vs 16%) (figures 8 and 16).

MORE (BUT AGEING) TREATMENT EQUIPMENT

There has been a steady and appropriate increase in the number of linacs in all states 46 Volume 20 No 1 | December 2023 and nationally. The disparity between states in 2011 has largely disappeared and all

states now have at least 7 linacs per million population (figure 9 and or 10) which is similar

LINACS

PER MILLION POPULATION

ideas with like-minded colleagues: on the sidelines, in a series of engaging workshops and in the RO Faculty Forum. The topic for this year’s RO Faculty Forum debate was, “This Faculty believes that brachytherapy is a better investment for the future than SABR.” The thought-provoking debate examined the economic, safety, sustainability and equity dimensions of both treatments. It was heartening to see so many Fellows and trainees come to see Sean Collins, Mei Ling Yap and Michael Jackson speak for the affirmative team, while the negative perspective was presented by Karyn Goodman, Jarad Martin and Peppe Sasso. After a spirited and interesting contest of ideas, the affirmative team was deemed the winner. Of course, the truth is that radiation therapy itself is the winner and, moving forward, we must treasure both important modalities. As always there was an impressive standard of presentation by the trainees at the Varian prize session. I would like to congratulate the joint winners, Dr Alexandra Powell and Dr Benjamin Challis. It was also great to see so many turning up for an early Saturday morning start for the Targeting Cancer Fun Run, which is a signature activity of the Targeting Cancer Campaign and a feature of the ASM every year. Congratulations to winners Dr Justin Whitley, Dr Barbara Laing and mystery prize winner Dr Emmeline Lee.

AMC Review

And now to other matters. I would like to offer a very big thank you to

the many staff and members for their hard work and countless hours spent preparing for the AMC review. It was a mammoth effort which reflects both the complex regulatory framework the College operates within, as well as the multiple requirements and considerations involved in specialty training. The College has received and provided detailed feedback to the AMC on the draft report, with the result that several conditions have been resolved. The draft report will now progress through the AMC governance process for ratification, before the final report is released to the College in mid-December.

New Accreditation Standards

The revised draft Radiation Oncology Accreditation Standards for training sites were distributed twice this year for consultation, with the feedback received incorporated into the draft document. The revised draft Accreditation Standards and the associated Process Guidelines have been trialled via the completion of some ‘paper-based’ reviews of key training sites, including those which have been recently identified as not meeting the current standards. This measure is designed to ensure that sites of concern, as highlighted by stakeholders, are clearly identified and investigated when assessed against the draft Accreditation Standards. It is anticipated that the revised standards will streamline and standardise accreditation processes, provide increased clarity

Participants in the RO Faculty Forum Debate.

for key stakeholders and strengthen the monitoring of training sites. All of which will improve the quality of training and potentially encourage new sites to offer RO training.

Biennial Facility Survey

The 2023 Biennial Facility Survey has now been completed, and we are hoping to publish the results early next year. This year’s survey represents the latest results in 10 years of data since the survey began and is an important tool that produces critical longitudinal data about radiation therapy in Australia and New Zealand. In early October, the College released Insights and Trends from the surveys conducted between 2010–2020. Key trends are highlighted below. We will continue to conduct the

“Despite our successes this year, there remains many challenges in meeting the growing demands for and equitable access to complex radiation oncology services across both countries.”

survey every two years and will update members about emerging trends and issues after each survey.

The Coming Year

As we move towards 2024, I wish to acknowledge all those who have contributed to the RO Faculty this year, whether through working groups, research projects, various committees or in other ways. Despite our successes this year, there remain many challenges in meeting the growing demand for and equitable access to complex radiation oncology services across both countries. In short, there is still a lot to do. While time is often a scarce resource, those who volunteer and become involved in the College not only make a great difference, but also gain a lot personally. That is certainly my experience. It is my hope that 2024 will see more members make the most of the many opportunities to add their voice and expertise to this work and to reap the rewards that participation brings. I look forward to working with you in the coming year, and wish all a safe, healthy and happy festive season. IN

