Inside News March 2024

The Present and Future

In his first message as President, Prof John Slavotinek considers the broader context beyond the

College, as well as recent RANZCR activities and achievements.

As a new President, I have spent some time considering the setting and current position RANZCR finds itself in. Radiation oncology and clinical radiology are conducted within the context of broader healthcare systems and are significantly influenced by them. In the interests of gaining a well-rounded perspective, and before considering specific College activities, it’s useful to look outward and review the overall challenges faced by healthcare systems in New Zealand and Australia, as well as many other countries around the world.

These challenges include:

An ageing population with evolving disease patterns and an increasing burden of comorbidity

Expansion of medical knowledge and available therapies

Rising demand for services, partly due to increasing patient and societal expectations

Problems with health workforce supply and distribution

Rapid rise in healthcare costs

in an environment of cost containment

Greater focus on patient safety; equity, diversity and quality of care; as well as our environmental impact

Rapid evolution of AI and other technologies.

The College has been proactively engaged in several initiatives related to these challenges, and I would like to highlight just a few of these.

Advocacy

Targeted and unrelenting advocacy by College staff and office bearers, as well as active participation by its members, is vital to ensure that the interests of members and optimal patient care are well represented in a wide variety of settings.

In terms of recent activity, a longstanding process initiated during the MBS review in 2013 came to fruition with the Australian Government’s announcement of the new agreed radiation oncology Medicare Benefits Schedule. This sets out how Medicare will fund radiation oncology in the future, more closely reflects modern practice and is a great achievement for the College.

In relation to diagnostic imaging, July 2023 saw an end to a 20-year funding freeze with

the announcement that annual indexation of 3.6% will be applied to the majority of diagnostic imaging services. To say this was late in coming would be an understatement but this shift is most welcome.

Advocacy in New Zealand prior to the 2023 election achieved an additional 15 radiology and five radiation oncology training places, and funding for two radiation oncology Fellowships.

In Australia, supervision rules for MSK ultrasound and nuclear medicine services were amended and government funding was provided to:

Increase the number of places under the Specialist Training Program (STP)

Increase regional and rural workforces via the pilot Regional and Rural Training Pathway (RRTP). Importantly, the College has supported the Australian Indigenous Doctors’ Association (AIDA) by providing Specialist Trainee Support Program funding for First Nations non-GP medical specialists.

Future advocacy will include brachytherapy services, removal of restrictions on all MRI machine licences (not just MM2-7) and building a sustainable regional and rural workforce through the RRTP.

“Since formation of the Artificial Intelligence Committee in 2018, RANZCR has become a leading professional body in this arena both nationally and internationally.”

Prof John Slavotinek

Artificial Intelligence

While the timing and degree of impact are difficult to predict, artificial intelligence (AI) is likely to be the single-most disruptive influence on clinical radiology and radiation oncology in many decades, and potentially since the very beginnings of our specialties.

Since formation of the Artificial Intelligence Committee in 2018, RANZCR has become a leading professional body in this arena both nationally and internationally. Our ethical principles for AI in medicine and standards of practice documents, as well as our position paper on the regulation of AI in medicine, are widely respected.

Recently RANZCR also proposed a multi-society collaboration with four other leading bodies: the American College of Radiology (ACR), the Canadian Association of Radiologists (CAR), the European Society of Radiology (ESR), and the Radiological Society of North America (RSNA). This culminated in publication, this January, of a multi-society statement in multiple leading radiology journals. This article provides guidance to members and others about appropriate development, purchase, implementation and monitoring of AI tools in radiology.

RANZCR Accreditation

The Australian Medical Council (AMC) is the accreditation authority for the medical profession under the Health Practitioner Regulation National Law in force in each state and territory (the National Law). It accredits medical education providers such as the medical

colleges and universities against set standards and in doing so authorises them to continue operation. AMC accreditation is required for RANZCR to operate as a training entity.

In 2023, and after submission of detailed documentation from RANZCR, the College underwent accreditation by the AMC. During a thorough process the AMC accreditation team spent more than a week in the College office and visited multiple training sites. This required significant time and effort from 50 College staff, our office bearers and 60 of our members. The outcome was an outstanding success with the College being granted accreditation until 2027, with the option of extension to 2030. This period of accreditation is much longer than usual and importantly, our members also felt they had made a significant contribution to a successful team effort.

The Future

I have elected to focus principally on some of our successes, but we face many challenges and some of these will be addressed in the accompanying article by our CEO. At present, there is a coordinated strong push by state and federal governments to reform processes relating to both accreditation of training and International Medical Graduates (IMGs). Such changes are outlined in the Kruk Review and the National Health Practitioner Ombudsman’s reports. These recommend major changes to accreditation activities and the role of colleges. This may affect all trainees and radiologists in New

Zealand and Australia, in public and private sectors and in the rural and metropolitan contexts. How we respond and the guiding principles we apply when facing challenges such as these will vary depending on the context in which we find ourselves.

I believe that willingness to continue to accept change, a collaborative approach, clearer communication with members, greater patient contact, research with a focus upon demonstrating our clinical value and the quality of care we provide our patients, as well as our ability to adapt to rapidly evolving technologies such as AI will be the most significant determinants of our long-term future.

Although change and the activities above are essential, there are good reasons to feel optimistic about the future. The quality of our training and skills as Australian and New Zealand specialists in radiation oncology and clinical radiology are the envy of many. We also have a skilled and dedicated CEO and College staff, office bearers, Deans, Board members and councillors, and are fortunate to benefit from the efforts of many members who volunteer to participate in College activities. I look forward to supporting College members as we address various opportunities and challenges during my term as President. IN

From the Frontline

Examining the effects of increased government regulation on specialist medical colleges.

Duane Findley, CEO

We enter 2024 at a time of great uncertainty for RANZCR, and indeed for all specialist medical colleges.

Medical colleges are an essential partner in the Australian and New Zealand health ecosystem. We establish and maintain clinical standards that are the envy of the world, build the curriculum for and train outstanding graduates who are in demand globally, partner with government to advance health innovations or to deliver outcomes, advocate for meaningful change in our professional sector, connect with the rest of the world to collaborate and share new thinking, and create the opportunities for our members to connect and learn from each other.

Much of this is done through the selfless volunteer contributions of our inspiring members, who in RANZCR alone, contribute tens of thousands of hours of their own time each year for the improved health of our communities. RANZCR and other colleges do all of this quietly and in the background, so that the community does not know the critical role we play in the health system.

The colleges save the health budgets of Australia and New Zealand many millions of dollars each year, achieving amazing outcomes at a fraction of the cost and time of a governmentmanaged solution. Yet it appears that, at the moment, the medical colleges are being painted as the source of many problems in the system. When our political system delivers power to a single political

party at the Commonwealth and all states, that party finds it tempting to ignore those who might be presenting inconvenient truths about the health system that do not match their collective world view; and the potential for groupthink is strong.

The Commonwealth Government, through their regulators, mandates the standards and processes that RANZCR must adhere to in the delivery of many of these services, particularly in the trainee, international medical graduate (IMG) and continuing professional development (CPD) spaces.

When the colleges, in the course of fulfilling the roles that have been imposed upon them by government and regulators, deliver politically embarrassing outcomes, the natural bureaucratic response is to commission reports that seek to deflect blame, and impose even more regulation and more regulators on the colleges.

In fulfilling its mandated role on training site accreditation, RANZCR sometimes collides with a state health sector that has suffered from chronic underfunding for years, or lacks the will to deal with poor employee behaviour, and that too often resents RANZCR for highlighting these issues. With IMGs, state and Commonwealth governments conveniently blame the colleges for upholding appropriately high IMG entry standards, rather than accept that decades of underfunding and lack of workforce planning for trainee places has resulted in specialist

shortages, leading to community and political pressure for a short-term fix.

The Medical Board of Australia (MBA) has mandated the components of the new CPD program that RANZCR and other colleges are now obliged to implement and appears unmoved by the concerns raised about this program in its present form by medical specialists.

In recent times, the government has commissioned two reports that impact the colleges; the Kruk report into the IMG system and the National Health Practitioner Ombudsman (NHPO) report on the training site accreditation system. Both reports call for sweeping changes that potentially could result in our current high accreditation

and IMG standards being compromised. At the same time, the AMC is reviewing the standards that colleges operate training programs under. Given the history of regulation in this sector, it is a fair bet that any new standards will be more costly and onerous than our current standards.