Volume 20 No 1 | December 2023 47

Varian Australasian Oncology Summit

2024

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RANZCR/ASMIRT/NZIMRT & ACPSEM CPD hours can be claimed for attendance of the Varian Australasian Oncology Summit 2024. © 2023 Varian Medical Systems, Inc. All rights reserved. Varian and Varian Medical Systems are registered trademarks of Varian Medical Systems, Inc. Refer enquiries to Varian Medical Systems Australasia on 1800.657.036 or customerservice-anz@varian.com

Chief Censor

Radiation Oncology

Giving Thanks

A reflection on 2023, and looking ahead to examination changes in 2024.

Dr Lisa Sullivan, Chief Censor (FRO)

ooking back at 2023, we have achieved many things and we couldn’t have done it without support from you all. From the bottom of my heart, thank you to all my colleagues who volunteer on College committees. I would like to especially thank Dr Vanessa Estall, Chief Accreditation Officer, who will complete her term at the end of this year. Over the past five years, Vanessa has shown how driven and passionate she is about our Training Program. Vanessa inspires us in her ability to advocate with kindness and consideration. Dr Anne Capp, our Deputy Accreditation Officer, will also conclude her term. Anne always has trainee wellbeing at front of mind ensuring that our trainees are in a safe, supportive environment. We are fortunate as a specialty to have amazing people such as Vanessa and Anne who volunteer in these demanding but essential roles. They have both given so much to the betterment of our trainees and sites. To our Trainee Committee, thank you for representing and advocating

for your fellow trainees. Tracy Lim and Riche Mohan have been wonderful trainee representatives and I look forward to working with our new 2024 Trainee Committee. I would like to take this opportunity to welcome Dr Ruth Sutherland to the College. Ruth is our new medical educationalist and will be working closely with the Learning Experiences and Outcomes (LEO) Committee to improve our training program. Recently we held the DOT workshop in Brisbane, which included a presentation from Dr Antonio Di Dio from Drs4Drs about clinician wellbeing. His important take-home messages were to look out for signs of burnout in our colleagues and to reach out for help. I encourage you all to explore the Drs4Drs website (www.drs4drs. com.au) for excellent resources and telephone numbers that provide urgent and non-urgent mental health support for doctors. As you are aware the Radiation Oncology Training Program was launched in 2022, with examination changes being progressively implemented. Changes to the Phase 1 Examination were implemented in 2023 and changes to the Phase 2 Examination are to be implemented in 2024. The new Phase 2 Examination will come into effect from Series 2 (July/August) 2024. The new Phase 2 Examination will continue to consist of written and Viva examination components with a modification in the structure to allow more effective and efficient assessment of a candidate’s breadth and depth of knowledge. These changes have been made to more closely reflect actual clinical

practice, improve agility with regard to assessing knowledge of smaller topics and more recent evidence, and better integrate testing of pathology knowledge in a clinically relevant context. We will keep candidates updated and further communication will be distributed in the coming months, particularly with regards to the transition arrangements for candidates planning to sit the 2024 Phase 2 Series 1 Examination. My thanks to A/Prof Alex Tan (Chief of Examinations) and Dr Tanya Holt (Lead Phase 2 Examiner) for leading these exciting reforms to the Phase 2 Examinations. The College is launching a Regional and Rural Training Pathway (RRTP) Pilot Program in 2023 with funding secured for five pilot positions in Australia for 2024 and 2025 clinical years. This is a pathway complementary to training programs, applicable to both specialties, and selects applicants who have an affiliation with rural and regional areas. The College received a very positive response, 25 EOI applications from trainee applicants and 11 EOI applications from training sites across both specialties. Four sites have been confirmed with four successful trainees being accepted into the program commencing 2024 clinical year. As we wind down for the year, I hope you have a relaxing summer filled with happiness. Thank you once again for all your support during my first year as Chief Censor and I look forward to 2024 which will focus on communication, collaboration and evaluation of our Training Programs. IN

Volume 20 No 1 | December 2023 49

Radiation Oncology

Chief of Professional Practice

Working Together

In latest news, the FRO Mentoring Program has been launched. Plus, a timely CPD reminder.

reetings. The FRO Professional Practice Committee (PPC) has had a busy 2023 and as we prepare for another productive year ahead, I’ll take this opportunity to mention a few key achievements in recent months.

ASM Session

Dr Carol Johnson, CHoPP (FRO)

At the ASM in Brisbane, I had the privilege of co-chairing a CPD Program session with Prof Dinesh Varma, Chief of Professional Practice FCR. It was fantastic to see so few radiation oncologists there this year so I am very hopeful that you are all now comfortable with the process. The majority in the session were radiologists, eager to ask questions and to watch a demonstration of the ePortfolio system. I offer my thanks to the CPD team and College staff for providing support to members in managing their CPD requirements; I know the support will be ongoing into 2024.

CPD

“I’d like to remind you that your annual CPD activities for 2023 are due to be finalised on the ePortfolio by 31 December.”

50 Volume 20 No 1 | December 2023

I’d like to remind you that your annual CPD activities for 2023 are due to be finalised on the ePortfolio by 31 December—only two weeks from now. If you’re seeking guidance, please visit the RANZCR website for a series of CPD ePortfolio “how to” videos which can assist you in navigating through some of the key processes required for submitting CPD activities. The CPD Handbook plus many other helpful resources are also available on the website. Please familiarise yourself with these and if you have questions or require support regarding the CPD Program or ePortfolio, please contact the

College team at: cpd@ranzcr.edu.au. Please do not leave your data entry too late—assistance will be limited.

Mentoring Program

The FRO Mentoring Program has officially launched during November with newly matched pairs of mentees and mentors eager to work together. The program kicked off with a training session tailored to the participants addressing the needs of our program and was delivered by a proficient international consultancy. We anticipate this being a very successful initiative, allowing the participants to work together on matters which relate most to each individual’s concerns and goals. The FRO PPC looks forward to seeing this important program continue to prosper into the first half of 2024. If you have questions or suggestions regarding the work of the FRO Professional Practice Committee, please get in touch at: professionalpractice@ranzcr.edu. au. I look forward to bringing you further updates on the work of the FRO PPC in coming editions. I’ll take this opportunity to sign off 2023 by offering you compliments of the season and best wishes for the new year. I look forward to continuing important work with the FRO PPC in 2024. IN

CPD ePortfolio video guides to assist in submitting CPD activities

Trainee Commitee

Radiation Oncology

Radiation Oncology Trainee Matters

Here, Dr Tracy Lim reflects on a year as Chair of the ROTC.

Dr Tracy Lim

s trainees, we are understandably focused primarily on getting through training and acquiring the required knowledge and skills. Advanced training is an exceptionally stressful and demanding time, and it is hard to see outside the bubble of the training world. However, being involved with the ROTC over the past couple of years has broadened my appreciation for the significant contribution that so many people pay to our training and progression. We often refer to “the College” as a faceless body, but I now understand that the College is us and the College is you. I now appreciate how much time and

effort goes into our training. There are of course the front-line clinicians who provide the direct learning along with many other craft groups. However, what we do not often get to witness is how many people volunteer their time to shaping our training program. This would not exist without the help and support of all those who are kind enough to spend considerable time writing and marking exam papers and reviewing documents and policies. To everyone who contributes to our learning and training progression, on behalf of all trainees, I sincerely thank you. As we wrap up 2023, I would like to thank the many people who have supported me and the ROTC. Thank you to our Dean, Dr Gerry Adams, for your ongoing wisdom and guidance and thank you for kindly giving up your Sunday mornings to attend our meetings. To our Chief Censor, Dr Lisa Sullivan, thank you for your commitment to our training progression and for your kindness. To all the Fellows who volunteer so generously your time and effort —including but not limited to our clinical supervisors, directors of training, examiners, accreditation officers, college committee members—we thank you. Thank you as well to the wonderful College staff who have continued to support

“The end of the year is an opportune time to reflect and thank those who have done so much, and I am most grateful for everyone I have been privileged to work with this year.”