There is a direct cost to RANZCR from this increasing regulation. The AMC operates on a “cost-recovery” model for its assessment visits, and it charged RANZCR close to $100,000 for its 2023 assessment of the College. This does not include the significant financial and opportunity costs to RANZCR in preparing for the AMC assessment visit. Other new regulations have compelled RANZCR to invest in new systems and staff to deliver

"We establish and maintain clinical standards that are the envy of the world, build the curriculum for and train outstanding graduates who are in demand globally, partner with government to advance health innovations or to deliver outcomes, advocate for meaningful change in our professional sector, connect with the rest of the world to collaborate and share new thinking, and create the opportunities for our members to connect and learn from each other."

against these new regulations at substantial cost.

The bureaucracy likes the regulatory approach. Imposing more regulations lets them show their constituents that they are “doing something”; and forces the colleges into the role of being the “public face” of, and having to deliver, potentially unpopular new processes. It also makes the colleges responsible for finding the money to deliver these programs, either through taking the money from members, or introducing new fees to cover the costs of delivery.

RANZCR has a strong working relationship with our regulators. We maintain a professional relationship with both sides of politics and with relevant government departments. We will continue to work with all stakeholders to promote the interests of our members; to argue for the application of a sensible regulatory framework that enhances, not hinders, our role in the health ecosystem; and to ensure that accreditation and IMG standards remain to a high standard. IN

Home Away from Home

Dr Vidisha Vaidya is a diagnostic radiologist, Director of Training and Director of Medical Education at SKG Radiology, Perth. Here, she reports on her work raising funds for Cancer Council WA.

For several years, I have found myself reflecting on the challenges our regional and rural patients face to access care, particularly treatment for cancer.

Part of my clinical role involves conceiving, organising and implementing bi-annual Radiology Fellowship Trial Case Reporting examinations (previously e-Film) and OSCERs (previously Viva-Voce examinations) at SKG Radiology for our WA radiology trainees. The disparity faced by regional and rural patients formed the inspiration to request our examination candidates to make a small and nominal donation directly to Cancer Council WA in lieu of our SKG Trial examination registration fee (the examination venue, examiners, workstations, IT and administration support are kindly provided by SKG). To maintain good clinical governance, accountability and transparency, the candidates are provided with a receipt for their taxdeductible donation directly from Cancer Council WA.

I am humbled and delighted to share that we have recently successfully reached and exceeded our original target of raising $5,000 this year. These funds will help

provide accommodation for our regional and rural cancer patients who need to travel to Perth to access medical care.

Support Accommodation for Regional Cancer Patients

Through discussions with the team at Cancer Council WA, we pledged the entire amount raised to ‘adopt a room’ at Milroy Lodge in Perth. Milroy Lodge is one of two Cancer Council-supported self-catering facilities that provides a no-cost ‘home away from home’ for patients receiving cancer treatment.

Surrounded by tranquil natural bushland, the facility offers a holistic approach to treatment by providing practical, emotional and social support to patients.

I recently visited the facility, and had the privilege of meeting Norman*, a gentleman from Kalbarri in the Mid-West who was in Perth for his prostate cancer treatment. This was Norman’s tenth visit and stay at Milroy Lodge. As is often the case with our regional and rural patients, Norman had a straightforward, stoic approach to his health circumstance and I found the entire visit to be a positive, moving and profoundly uplifting experience.

We hope to continue to raise funds for Cancer Council WA through this initiative and adopt a second room at Milroy or Crawford Lodge.

A Note of Thanks

It takes a village to bring an initiative like this to life. I would like to express my heartfelt gratitude to Dr Sue Ulreich, CEO and Senior Radiology Consultant at SKG Radiology for her steadfast support; Ms Julie Rogers (Executive Assistant to the CEO) for her fantastic administration support; and Mr Steve D’Costa (Senior PACS Engineer, Sonic Radiology) for his dedication and commitment to the IT support. My sincere thanks also to more than 20 SKG Radiologists who have contributed their time and expertise over the three years as examiners for our Trial OSCER/VivaVoce examinations. I am also grateful to the team at Cancer Council WA and Milroy Lodge for their time and assistance. Finally, my heartfelt thanks to my wonderful husband, Navin, for his unwavering belief in me through the rain and sunshine of life. I will always be grateful. IN

Scan the QR code to find out more about Milroy and Crawford lodges

Dr Vaidya (centre) outside Milroy Lodge’s complementary therapy room, with Ron ten Hoor and Fiona Dyball from Cancer Council WA.

Award Winning

In this year’s Australia Day Honours, RANZCR Fellow Dr Nick Stephenson was awarded Member of the Order of Australia for significant service to medicine, and to medical imaging training. Here, he reflects on his work and what the AM honour means to him.

It is an honour to be recognised for the work I have done to improve the healthcare and wellbeing of country Australians, by helping make rural Australia’s medical workforce more resilient and self-sustaining.

I got involved in radiology and medical workforce issues very early in my radiology career, because of the rural medical workforce shortage and its direct impact on the healthcare and wellbeing of country Australians. The shortage is the major cause of the poorer health outcomes that remote, rural and regional Australians experience, and it has gotten worse for GPs and radiologists over the past 28 years.

I realised back then that the key was more rurally based training. The evidence base for that has steadily improved, such that there is now excellent observational evidence that the way to get new doctors to choose to live and work rurally is to train them rurally. The best results come from ‘longitudinal integration’ and ‘community immersion’.

Thus, for almost 28 years I have been encouraging and supporting the ruralisation of all elements of the medical workforce pathway: high school aspirants; medical schools; junior residency; accredited training

programs; +/- post Fellowship subspecialty training; recruitment and settlement in communities and professional practice; retention of locally resident doctors; the teaching, training, guiding and mentoring of the future generations of rural doctors. I believe this is why I have been honoured with the AM on Australia Day.

I did not do it alone, and I owe huge thanks to many people who supported me and still do. I thank those who worked with me or encouraged me on the Riverina Medical Specialist Recruitment & Retention Committee for many years and those who worked with me on the Rural Medical School Implementation Committee.

I am also very grateful for the Commonwealth government's decision to create the MurrayDarling Network of Medical Schools, west of the Great Dividing Range in NSW and Victoria, and especially to the Nationals leader of the time. This leader knew that if medical students and doctors are trained rurally, then they will choose to live and work rurally. He was able to implement the policy, despite resistance.

For rural Australia, resilience requires enough locally resident doctors to handle the very varied caseloads, and the stresses of more frequent after-hours calls and working more remotely than most.

To be self-sustaining, rural Australia needs enough locally resident doctors of varying age, experience and skill set, who have the time, energy, ability and support to train the continuing generations of rural doctors.

Rural medical school training needs to be supplemented by rurally based postgraduate training programs. The same is probably true for all healthcare professions and probably also for all careers.

Longitudinal integrated training and prolonged immersion in community settings is the evidencebased step that needs piloting, implementation and/or expanding across many specialties.

Encouraging all school students, and their parents, to believe the young individual can achieve a career goal that optimises the individual’s potential, whatever the career and whatever the student’s background, is a key driver of the best outcomes for the individual and for society. That is why I support the Made For A Trade movement, as well as rural medical school expansion, and the development and expansion of rurally based medical specialist training.

So, I intend to continue my efforts with renewed vigour. I hope others who have supported me, and/or are working in similar fields, also feel invigorated by this recognition.

Thank you to all Australians for this honour. IN

Survivors Celebrated on World Cancer Day

Targeting Cancer shares the story of lung cancer patient Clinton Payne.

RANZCR and its Targeting Cancer campaign recently celebrated the stories of cancer survivors to mark World Cancer Day on Sunday 4 February. This year’s theme was ‘Close the Care Gap’, with organisers calling on leaders to invest in resources to achieve better outcomes for all, aiming for a cancer-free world.

“World Cancer Day is an opportunity to celebrate the stories of cancer survivors in Australia and New Zealand,” said RANZCR President Prof John Slavotinek. “Radiation therapy is vital to curing cancer and improving the quality of life for people living with cancer, but right now there are still thousands of patients who struggle to get the radiation therapy they need.

“By sharing patient stories, we’ll help governments see the need for greater investment in the radiation oncology sector to improve access for those suffering from this terrible disease.”

This year, Targeting Cancer shared the story of Sydney-based sports journalist Clinton Payne, who has been living with advanced lung cancer for more than three years.

“The cancer started with sudden chest and hip pain, and then one day I coughed up blood,” said Clinton. “I rushed myself to hospital and had a scan which looked like a Christmas tree because the cancer had spread so fast. After three rounds of radiation therapy, I am very happy to say I have now been cancer-free for a year-and-a-half. My story shows you that with the best possible treatment, you can get back to living a normal, healthy life.”

Dr Lucinda Morris is a radiation oncologist (radiation cancer specialist) at St George Hospital in Kogarah and has treated Clinton over a three-year period. “We used an advanced radiation therapy technique known as stereotactic ablative body radiotherapy (SABR) to treat Clinton,” said Dr Morris. “SABR is a highly targeted treatment which allows us to deliver very high doses of radiation with millimetre accuracy to the cancer while avoiding the healthy lung. It also allows us to treat patients quickly, typically in one to five days, with each visit only taking around 30 minutes.

“The treatment worked wonderfully for Clinton,” Dr Morris happily reported. “He’s had no side effects, and I am happy to say he’s now back to his old self, working

as a busy journalist and doing all the things he loves to do, including playing lots of sport!”

Dr Morris is also the co-chair of Targeting Cancer and said Clinton’s story shines a light on radiation therapy as a safe and effective treatment. “It is timely that we shared Clinton’s story on World Cancer Day as we look to Close the Care Gap by making sure everyone gets life-saving radiation therapy when they need it.” IN

To find out more about Targeting Cancer, visit www.targetingcancer.com.au

Scan the QR code to watch Clinton’s story.

Lung cancer patient Clinton Payne at St George Hospital; and his medical team delivering stereotactic ablative body radiotherapy (SABR).

The Science of Successful Goal Setting

It’s no secret that setting goals can help people achieve great things—but even the simple act of working towards a goal delivers meaningful benefits all on its own. Learn why, and what it takes to be a successful goal getter.

Setting goals is something that’s often linked with making resolutions at the beginning of a new year when the ‘fresh start’ effect is in full force, but for radiologists and trainees alike, there’s good reason to make the behaviour a habit all year round.

For starters, having goals to work towards can undoubtedly help to focus your attention on things that are important, create positive change and even improve productivity in your professional life, but it turns out there’s more to the goal-setting story than that.

While recent research1 has identified the mental health of healthcare professionals in Australia as being an urgent priority—and one that extends beyond burnout— studies also suggests that the simple act of goal setting is protective and beneficial for wellbeing2

One explanation is the fact that goal setting fosters a sense of purpose3. That’s an attribute that’s been associated with everything from a healthier stress response to feeling more motivated and being more likely to proactively look after your health4. It’s also been

linked to enjoying better resilience5, to help you adapt and keep moving forward when life gets challenging.

And then there’s the fact that well-constructed goals (more on what they look like in a moment) can also help you introduce and adopt behaviours (things like exercising regularly6 and getting a better night’s sleep7) that have been shown to promote better mental health.

How to be a successful goal-setter

Regardless of the exact goals you’re interested in setting, and whether they’re personal or professional in nature, behavioural science has shed light on some key factors that will either increase how likely you are to achieve them or influence how satisfied and fulfilled you’ll feel when you do.

In addition to setting goals that are SMART (specific, measurable, achievable, realistic and time-related), here’s a handful of other research-approved strategies to bear in mind if you want to reap the biggest goalsetting rewards.

Set intrinsic goals instead of extrinsic ones

While intrinsic goals are those that focus on improving things like health, growth and relationships, extrinsic goals are ones that primarily result in more materialistic outcomes, like wealth or status. The results of an Australian study published last year show that while achieving both types of goals can feel good in the moment, it’s only realising those intrinsic goals that provides feelings of long-term wellness. More than that, the research even suggests that, over time, focusing exclusively on extrinsic aspirations can actually be detrimental to wellbeing8

Make sure every goal matters to you

Research suggests it’s goals that resonate with you, instead of being ones that others choose for you or that you think you ‘should’ be striving for, that are more likely to stick9. So as well as leaning towards intrinsic rather than extrinsic goals, choose ones that have some meaning or significance for you, personally.

“Research even suggests that, over time, focusing exclusively on extrinsic aspirations can actually be detrimental to wellbeing.”

‘Start doing’ instead of ‘stop doing’

Studies indicate that people who set approach-oriented goals have a significantly higher success rate in terms of attaining them, than people who choose avoidanceoriented ones10. In real terms that might look like this: instead of ‘don’t sit still for more than 60 minutes’, decide to ‘take some steps every 60 minutes’ if your goal is to be less sedentary.

Don’t keep your goals to yourself

Sharing what you’re striving to achieve with someone else is more likely to deliver success than if you keep your goals a secret. There’s a catch though—the study also found that some people are better than others to confide in. The short story? According to the researchers, people tend to be more motivated and show a greater commitment to their goal if they share it with someone who they hold in high esteem11. It’s accountability—and wanting to avoid the embarrassment of falling short—that drives the success of this tactic.

Build in an ‘if-then’ plan

It’s one thing to set a goal, it’s another to take the necessary steps to achieve it. ‘If-then planning’ (known officially as an ‘implementation intention’) can help. Say, for example, your goal is to start doing something active every day, you might determine that ‘if my morning alarm goes off then I’ll get up and do a 30-minute workout to achieve my goal of daily activity’. According to a study published in 202112, it’s a strategy that genuinely increases the likelihood that you’ll achieve your goals, thanks to the way it encourages habits to build by specifying the ‘when’, the ‘where’ and the ‘how’—a behaviour will lead you towards making a goal a reality. IN

1 https://journals.sagepub.com/doi/abs/10.1177/10398562231164555

2 https://www.researchgate.net/publication/23545621_Increasing_wellbeing_through_teaching_goal-setting_and_planning_skills_Results_of_a_brief_ intervention

3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923189/

4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246300/

5 https://journals.sagepub.com/doi/10.1177/15210251221076828

6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440859/

7 https://www.health.harvard.edu/mind-and-mood/more-evidence-thatexercise-can-boost-mood

8 https://psycnet.apa.org/record/2022-90266-001

9 https://www.pennmedicine.org/news/news-releases/2021/september/ choosing-personal-exercise-goals-then-tackling-them-immediately-is-key-tosustaining-change

10 https://journals.plos.org/plosone/article/file?id=10.1371/journal. pone.0234097&type=printable

11 https://news.osu.edu/share-your-goals--but-be-careful-whom-you-tell/

12 https://www.frontiersin.org/journals/psychology/articles/10.3389/ fpsyg.2021.565202/full

Nuclear Medicine in Missouri

Dr Liesl Celliers reports on her experiences as a visiting scholar at the Mallinckrodt Institute of Radiology.

RANZCR Fellow Dr Liesl Celliers, who is based at Sir Charles Gairdner Hospital’s Nuclear Medicine Department and Perth Radiological Clinic, was a recipient of the Bill Hare Fellowship to further her studies at the Mallinckrodt Institute of Radiology at the Washington University School of Medicine in St Louis, Missouri. The Mallinckrodt is a globally recognised centre of imaging excellence, and its expertise in PET and Nuclear Medicine was a drawcard for Dr Celliers.

Here are some excerpts from her Fellowship report:

“The Mallinckrodt Institute has a long and illustrious history in PET and nuclear medicine, including establishment of the first cyclotron to produce radioisotopes for medical research in 1941 (commandeered in 1942 by the US government to produce some of the world’s first plutonium for the Manhattan Project.) It was the site of the first cyclotron on a US medical campus in 1962 and, in 1964, was one of the first six sites in the US to acquire a CT. In the 1970s, PET was invented at the Mallinckrodt by pioneers Dr Michael Phelps and Dr Michel Ter-Pogossian. Over the next twenty years, researchers from the Mallinckrodt worked together with CTI PET Systems (which would eventually be acquired by Siemens) to develop some of the first whole-body imaging techniques that provided the foundation for modern day molecular imaging.

The Mallinckrodt Institute Visiting Fellowship program was established several years ago to offer a practicing

radiologist from outside the US with an opportunity to observe Nuclear Medicine and PET procedures in a clinical setting within a large US teaching hospital. They only allow one Visiting Scholar at a time so the timetable can be individualised depending on their experience and particular interests. In my case, my interests were mainly around oncology response assessment, preclinical imaging and imaging for clinical trials and research, but I was also interested to see more broadly how nuclear medicine practice has evolved in the US.