us, and especially me, in this role this year. On a more personal level, I’d like to extend my gratitude to my director of training, my clinical supervisors, my department and my colleagues who have so kindly facilitated my attendance at the various council and committee meetings during the year. Without their support, this role would have been significantly more challenging. I hope that other departments will also consider supporting their trainees in their advocacy roles. Last, but not least, I’d like to thank my wonderful ROTC team for all their incredible hard work and dedication this year. Thank you to Dr Sarah Li, Dr Aaron Jin, Dr Riche Mohan, Dr Jennifer Yeh, Dr Caryn Wujanto and Dr Su-Shan Chan. Thank you for your invaluable contribution, for going above and beyond and for your unfailing support. I could not have imagined a better team to work with. To the new incoming ROTC team for 2024, best of luck and I know you will continue to represent us trainees. The end of the year is an opportune time to reflect and thank those who have done so much, and I am most grateful for everyone I have been privileged enough to work with this year. I hope I can inspire other trainees and Fellows to contribute to college activities for the progress and benefit of future generations of radiation oncology trainees. We are where we are, not only from our own effort and on our own merits, but also often because of other people’s support and contribution. Thank you for a wonderful year 2023 and Happy Holidays. IN

Volume 20 No 1 | December 2023 51

ADVERTORIAL

HYPOFRACTIONATED RADIATION THERAPY IN CANCER CARE: EXPERT PERSPECTIVE FROM ASIA-PACIFIC IN A RECENT REVIEW article featured in the ASTRO Green Journal, the current state of hypofractionation adoption in key Asia-Pacific (APAC) countries, including Australia, South Korea, Japan, and Singapore, was discussed. This publication, a product of insights from the Therapy Advancement – Thought Leadership Council (TA-TLC), aimed to enhance the adoption of hypofractionation in the APAC region. Despite the increasing recognition of hypofractionation and its inclusion in treatment guidelines based on mounting evidence, significant obstacles impede its adoption and utilization across geographic regions and various disease sites in the APAC countries. Esteemed radiation oncologists (experts) from South Korea, Japan, Singapore, and Australia shared their perspectives and experiences in the review article, with a focus on tumour sites such as the brain, breast, lung, and prostate. These experts discussed several barriers to the adoption of hypofractionation. One of the main barriers identified was the prevailing reimbursement model in various APAC countries. Traditional pay-per-fraction models, particularly in Japan and South Korea, may discourage physicians from adopting hypofractionation due to their emphasis on the number of fractions and mode of delivery, influencing treatment schedule choices. In Australia, the difference in payment structures between the public and private sectors presents challenges, often resulting in patients bearing out-of-pocket costs beyond insurance coverage in the private sector. The experts highlighted that concern regarding potential toxicity and late effects associated with hypofractionation is another major barrier. While substantial evidence supports hypofractionation for certain cancers, data gaps for conditions like breast cancer, brain tumours in younger patients, and prostate cancer contribute to hesitancy among healthcare providers. Dr. Lucinda Morris, a co-author, pointed out that the APAC region has lower hypofractionation adoption than many parts of Europe, emphasizing the importance of learning from best practices in other regions and country es. During TA-TLC meetings, barriers to adoption, including reimbursement and referral pathways, emerged as major concerns. Furthermore, the experts identified professional biases and practice cultures as additional barriers to the adoption of hypofractionation. Surgeons, acting as gatekeepers