I spent most of my time in the Clinical PET Facility of the Mallinckrodt Institute, which is a busy imaging department averaging 50 to 60 PET cases per day within the Centre for Advanced Medicine at the Barnes-Jewish Hospital and Siteman Cancer Center. In addition to the scans performed each day for inpatients and outpatients of the hospital and cancer centre, many further PET/CT studies are

Dr Liesl Celliers

imported each day from satellite sites or other institutions for second/ expert opinion. The Clinical PET facility is staffed daily by five to six attending nuclear medicine physicians and six to seven nuclear medicine residents and fellows, together with a team of thirty nuclear medicine technologists spread across two campuses. Overall the faculty comprises 16 MD or MD/PhD members and one PhD member headed up by eminent radiology professor and translational researcher Dr Farrokh Dehdashti.

As expected, the vast majority of clinical PET studies were oncological staging and response assessment studies performed with F-18 FDG. However, radiopharmaceuticals other than FDG such as F-18 PyL, Ga-68 PSMA-11, and Ga-68 or Cu-64 dotatate were also routinely used. Approximately 5% of clinical studies were brain studies using FDG and amyloid tracers. Myocardial imaging with N-13 ammonia and FDG were also performed daily for evaluation of myocardial perfusion, viability and sarcoidosis. In addition, many other novel tracers were produced for clinical research.

The Center for Clinical Research, located on the floor above the Clinical Facility, has two further dedicated Siemens Biograph Vision scanners, a Siemens Biograph PET/MRI and two 3T MRIs. Closely affiliated with the Center for Clinical Research, the nearby Preclinical PET Facility has a Mediso nanoScan PET/ CT, Siemens Inveon PET/CT scanner, MR Solutions PET/MR as well as several small animal MRI scanners. It was fascinating to spend time in both the Center for Research as well as the Preclinical Imaging Facility and to see how they were so well integrated with the medical school and hospital.

Another area I spent time in was the Center for Clinical Theranostics Research, also staffed by the Nuclear Medicine and PET faculty, equipped with four outpatient

Bill Hare Fellowship

The Bill Hare Fellowship supports a Fellow more than five years post-Fellowship for a period of intensive or overseas study, or for attendance at an international short course, with a grant of AU$30,000. If you would like to apply for the Bill Hare Fellowship, or any of our research grants or awards, the College is now inviting applications for 2024. Visit www.ranzcr.com/college/grants-and-awards/researchawards-and-grants

radiopharmaceutical therapy bays, dedicated clinical exam rooms, and a hot lab with access to GMP radiopharmaceuticals.

Today, the Mallinckrodt Institute still boasts several pioneers and leaders in the fields of molecular imaging, including Prof Richard Wahl (who, among many other notable achievements, is author of the PERCIST criteria) and Prof Barry Siegel. I had the opportunity to join them both in the reading room, morning teaching sessions, as well as tumour board meetings, and to join Prof Siegel and his wife (also Prof Siegel, an eminent Paediatric Radiologist and author of “Paediatric Sonography”) for dinner. Prof Marilyn Siegel also happens to be an expert in response assessment and reporting for clinical trials, and I was pleased to be able to spend several sessions with her in the Imaging

Response Assessment Center (IRAC) doing RECIST, Lugano and other specialised response assessment reports using purpose-built software that Marilyn has helped to develop.

Other highlights included an evening at the Enterprise Centre watching the St Louis Blues (unsuccessfully) taking on the Vegas Golden Knights; the annual Golden Glow Christmas lights at the Missouri Botanical Garden; a visit to the renowned St Louis Zoo in Forest Park; and a cruise on the mighty Mississippi River.

I decided to make the most of my trip to the US by attending the RSNA in Chicago the week prior to my Visiting Fellowship. Highlights there were the Chicago Architecture Center riverboat cruise, shopping on the Magnificent Mile and completing the RSNA fun run at -10 degrees Celsius!” IN

Bill Hare Fellowship

PETT III: the first PET ever built for use with human beings in 1971

RANZCR Workshops, Courses and Events 2024

25-26

MAY 2024

FROGG 2024 TRAINEES’ WEEKEND

Sydney Masonic Centre, NSW

Register Now: (na.eventscloud.com/website/69832/)

2-4

AUG 2024

RANZCR NZ ASM

Millennium Hotel, Queenstown, NZ

NZASM (www.ranzcr2024.co.nz)

CPD Hours calculated once program is finalised.

17-19

OCT 2024

RANZCR ASM

Perth Convention and Exhibition Centre, Perth, WA

22 JUNE 2024

REMEMBER: EVENTS ARE A GREAT WAY TO GAIN CPD HOURS

RANZCR RECRUITERS EXPO

W Hotel Sydney, NSW

Register Now: (na.eventscloud.com/website/65456/)

VARIOUS DATES 2024

RANZCR/ACR EDUCATION CENTRE COURSES 2024

Swissôtel, Sydney, NSW

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

12–14 August: Neuroradiology

16–18 August: Breast Imaging Boot Camp Register Now: https://na.eventscloud.com/ website/65219/

Find details on these events and many more 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:

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

A Gathering Under the Stars

Planning commences for 2024 ASM on the lands of the Whadjuk people in Boorloo (Perth).

Diversity, inclusion and First Nations are all topics that will be addressed at the 2024 Annual Scientific Meeting alongside core themes that have been the foundation of the ASM over the years.

The 2024 organising committee commissioned proud Noongar/ Yuggera woman Hayley Thompson, owner of Djooken Djilba Art, to create an artwork to reflect the vision of this year’s theme: A Gathering Under the Stars. The piece is a representation of the many different groups coming together in a journey ‘Under the Stars’. Though the journey is not linear, it connects different people and places through knowledge sharing and mutual support.

The hill-like symbols in this artwork represent the different lands people are coming from in this journey.

Western Australia’s rich, diverse and authentic Aboriginal cultural experiences provide a unique point of difference from previous ASM destinations. Delegates will be able to embrace, learn and connect with our First Nations culture and further their cultural competencies and appreciation of the world’s oldest surviving peoples.

In keeping with the ASM theme, award-winning radio astronomer Dr Natasha Hurley-Walker has been announced as the 2024 Nisbet Orator. Dr Hurley-Walker is

passionate about bringing the beauty of astronomy to the world. After obtaining her PhD in radio astronomy from the University of Cambridge, she relocated to Australia to help commission the Murchison Widefield Array, a low-frequency precursor to the Square Kilometre Array (SKA), a multi-billion dollar international project to build the world’s largest radio telescope.

In outback Western Australia, more than 131,000 antennas spread across vast distances are being built for the project. The SKA will have a combined collecting area equivalent to approximately one million square metres, or one square kilometre. The project is one of the largest scientific endeavours in history and will be more than 10 times more sensitive and much faster at surveying galaxies than any current radio telescope.

Clinical radiology co-convenors Dr Lisa Sorger and Dr Susanne Guy have been curating a program that will engage and challenge our thinking. Confirmed speakers include Dr Nishat Bharwani (gynaecological imaging, oncological imaging and urological imaging); Dr Geraldine McGinty (payment models for imaging, impact of AI on medical imaging); Dr Philip Robinson (sports acute and overuse injuries, clinical effectiveness studies, sarcoma

imaging and management); and Dr Mathias Prokop (artificial intelligence and integrations into radiology workflow).

Following last year’s successful introduction of a dedicated interventional radiology (IR) and interventional neuroradiology (INR) stream, the Perth ASM will continue down this path of planning. The IR stream will be convened by Dr Jonathan Tibballs who is in the midst of confirming a keynote speaker—details coming soon.

A/Prof Suki Gill will be convening the radiation oncology program and is keen to attract a strong contingent of international experts to complement the invited speaker list. Prof Billy W Loo Jr, Prof Matthias Guckenberger, Prof Joost Nuyttens and Prof Laura Dawson are just some of the speakers confirmed to date, with more to be announced as further planning progresses.

The call for abstracts is now open until 8 April and is a great opportunity to be part of the program and share your research and innovations in the fields of radiation oncology and clinical radiology. IN

Be sure to book your leave as there is no better time to visit Perth and experience the vibrancy and authenticity of the city. For further details, visit www.ranzcrasm.com

Under the Stars by Hayley Thompson

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 speak to past President Prof Liz Kenny AO about her numerous volunteer roles.

Tell us about your roles and College involvement.

When I was a senior registrar, I was co-convenor for our annual Branch Scientific Meeting, and this really started my involvement with RANZCR. Since then, I have been fortunate to have been involved in the Radiation Oncology Faculty Board and College Council, culminating in being appointed as Dean of the Faculty of Radiation Oncology and then President of the College. After stepping down as President, I have had the privilege of being involved in the MBS review, the AI Committee, the Theranostics Guidelines Group, and the Diversity, Equity and Inclusion Task Force. My earliest time with the College opened my eyes to the fabulous people that make up our organisation and to the critical broader role that we play in caring for our patients and our community.

What drives you to volunteer?

The College has been such a part of my life, this is hard to answer. I have never viewed it as volunteering, but as part of my professional responsibility. The opportunity to interact with wonderful people who share a passion for doing good is great for my soul. It rounds out my professional life, and has introduced me to inspiring people and organisations in our own countries and around the world. Not too many

other people from different walks of life get such opportunities.

Which achievements are you most proud of? Helping to bring clinical radiology into a more clinically based specialty and supporting the increasing recognition that interventional radiology is a distinct image-based clinical specialty. Fostering the creation of the Tripartite Committee and initiating the Radiation Oncology Practice Standards was critical to my own specialty of radiation oncology. When we consider the current version of our practice standards, our College can feel justifiably proud. These standards were then used as a basis for the Standards of Practice in Interventional Oncology by CIRSE. To then have these as the basis for an international accreditation system for interventional oncology services has been exceptionally rewarding. Nothing will lift the profile of our interventional radiologists involved in cancer care more than being involved in this program. The beneficiaries will of course be our patients, and it will also be good for system expenditure and use of resources.

What have you gained by volunteering? As the years (and indeed decades) pass, I think that I’ve become a better listener. Skills developed in setting meeting agendas, managing meetings and getting the best out of the team continue to evolve. I’ve had phenomenal mentors who set benchmarks for meeting management, and I will always remain indebted to our recently departed Prof Tom Reeve AC CBE, past president of RACS, who was a master. I’ve also keenly appreciated the extraordinary benefit of life mentors, from those who know so much more than me and who have supported me through everything. Roger Allison, Chris Atkinson, Andy Adam, Lester Peters and Don Swinbourne come immediately to mind. If I have gained any life skills in my professional life, I hope that I have been able to mentor others.

Any advice on volunteering?

Just do it. You won't look back. If you have the passion and want to contribute to society, join in whatever capacity you can. When we really distil the College ethos, it is all about improving the lives of its members and the people we serve. IN

Introducing the New Trainee Wellbeing Officer

Dr Paul Beech is a radiologist and nuclear medicine specialist based in Victoria. Here, he tells us how he became involved in education and training, and what he hopes to bring to the role of Trainee Wellbeing Officer.

Bef ore I introduce myself, I would like to thank Dr Jennifer Chang. Jen has done an incredible job over the past few years in the role of Trainee Wellbeing Officer (TWO) and I wish her all the best in the world of accreditation as the Chief Accreditation Officer.

I’m Paul Beech and I have been appointed as the Trainee Wellbeing Officer. A little bit about me: I am a dual trained radiologist and nuclear medicine specialist with appointments at Alfred Health, Monash Health and the Epworth in Melbourne. I have been involved in training and education since completing my own training, first as a clinical supervisor, then as a Director of Training for the Alfred and more recently as the Victorian Branch Education Officer (BEO). I have enjoyed the challenges that the BEO position has presented including the ever-changing landscape that we have had since the commencement of the COVID-19 pandemic and the various adaptations that have been made over that time in the way training is delivered.

Outside of medicine I am involved with the sport of springboard and platform diving, having officiated at a range of state, national and international events. Through involvement in both volunteering in sport and in the radiology training programs, I have seen commonalities in the issues that have intensified since the pandemic, with increased stress and time pressures. This has made ‘wellbeing’ an essential component in the training and education space, and was part of the reason I was

pleased to apply for the Trainee Wellbeing Officer role and continue the work that Jen has started in the position.

The role of the Clinical Radiology Trainee Wellbeing Officer is to provide support to trainees, IMGs and DoTs and promote wellbeing. I have a seat at the table of the Clinical Radiology Education and Training Committee (CRETC) where they facilitate and support clinical radiology training. It’s my role to ensure that the CRETC always has wellbeing front of mind. I also work closely with our Trainee Liaison Officers Jenna and Lisa, who support our trainees.

I look forward to working with the DoTs and providing guidance on how they can support their trainees—while ensuring they feel supported too.

I welcome any suggestions and feedback on what you may like to see from the TWO: you can contact me via p.beech@alfred.org.au or tlo@ranzcr.edu.au IN

“Through involvement in both volunteering in sport and in the radiology training programs, I have seen commonalities in the issues that have intensified since the pandemic, with increased stress and time pressures.”

Dr Paul Beech

RANZCR Research Grants 2024

The College is pleased to offer the following research awards and grants this year—applications are open now.

RANZCR research grants provide financial support for Fellows, Educational Affiliates and student members in clinical radiology and radiation oncology to conduct research and foster a culture of research at the College. Grants are awarded for sums between AU$5,000 and AU$30,000. Applications close on 10 June 2024.

Clinical Radiology Research Grants

The following grants provide financial support for Fellows, Educational Affiliates and trainees. Applicants who are trainees must be supervised by a Fellow of the College. Grants are awarded for sums between AU$5,000 and AU$30,000.

Clinical Radiology Early Career Researchers Prize

This prize recognises a clinical radiology trainee or junior Fellow (up to two years post-Fellowship) who is the first author of a paper accepted for publication by The Journal of Medical Imaging and Radiation Oncology (JMIRO) or another Medline indexed peer-

reviewed journal. The value of the prize is AU$1,500.

FCR Indigenous Health Research Prize

This AU$2,000 prize is for Fellows, Educational Affiliates and trainees and will be awarded in the case of high-quality clinical radiology research in Indigenous health being published in a peer-reviewed journal.

Radiation Oncology Research Grants

The following grants provide financial support for Fellows, Educational Affiliates and trainees. Applicants who are trainees must be supervised by a Fellow of the College. Grants are awarded for sums between AU$5,000 and AU$25,000.

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.

FRO Indigenous Health Research Prize

This AU$2,000 prize is for Fellows, Educational Affiliates and trainees and will be awarded in the case of high-quality RO research in Indigenous health being published in a peerreviewed journal.

FRO Quality Improvement Project Prize

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

Bourne and Langlands Prize

This AU$1,500 prize is awarded to a trainee who has written an exceptional trainee research requirement manuscript.

For more information, and to download application forms and guidelines, visit www.ranzcr.com/college/awards-andprizes/research-awards-and-grants or email gaps@ranzcr.edu.au

2024 Awards and Fellowships Grants

Nominations and applications for the College’s range of awards, honours and Fellowships are now open. These are available to recognise outstanding service by members to their professions, and to support members to further their knowledge and expertise by travelling overseas.

APPLICATIONS CLOSE 8 APRIL 2024.

College Honours

Gold Medal

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 or Singapore.

Roentgen Medal

The Roentgen Medal is awarded to Fellows who have made a very valuable contribution to the College over a significant period of time.

Life Membership

Life Membership is awarded to Fellows over 65 who have made an unusually significant contribution to their field or the College.

Honorary Fellowship

An Honorary Fellowship recognises individuals who have contributed to the advancement of clinical radiology or radiation oncology and allied sciences, either through original research or by special services to the College.

Denise Lonergan Educational Service Award

This award recognises members who have demonstrated outstanding long-term commitment, participation and leadership in training and education in radiation oncology.

Clinical Radiology Educational Service Award

This award recognises members who have demonstrated outstanding long-term commitment, participation and leadership in training and education in clinical radiology.

Sally Crossing Award for Consumer Advocacy

The Sally Crossing Award for Consumer Advocacy acknowledges outstanding commitment of consumers involved in healthcare advocacy. The award honours the memory of the late Sally Crossing AM, in recognition of her exceptional contributions to advocating for cancer patients.

RANZCR Community Services Award

The RANZCR Community Services Award acknowledges individuals whose contributions have had a significant positive impact on their community and/or society more broadly, either within or outside the fields of clinical radiology or radiation oncology.

Educational Fellowships and Scholarships

Thomas Baker Fellowship

This Fellowship enables a clinical radiology or radiation oncology member up to six years postFellowship to further their knowledge by studying abroad for between three and 12 months. It is supported by a grant of AU$20,000 from The Baker Foundation.