for patient referrals to radiation oncologists, may limit information about radiation therapy options, leading to discrepancies in referral pathways and hindering a multidisciplinary approach to cancer treatment. Singapore, in particular, has witnessed a decline in referrals for hypofractionation, particularly for brain metastases, attributed to the evolving landscape and treatment modalities in oncology. Limited resources, technology, and administrative capabilities, especially in rural areas, constitute another barrier. To optimize hypofractionation use, the experts proposed several solutions. Restructuring provider reimbursement models to focus on patient outcomes and advanced techniques, rather than pay-per-fraction models, can incentivize adoption of hypofractionation. Publicizing information on hypofractionation reimbursement models and facilitating communication among government agencies, providers and payers can contribute to fair compensation. Addressing knowledge gaps is crucial, with the experts advocating for increased availability of clinical trial data and real-world evidence. Establishing centers of excellence for research and development, along with knowledge sharing and training, can further support this initiative. Dr. Dasantha Jayamanne, another co-author, suggests applying lessons learned from the COVID-19 pandemic, such as efficient appointment scheduling, to optimize resource allocation. Promoting a multidisciplinary approach to treatment planning, considering radiation oncologists’ opinions, can lead to better patient outcomes. In conclusion, the experts emphasized that optimizing the use of hypofractionation radiation therapy requires addressing reimbursement models, knowledge gaps, and professional biases while fostering collaborative research and advocacy. Implementation of these solutions can position hypofractionation as an accessible and beneficial aspect of cancer care. To view the complete article including a full list of references, please refer to: Akimoto T, Aoyama H, Chua MLK, et al. Challenges and opportunities with the use of hypofractionated radiation therapy in cancer care: regional perspectives from South Korea, Japan, Singapore, and Australia. Adv Radiat Oncol. 2023;8(6):101291. doi:10.1016/j.adro.2023.101291

Further information can be obtained at www.varian.com Please direct all enquiries to Varian Medical Systems Australasia on 1800 657 036 or customerservice-anz@varian.com

52 Volume 20 No 1 | December 2023

Branches

News

Wellington Window

New Zealand Branch Chair Dr Gabes Lau recaps events and shares updates and insights from across the ditch.

Dr Gabes Lau

ia ora koutou. It was a close, scintillating Rugby World Cup Final that had the nation on the edge of our seats. Not the send-off we would have liked for a number of stalwarts, but they played with passion and heart. Before I go on, let me congratulate all the organisers of the recent ASM in Brisbane— another excellent event. It was great to see everyone there.

Training & the Workforce Crisis

It is likely that 2023’s biggest advocacy success in Aotearoa was the increase of five additional funded training positions for radiation oncology. This was fantastic news after many years of advocating. It is not yet confirmed if the increase will be ongoing in future years. (Note: radiology got an increase of 15 in 2021.) Sadly in 2023, New Zealand also lost a training site. Dunedin no longer had enough consultants to maintain training for radiation oncology and so the College was forced to withdraw accreditation. This loss

of training capacity highlights the urgency in coming up with longterm solutions to train and retain more of our Fellows in New Zealand. As the health workforce shortage is international, reliance on IMGs is not a sustainable solution. Radiology, on the other hand, has seen an expansion of accredited training sites in recent years, with a few additional regional sites on the horizon. Work to increase training in the regions is being led by the National Radiology Action Group (reporting to Te Whatu Ora) with support from the College. The Regional Training Working Group has already had one meeting and discussed some short-term and long-term strategies to increase regional training. I strongly encourage regional, including private, services to reach out if they are interested in training. Te Whatu Ora seems supportive of expanding regional training, so now is the time.

Te ORA Hui

In our ongoing efforts to increase interest in radiation oncology and

radiology, the College’s Wellington office arranges for booth sponsorship at various conferences. In September, the College sponsored the Te ORA Hui (Māori Doctors Association Conference) to try and attract Māori junior doctors into our training programmes. Thank you very much to the registrars and radiation therapist that staffed the booth. I see from the photos (pictured inset, below) that we do try and get them young.

Heading into 2024

I think we are all expecting a range of changes in the health space in 2024. National and ACT have indicated a number of changes are ahead of us. We will need to wait and see how they go about actioning their campaign promises. It is worth noting that ACC has been reviewing the High Tech Imaging Contract—hopefully we will know more early in 2024. Consultation on the review of the HPCAA is also expected in 2024. I’m sure that will keep us all busy. I wish you and your whanau the happiest of holidays. Ngā mihi. IN

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

Te ORA Hui (Māori Doctors Association Conference).

Volume 20 No 1 | December 2023 53

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY

Volume 67 • Issue 7 • October 2023 • Pages 691–806

Where does the Gadolinium go? IV contrast for CT in acute abdomen QOL after HDR or LDR for intermediate risk prostate cancer Radiation oncologists’ scope of practice

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!

11/7/2023 8:41:54 PM

JMIRO

News

New Horizons

As Prof Michael Barton steps down as JMIRO Editor in Chief, we asked him to share some of his challenges and highlights in the role.

fter five years at the helm, Prof Michael Barton has stepped down as Editor In Chief of the Journal of Medical Imaging and Radiation Oncology (JMIRO). Prof Barton has steered the Journal through COVID and other challenges, including the uptake of Open Access publishing.

What interested you in the role of JMIRO’s Editor in Chief?

JMIRO had evolved under the leadership of the previous Editor in Chief, Prof David Ball. It was an eye-opener for me that a radiation oncologist could lead the journal, as we are very much the junior partners in the College and all previous editors had been radiologists. I have been an academic oncologist for over 30 years, involved in paper writing, reviewing and editing for international journals. I felt I had the skills and experience to contribute to JMIRO and I had a number of thoughts about improving the journal. These included the introduction of Special Issues, a presence in social media to promote our publications, and a better author experience with shorter review times and better reviews.

What do you think are the biggest challenges facing the journal now and in the future?

JMIRO has a unique challenge to provide interest and value to all College members. Medical imaging and radiation oncology are very different specialties arising from a common technology. We surveyed the College membership. They want a journal that publishes high-quality papers but is accessible to local

authors. Members are interested in what their colleagues are up to and JMIRO has always had a role as a stepping stone to break into academic publishing. JMIRO is a volunteer organisation. In order to attract good papers, we need to provide high-quality timely reviews. We have initiated reviewer training for registrars and annual webinars on the mechanics of writing, publishing and promoting academic papers. We now offer incentives for reviews provided in under five days and we have seen a significant decrease in review times. Selection of content is a challenge. Fortunately, JMIRO has excellent Deputy Editors in Medical Imaging (Dr Gabes Lau) and Radiation Oncology (A/Prof Belinda Campbell) who provide expert advice on journal directions and the suitability of submissions. Special Issues are designed to provide overviews of major topics but preferably they should interest both faculties. Finally, there is the challenge of promoting the papers in JMIRO. There is no use doing research and publishing it if it’s not used. We now have two active and engaged Social Media Associate Editors, Dr Mark Bekhit and Dr Vicky Batumalai, who work with our publisher to develop content and disseminate it. The College has provided support for eposter and short video production. The future challenge is to take advantage of the Open Access (OA) movement in academic publishing. OA increases readership and citation. Research is mostly publicly funded and should not be hidden behind a paywall. Our publisher, Wiley, has an agreement with the Council of

Prof Michael Barton.

Australian University Libraries to publish as OA any paper from a first author affiliated with an Australian University. This agreement is expected to expand.

Is there anything you would have liked to achieve but haven’t? We have a number

of registrars who have become reviewers for JMIRO. I would have liked to see the reviewing of papers recognised as a research activity in the training of radiologists and radiation oncologists. All members need to be able read new research and evaluate it in a timely fashion but most have not had training. This means that the quality of reviews we receive is variable and can be frustrating for authors (and editors!).

Which moment as Editor in Chief are you most proud of?

I am most proud of the Special Issues. They cover important areas of practice and bring together reviews and original research in a coherent package. Our most cited papers now mostly come from Special Issues. IN

Are you interested in becoming the next JMIRO Editor in Chief? We encourage any Fellow to express their interest via members@ranzcr.edu.au

Volume 20 No 1 | December 2023 55

News

Members

In Real Life College committees enjoy meeting face-to-face for the first time post-lockdowns.