Bill Hare Fellowship

This Fellowship supports a Fellow more than five years post-Fellowship for a period of intensive or overseas study (three to 12 months) or for attendance at an international short course (two weeks to one month) with a grant of AU$30,000.

Rouse Travelling Fellowship

This Fellowship is available for a Fellow (more than five years postFellowship) from Australia to attend the 2024 New Zealand Annual Scientific Meeting. The Fellow is also expected to visit and present in their field of interest in three training centres in New Zealand, with the support of an AU$8,000 grant.

Indigenous Scholarship

This scholarship is available to support trainees who identify as being of Aboriginal, Torres Strait Islander or Māori heritage during their studies. Six individual annual scholarships of up to AU$5,000 each are available, to be used towards expenses for educational activities.

Windeyer Fellowship

For more information, to nominate someone or to apply, visit www.ranzcr. com/college/grants-and-awards or email gaps@ranzcr.edu.au

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.

ANZSNR Annual Scientific Meeting 2024: Register Now

We are delighted to announce that registrations for the 2024 ANZSNR Annual Scientific Meeting are open. The 2024 ASM will be held at the Ta Pae Convention Centre, Christchurch from 2–4 May. We are excited to be joined by two internationals leaders in the field of neuroradiology:

Prof Larry Ginsberg (US) Head & Neck/ENT Radiologist

Dr Mayank Goyal (Canada) Interventional Neuroradiologist

We have secured a strong faculty of local speakers; many are internationally known experts in their respective fields.

A combination of approach-based, case-based, discussion/panelbased and interactive talks will be provided throughout the program. All recorded talks will be made available to delegates on demand following the ASM.

Registrations

Registrations are open and can be done via the ASM website: www.anzsnrasm.com/registration ANZSNR members are offered heavily discounted registration with social events as optional add-ons for student members (RANZCR trainees). If you are not a current member and wish to join, please contact secretariat@anzsnr.org.au

IRSA Annual Scientific Meeting (ASM) 2024: Register Now

Early bird registrations are now open for IRSA’s 2024 Annual Scientific Meeting, held at the Te Pae Christchurch Convention Centre from 5-7 August.

This year’s ASM theme, Frontiers in Embolisation, will be supported by two world-renowned leaders in embolisation. We are excited to welcome:

Prof Jafar Golzarian Works at the University of Minnesota Medical School in the Department of Radiology, Interventional Radiology Division. He is a Board Director and Founder of GEST.

Prof De Baère

Thierry Jacques De Baère is head of the Interventional Radiology Unit

Accommodation

The Crowne Plaza is the hotel we recommend for delegates—located a few minutes’ walk from the Convention Centre. To secure a room, we recommend you book now, via the registration link.

Flight discounts

We are pleased to offer delegates travelling from Australia discounted airfares with Air New Zealand. Discount is up to 10% for travel between 27 April to 11 May 2024. Book online at www.airnewzealand. com.au and enter the promo code ANZSNR into the promo code box. We look forward to welcoming delegates to New Zealand.

at Institut Gustave Roussy Cancer Centre in Villejuif, France, which is the largest cancer in France.

The program includes a mix of interactive workshops, practical sessions, networking opportunities and didactic lectures, and is available to view at www.irsaasm.com.

The ASM will appeal to interventional radiologists, general radiologists with an interest in IR, RANZCR accredited trainees, nurses and radiographers.

Register Now

To take advantage of the early bird offer, you are invited to register at www.irsaasm.com.

IRSA members are reminded that they receive substantial registration

discounts. If you are interested in joining IRSA, please visit: www.irsa.com.au/join-us/

Call for Abstracts

Call for Abstracts is now open for Registrars (RANZCR Trainees)/IR Fellows for Oral Presentation at the IRSA ASM.

The winner of the Registrars/IR Fellow Oral Presentation receives the following prize jointly offered by IRSA and CIRSE: Free registration to the CIRSE 2024 Congress in Lisbon, Portugal 14–18 September 2024, plus return economy airfare and five nights’ hotel accommodation.

Abstracts are due for submission by 14 June 2024. Visit www.irsaasm.com IN

Striding Forward

The Interventional Radiology (IR) and Interventional Neuroradiology (INR) Training Pathway Working Group continue to develop an IR & INR training program.

The IR and INR Training Pathway Working Group, under the direction of the College’s Interventional Radiology Committee, is developing two dedicated training programs for interventional radiology and interventional neuroradiology. The development of these advanced training programs is to ensure professional practice across the continuum of radiologists practising in IR and INR.

These contemporary, formal training programs will define minimum competencies required for specialist IR and INR practice in Australia and New Zealand and are to be accredited by the Australian Medical Council (AMC) and the Medical Council of New Zealand (MCNZ).

The objectives of the Specialist IR and INR training programs are to:

offer a dedicated patient- and trainee-centred Fellowship-level program for all clinical radiologists who choose to specialise in IR or INR in Australia and New Zealand, providing a number of alternate pathways into the program

provide a formal RANZCRendorsed professional qualification to those who complete the requirements of the specialist Fellowship interventional radiology or interventional neuroradiology program satisfactorily and demonstrate core competencies in training.

Projects

The working group has continued to make significant progress and has

reached the following critical project developments:

1. Undertaken an audit of local and international IR and INR programs for the purpose of learning from other established programs.

2. Published the RANZCR Specialist Interventional Radiology and Interventional Neuroradiology Range of Practice.

3. Developed high-level learning outcomes and drafted the curriculum framework.

4. Developed a set of learning domains that are the key learning areas of the curriculum and provide the structure for the training programs.

5. Drafted the core content across the learning domains.

6. Developed the assessment structure in line with best practice in medical education.

In 2024, the working group is committed to developing two training programs that will be ready for member consultation. The consultation will provide members with an opportunity to review the proposed training program for IR and INR including, but not limited to, the:

• proposed structure, duration and entry pathways

• learning outcomes

• principles that have informed the development of the curriculum framework

• dedicated areas of learning, known as the learning domains

• assessments built throughout the program that contribute to measuring the competency of specialist trainees.

Keeping Members Informed Via the ASM

The 2023 RANZCR ASM featured the inaugural and dedicated streams for IR and INR. One of the many sessions within these streams included an overview of the work that RANZCR is undertaking in IR and INR. Dr Andrew Cheung, co-Chair of the working group, had the opportunity to speak on the important work that the group has been doing.

Dr Cheung’s presentation provided an overview on the training programs’ main components including the learning outcomes, learning domains, teaching and learning methods, assessment methods as well as the entry pathways into the training programs.

Member Consultation

The working group will be releasing a document on the IR and INR specialist training programs for member consultation later this year. This will be an opportunity to provide feedback, informing the development of the training programs. IN

The working group will keep members informed of progress through College newsletters, eNews and the College’s website www.ranzcr.com, we welcome all feedback from the College membership via interventional@ ranzcr.edu.au

Dr Andrew Cheung, co-Chair of the IR and INR Training Pathway Working Group

Becoming a RANZCR Associate

The College welcomes the medical community to join its CPD Home as an Associate.

The Medical Board of Australia and the Medical Council of New Zealand have mandated that all doctors and medical specialists must have a CPD home.

In NSW, many health districts are writing to all doctors and medical specialists asking them to confirm their CPD home. This will undoubtedly start to be communicated to all doctors across Australia. This an ideal opportunity to start to build connections with those interested in being future radiologists and building knowledge of our specialism with senior medical officers as well.

In my health district I have received many enquiries, especially from junior doctors advising they are interested in radiology and would like to have the College

as their CPD home.

The College voted in 2022 to accept junior doctors, senior medical officers and medical specialists to join the College as a RANZCR Associate.

I am writing to you to encourage you to share this information within your respective health districts and networks to reach eligible professionals and to refer any interested doctors to the links below. This is a valuable opportunity to reach out to future radiologists and engage with senior medical officers that have an interest in radiology to build knowledge, skills and relationships within the field of medical and interventional imaging, radiation oncology and cancer care.

Who is Eligible?

The new RANZCR Associate enables individuals who do not qualify for admission to membership of the College, but whose scope of practice aligns with medical imaging, image guided intervention and cancer care

to become a RANZCR Associate and nominate RANZCR as their CPD Home. The Associate categories include:

1. Specialist Associate

For doctors who have trained and gained a Fellowship from a recognised specialist medical college in Australia or New Zealand or another recognised specialist medical society.