ince the radiology community has been recovering from the COVID lockdowns, face-to-face meetings have been scarce, with online meetings the norm as we all dealt with the effects of the pandemic, travel restrictions and suspension of once ‘normal’ activities. The Clinical Radiology Research Committee and the JMIRO Editorial Board were two College committees that took the opportunity to meet in person recently—which was a breath of fresh air for participants at both meetings. The committee members, all of whom believe in the rewards of volunteering their time to the Research Committee, valued the face-to-face meeting. Dr Rebecca Woodward, who travelled from New Zealand to attend the Clinical Radiology Research Committee meeting, said “I valued the face-to-face meeting as an opportunity to develop relationships with other committee members. It was a chance to have broader discussions about the place of research in delivering improved outcomes and strengthening our profession.” Clin/A Prof Glen Lo, who came from Perth to Sydney for the JMIRO Editorial Board meeting, said “Great to meet face to face … as we are in a less restrictive phase of the COVID-19 pandemic it has been invaluable to be able to meet faceto-face again to physically connect with other members of the team.” The College values the service of our volunteers very much, and welcomes the opportunity for organising face-to-face meetings of committees and SIGs. IN

56 Volume 20 No 1 | December 2023

CRRC members and College staff.

JMIRO Editorial Board members and College staff.

“I valued the face-to-face meeting as an opportunity to develop relationships with other committee members. It was a chance to have broader discussions about the place of research in delivering improved outcomes and strengthening our profession.”

Members

Vale

William (Bill) Duncan, FRCR, FRCPE, FRCSEd, FRCPC, Hon FRANZCR—a personal remembrance by Prof Alan Rodger.

News

IN MEMORIAM Dr William Duncan, Honorary, Overseas Dr Stephen Wong, Fellow, NSW

rof William (Bill) Duncan, honorary Fellow of the College, died aged 93 on 29 September 2023, in Edinburgh. Bill is well known to our older fellows, particularly for his work in heavy particle irradiation. It was Bill Duncan who, during 1975–85 in Edinburgh, by unbiased, painstaking work in his methodologically meticulous randomised controlled trials (RCTs) into fast neutron versus photon therapies, proved that “there is no convincing evidence that fast neutrons are either safer or as effective in cancer control as photon therapy”1. His trials were a lesson in how to conduct RCTs, saving many patients from the morbidity associated with fast neutrons. For years he faced antagonism from some proponents of neutron therapy. In 1987, for this seminal work, Bill and his team were awarded the Röntgen Prize by the British Institute of Radiology. Bill, born in Aberdeen, studied at its university where he met Joyce Gelletly, a fellow medic. They married in 1954. They had three sons and, like their mother, they survive Bill. After National Service as MO to the Parachute Regiment at Catterick, Bill took up radiotherapy in Manchester’s Christie Hospital under the famous Dr Ralston Patterson, whose World War II visit to the governments of Australia influenced radiotherapy in this country. In 1964 Bill became a consultant at the Christie in gynaecological cancers but in 1971 he was appointed to the chair of radiotherapy in Edinburgh. Bill switched to urological

Prof Duncan (second from left) with some of his neutron trial team, Dr R H MacDougall (far left), Prof Rodger and Dr S J Arnott (far right).

“We who were mentored by Bill know he was utterly trustworthy and supportive. He worked to a high standard and expected that of us.”

malignancies to suit the department. He introduced chemotherapy for testicular tumours and instituted multidisciplinary working, walking at his customary fast pace, his team in tow, to staging cystoscopy sessions with our urologists. In 1985 Bill became head of radiation oncology at Toronto’s Princess Margaret Hospital (PMH). Over the next five years he achieved what he told me he was going there to do, “rebuild, restaff and re-equip a museum of radiotherapy that stopped collecting in the 1960s”. He insisted the PMH be moved next to Toronto General, not to a suburb; he closed the hospital when waiting times became unmanageable; he got the equipment and staff to remedy that; he stood up for radiation oncology and its staff. As a result, he alienated some locals.