2. Medical Associate

For medical students or junior doctors who are interested in a career in clinical radiology/radiation oncology. Non-specialist doctors that are qualified and recognised by AHPRA as a doctor but who has not gained a Fellowship from a recognised specialist medical college in Australia or New Zealand or another recognised specialist medical society.

3. Nursing & Allied Health Associate

For other healthcare professionals whose scope of practice identifies with clinical radiology or radiation oncology.

RANZCR Associates can join the College at any time by submitting an online application form. In nominating RANZCR as their CPD Home, Associate Members have access to:

CPD management

Ability to join our Special Interest Groups

Courses, workshops and tutorials at discounted rates

Networking opportunities to build relationships

Use of RANZCR Associate logo.

Further information can be accessed on our website regarding RANZCR Associate benefits, fees, application process and subscription policy: www.ranzcr. com/college/membership/ associates. IN

Dr Rajiv Rattan

Lungs in Focus

Introducing the National Lung Cancer Screening Working Group: an initiative of the Australian and New Zealand Society of Thoracic Radiology, in partnership with RANZCR.

In July 2025, the Australian Government will commence the National Lung Cancer Screening Program (NLCSP), intended to service current or recent ex-smokers of a defined risk profile to enable early detection and treatment of lung cancer. The program aims to reach 5.3% of the national population and modelling anticipates, during the first year of screening, an increase in radiology workload of 227 CT scans per working radiologist (Deakin University data, 2022). Screening data will be collected by the National Cancer Screening Register, alongside the current cervical and colon screening programs. New Zealand is also working towards a lung cancer screening (LCS) program and all radiologists will be touched by the effects of these initiatives.

In response to the needs of Cancer Australia, the Department of Health and Aged Care and the National Aboriginal Community

Controlled Health Organisation in designing and implementing the NLCSP, a radiology working group has been established as a partnership between RANZCR and its Special Interest Group, the Australian and New Zealand Society of Thoracic Radiology (ANZSTR).

The working group will commence activity in the coming weeks, with upwards of 50 volunteer members drawn from the breadth of public and private radiology, and ranging from junior radiologists with an interest in the area to those with senior expertise in LCS and related research and with central roles in relevant bodies including the NLCSP Expert Advisory Committee.

The working group comprises a steering committee and multiple sub-committees to encompass work in NLCSP program-level advocacy, CT technique, structured reporting and template composition, guideline development for the reporting of

incidental findings, development of radiologist education and training material, and advice on the role of relevant software and artificial intelligence tools including the use of a vendor neutral archive.

This large body of work put forward by the ANZSTR Executive and the members of the working group will form the most substantial input into health policy undertaken by a Special Interest Group of the College to date.

Other significant ANZSTR activities across recent years include consultation regarding occupational dust disease and engineered stone, which has lately emerged as a novel and profound public health threat; recommendations on lung nodules and pulmonary embolism in liaison with The Royal Australasian College of Physicians and Choosing Wisely Australia; and guidance on imaging and reporting in COVID-19 pneumonia as RANZCR responded to evolutions in the early pandemic.

ANZSTR will shortly welcome new executive members as the Special Interest Group expands its leadership and builds towards hosting in-person educational events as part of a multimodality continuing professional development program to be created and curated by the members of the Lung Cancer Screening Working Group.

The ANZSTR Executive is grateful to everyone who has expressed interest in the working group and is looking forward to progressing this vital project over 2024. The Special Interest Group may be contacted at anzstr@ranzcr.edu.au IN

2023 ANZSTR Executive, from left to right: Catherine Jones, Miranda Siemienowicz (Chair), Sharyn MacDonald, Stefan Heinze, Samantha Ellis and Hannah Rouse (Deputy).

Radiology in 2024 and Beyond

An exploration of some of the trends shaping our profession and the associated opportunities and challenges.

Dr Rajiv Rattan, Dean (FCR)

We are now well into 2024 and at this point in time, I would like to share some thoughts about the accelerating pace of change for our profession in an ever-evolving healthcare landscape, both binationally and globally.

In exploring some of the trends shaping our profession this year, and likely for the next few years, I invite you to reflect upon the opportunities and challenges these represent and consider how you will respond.

The Role of AI

Among healthcare disciplines, radiology has historically been at the leading edge of new technology. About 50 years ago, the original Hounsfield EMI scanner had a 2.5 MB hard drive and obtained two slices in five minutes.

Now, five decades later, we are able to acquire volumes of data in a matter of seconds. Scanning the heart in a single heartbeat is

normal for us now.

AI brings a whole new paradigm shift to the practise of radiology. In Australia and New Zealand, AI is slowly being adopted and is at a fledgling state. The regulatory environment is changing.

In an effort to foster greater international collaboration in the area of AI, RANZCR has partnered with ACR, CAR, ESR and RSNA to produce a paper titled: Developing, purchasing, implementing and monitoring AI tools in radiology: Practical considerations A multisociety statement from the ACR, CAR, ESR, RANZCR and RSNA. This is a step in the right direction and puts us all in the driver’s seat.

Wherever we are working, it is time to look carefully at our current practices, and to anticipate and envision how we can take advantage of the many benefits that AI can deliver.

AI dominated the discussions at RSNA 2023. There are currently radiology departments/practices in North America and Europe which are already employing several AI engines to enhance workflow and improve efficiency.

Rather than taking radiologists’ jobs away as some had feared, AI is facilitating a realignment of tasks by handling the mundane and repetitive functions so that we can focus on the more complex aspects and improve both accuracy and speed. AI is also proving valuable in enhancing workflow, prioritising studies and reducing study times, especially with shorter sequences on MRI.

Interestingly, AI is already being

used in radiology education.

For example, trainee reporting worklists can now be screened with AI to identify cases from the curriculum that trainees have not been exposed to.

Quality of Radiology Reports

The quality of our reporting is the lynchpin of our professional value to referrers and patients. This cannot be overstated. The report with our name on it, is not only a vehicle for communicating results but it also represents the trust that our referrers place in us and our profession.

Anecdotally, some referrers have expressed concern that radiology reporting can be too generic and non-specific, and does not provide the level of clarity that is vital for accurate diagnosis and making decisions about patient care.

It is somewhat understandable that, given the increasing volumes most of us are reporting, it is incredibly hard to keep abreast of the latest in every aspect of radiology. However, the fact remains that the radiology report will always be a critical tool.

AI may be able to play a role in lending a ‘helping hand’ to free us to hone our clinical skills, finetune our reporting, and provide more precise and accurate guidance for referrers.

It is incumbent upon each of us to leverage our clinical expertise and add value wherever relevant throughout the patient journey.

Global Workforce Shortage

The global shortage of radiologists is presenting ongoing challenges

for government, healthcare settings and patients, an experience that is shared in both Australia and New Zealand.

Creating a sustainable pipeline of clinical radiologists requires a significant and ongoing investment in quality training and strategies to attract junior doctors to our specialty.

The College continues to direct its advocacy efforts to address these issues, and the new Rural and Regional Training Pathway (RRTP) program is offering a viable retention strategy to build a sustainable workforce in rural and regional Australia.

IR/INR

The College has submitted applications for two new fields of specialty practice—interventional radiology (IR) and interventional neuroradiology (INR) to the Medical Board of Australia.

The College is turning its focus to the governance structures

“AI may be able to play a role in lending a ‘helping hand’ to free us to hone our clinical skills, finetune our reporting and provide more precise and accurate guidance for referrers.”

required to support these two fields of specialty practice.

CPD Home

On another note, it is pleasing to hear that there has been a steady stream of junior doctors joining RANZCR’s CPD Home and taking advantage of our quality-assured training.

What Can You Do?

It is clear that we can’t be complacent and take a ‘business as usual’ approach to our practice. We need to prioritise excellence in all that we do. We need to engage

in the patient journey, and continue to add value in our reporting and in our interactions with referrers and patients.

At the same time, it is paramount that we each prioritise our own wellbeing, take steps to create an appropriate work-life balance and manage fatigue and stress.

To keep pace with the rapid changes, we need to accelerate our uptake of technology and make the most of professional development opportunities to keep abreast of the latest developments.

We can’t afford to be left behind. An exciting future is here. IN

New Year Highlights

Details on changes to the WBA requirements in the training program, the College’s new Selection Policy, and more.