His contract was not renewed. In 1990 he returned to the chair in Edinburgh. We who were mentored and trained by Bill know he was utterly trustworthy and supportive. He worked to high standards and expected that of us. Bill was a family man. In his last years he daily took the two buses to see Joyce in her care home. In retirement he had time for painting in watercolours. His Christian faith was lifelong and personal. Bill was a wonderful clinician, boss and colleague. IN

1 Warren, P. 2023. William Duncan: radiation oncologist who disproved the hyped claims for fast neutron therapy. BMJ. 383: 2546. Acknowledgements: I am grateful to Dr Graeme Duncan for information on his father and to Profs Alastair Munro and R Hugh MacDougall for information on Prof Duncan’s life.

Volume 20 No 1 | December 2023 57

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Member Rewards Program

Australia

As a member of the College, you can access a specially selected, member-only rewards program to deliver maximum value from your membership subscription fee. The program caters to a variety of needs with a range of financial, insurance, legal, travel and lifestyle products and services included. THE ACCOMMODATION BROKERS They say “memories last forever” and some of the best memories for us all are holiday memories. Our partner The Accommodation Brokers has been delivering holiday discounts to our members for more than three years and the ongoing feedback has been very positive.

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

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This offer is available to the following services provided by KPMG Enterprise Australia, New Zealand and Asia: Audit and Assurance; Tax, Transactions, and Accounting; Advisory; Accelerating Business Growth. To access the offer, please complete the online form. You will then be connected with the appropriate contact. ranzcr.com/contact-kpmg

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Volume 20 No 1 | December 2023

BMW Corporate offers Australian College members and their spouses the following benefits: • A free Service inclusive for three years or 60,000kms* • Benefits extended to your spouse or de-facto partner • Reduced dealer delivery of $1,850 excluding taxes • Access to a dedicated Corporate Sales Manager

This offer currently excludes electric cars. *Complimentary basic scheduled servicing, including Vehicle Check, is valid from date of first registration for whichever comes first of 3 years/60,000kms, and is based on BMW Condition Based Servicing or Service Interval Indicator, as appropriate. Normal wear and tear items and other exclusions apply. Servicing must be conducted by an authorised BMW dealer. Consult your preferred BMW dealer for further terms and conditions.

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News

Beyond Our Horizons: The Lagoon Nebula

Dr Arthur Daire, winner of the 2023 ASM’s “RANZCR’s Got Talent” photographic competition, shares the story behind his amazing photo.

“I BECAME INTERESTED in astrophotography three years ago, initially taking moon pictures with a Canon 100–400mm telephoto lens combined with a x1.4 teleconverter. I got more interested after seeing Horse Head Nebula (IC 434) images—it’s a beautiful reflection nebula in the constellation of Orion. So I invested in a telescope, a go-to-mount and a dedicated astrophotography camera and got my own picture of the Horse Head Nebula. Taking these pictures requires

Dr Daire’s astrophotography equipment set-up; and his winning photograph, ‘The Lagoon Nebula (M8)’.

a computer running software to manage the imaging session (ZWO ASIAIR plus, in my case) and filters to counter the light pollution. Filters allow light of particular wavelengths to pass through, thus blocking light from streetlamps, car lights and home lights. Telescope mounts have to be polar aligned for astrophotography, so they know their position and where they are pointing in the sky.

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Because light emitted is faint, multiple long exposures are taken then stuck together. The Lagoon Nebula image was a stack of 25 images each 300 sec (5 min). The photograph depicted the conference theme in a way that there is more ‘beyond’ our work borders that happens and we can participate in communities—like volunteering for causes such as Radiology Across Borders.” IN

ANZTS Update

Professor Dinesh Varma elected President of Australian & New Zealand Trauma Society. CONGRATULATIONS TO Prof Dinesh Varma, who was appointed President of the Australian & New Zealand Trauma Society (ANZTS) at its 2023 ASM, held in Melbourne in October. Established in 1997, ANZTS is the only multidisciplinary trauma society in Australasia. Prof Varma has held several other senior leadership positions including: Chief of Professional Practice RANZCR; Deputy Chair, Mission TBI, MRFF, Govt of Australia; President RANZCR 2011– 2013: President AOSR 2018–2021; Chief Censor RANZCR 2015–2018. We wish him well for the upcoming term. IN

Volume 20 No 1 | December 2023 59