Welcome to 2024. I hope everyone was able to rejuvenate over the holiday period and is looking forward to a very productive year. In particular, I would like to welcome our new trainees. The Specialty Training Unit of RANZCR looks forward to supporting you as you journey through our world-class clinical radiology training program.

I am pleased to note a number of highlights as we begin the new year, including our recent AMC accreditation, the newer Regional and Rural Training Pathway, changes to the WBA requirements in the training program, and the College’s new Selection Policy.

The AMC advised the College late last year that our specialist medical programs have been granted accreditation for another three years until 31 March 2027 a good result and recognition of all the hard work our team put in.

The College launched the Regional and Rural Training Pathway (RRTP) in 2023. The College was provided with funding to support five pilot training positions for a period of two years. The interest was so overwhelming that RANZCR has continued to advocate for ongoing Federal funding for these positions and to increase the number of funded posts for future rounds.

In the accreditation space, training site accreditation visits are due to kick off shortly for the year. You may recall that the team has been managing a large backlog of visits due to the impact of the pandemic, and some sites have

been visited outside of their regular cycle. Furthermore, work on the revised training site accreditation standards is in the process of being finalised, with the new standards to be launched this year.

The Curriculum and Assessment Committee has been very busy reviewing your feedback on the updated curriculum and workbased assessments and, as of February 2024, made changes to the WBAs, reducing the assessment burden on trainees and supervisors by up to 80% across multiple categories. Our member feedback is always critical to the review and success of all our work.

Our examinations team remains as busy as ever. Over the past two years, significant structural changes were made to the examinations for both Phase 1 and Phase 2. We will now move to the evaluation phase in 2024. A working group will undertake an evaluation of the impact and outcomes of the new clinical radiology examination program. As always, we will be guided by your feedback. In 2024, all Phase 2 written examinations will return to being held in examination venues located across Australia, New Zealand and Singapore.

To ensure transparency, fairness and equity for our next generation

of clinical radiologists, the Selection Policy was released late last year and will be in effect for recruitment processes throughout 2024. This policy has been the culmination of a number of years of work by our dedicated members.

I would like to take this opportunity to extend my thanks to all members involved in the supervision and training of our trainees, as well as members of the various education and training committees. I would like to extend a warm welcome to Dr Jennifer Chang, commencing this year as Chief Accreditation Officer, who will bring a new perspective to the role, and also to the new Trainee Wellbeing Officer (TWO) Dr Paul Beech. The TWO works closely with our Trainee Liaison Officers (TLOs) in Australia and New Zealand to support all our trainees. IN

“I would like to take this opportunity to extend my thanks to all members involved in the supervision and training of our trainees, as well as members of the various education and training committees.”

Dr Barry Soans, Chief Censor (FCR)

Updated CTCA Training Guidelines

An overview of significant changes to the Recognition of Training in CT Coronary Angiography (CTCA).

Ihope everyone had a nice break and is now geared up for another exciting year ahead. Late last year the Professional Practice Committee (PPC) agreed on the 2024 workplan and it is going to be another busy year.

In July, we will see the introduction of changes for the Recognition of Training in CT coronary angiography (CTCA). I am pleased to announce that we have been able to garner significant changes to these requirements even when, at times, other craft groups have wanted increased requirements. A considerable body of work was undertaken by myself and PPC members Dr Tanya Wood and Dr Catherine Jones over a number meetings in the past two years.

The current recognition requirements have been in place for over a decade and have not been reviewed. They have imposed a significant administrative burden on our members with emphasis on maintaining logbooks and case numbers and were not in line with the Medical Board of Australia’s (MBA) contemporary expectations of continuing professional development (CPD).

As an example of the new requirements, radiologists who have achieved initial certification plus one (1) recertification (i.e. at year 9) has changed from the need for a detailed logbook and case numbers to ONLY completion of CPD relevant to CTCA. As the MBA requires us all to undertake CPD relevant to our scope of practice, this shift to CPD brings it to being

in line with MBA’s requirements of maintaining competency in other areas of practice. These requirements will be within the MBA’s current requirement of 50 hours of CPD per annum.

For the Level A and Level B requirements, we worked hard to bring these closer together as the current requirements were impacting the number of Level Bs in Australia and, in some states, limiting patient access to these services. The emphasis now on being a Level B is to teach, train and mentor others.

Each CTCA registered specialist will receive an individual email outlining how the revised training requirements will affect them, starting with those who are due to recertify in 2024 and 2025. If you think you should have received an email and have not, please contact the secretariat via email: CTCA@ranzcr.edu.au.

All the changes are outlined on the Conjoint Committee for the Recognition of Training in CT Coronary Angiography website: www.anzctca.org.au.

We believe we are heading in the right direction and hopefully this can be a precursor to further discussions with the other parent bodies in the future for further changes. I would like to thank Dr Wood and Dr Jones for their expertise and dedication in gaining these changes.

The PPC does seek additional members from time to time and I would urge members to consider getting involved by applying when opportunities arise to support and

“We believe we are heading in the right direction and hopefully this can be a precursor to further discussions with the other parent bodies in the future for further changes.”

make a difference to our members. These opportunities are placed on the RANZCR website Current Opportunities page: www.ranzcr. com/fellows/general/get-involved/ current-opportunities.

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. IN

Prof Dinesh Varma, CHoPP (FCR)

New Beginnings

Dr Sanjay Hettige, Chair of the CRTC, introduces the Trainee Committee for 2024.

Welcome everyone to 2024! As I type this I wonder where the start of the year has already gone. The first days of January seem like a distant memory and the clinical year has well and truly started. A special welcome to all the firstyear clinical radiology registrars who have started in 2024. The beginning of radiology training can seem like a daunting mountain to climb, especially when many of you are also studying for Phase 1 examinations, but know that your senior colleagues have been through the same process and are on hand to support you and share with you their knowledge and wisdom.

I’d like to introduce you to your Clinical Radiology Trainee Committee for 2024.

Your trainee representatives are:

Myself (NSW)

Navtej Chhibber (NSW)

Wendy Huang (NSW)

Jasjit Walia (NSW)

Rachel Gordon (Vic)

Subhashaan Sreedharan (Vic)

Daniel Joh (NZ)

Sophie Lee (NZ)

Henry Colovic (SA)

Joy Kim (WA)

Johannes Peters (Tas)

Hayley Collins (ACT)

We look forward to advocating on your behalf and improving the training experience for clinical radiology trainees. Priority issues that we will be advocating on in 2024 include more flexible structure of Phase 2 examinations, better provisions for flexible training and

ongoing advocacy for representation within College governance.

As always we look forward to hearing your feedback, questions and comments. You can reach us at clinicalradtc@gmail.com. Also feel free to reach out to me personally as well. You can reach me at 0405 472 499 or sanjay.hettige@gmail.com.

We look forward to working with you all this year to make sure radiology training is the best it can be. IN

Dr Sanjay Hettige

New MBS Funding Schedule

A brief update on the introduction of the recently announced new MBS funding schedule for radiation therapy, which will come into effect on 1 July 2024.

It is great to be able to begin this new year on a positive note, following the Federal Government’s announcement of the new MBS funding schedule at the Mid-Year Fiscal and Economic Outlook (MYEFO) in December.

Reviewing the way Medicare funds radiation oncology has been a priority for the College, and we've been advocating for change for 10 years. We thank all members of the MBS Working Group, led by A/Prof Dion Forstner, for their time and effort.

This is an enormous achievement for RANZCR and, once implemented, will deliver a framework for reimbursement that promotes evidence-based quality radiation therapy that is economically sustainable and better reflects the increasing complexity of the services we deliver.

At the time of writing, the final details have only just been released by the Department of Health & Aged Care (DoHAC). No doubt there will be questions, however for now we can share the following.

When will the new schedule be published? The new Medicare Benefits Schedule (MBS) items can be found in Word and PDF format in the College document library (www. ranzcr.com/college/documentlibrary) , accompanied by the official correspondence from DoHAC.

When will the new schedule come into effect? The new schedule will come into effect on 1 July 2024. The old schedule will not be available for billing after 30 June 2024. It is therefore crucial that sites are proactive in updating their IT systems with the new item numbers and have trained relevant staff prior to the introduction.

Are the new item numbers directly comparable to those used currently? As the current schedule does not directly correspond to the new item descriptors, all sites will need to quickly familiarise relevant staff with the new schedule. The College strongly encourages all members to:

• Ensure management (particularly in the IT space) within your department and wider hospital/ network are aware of the change in schedule and implementation date;

• Discuss how and when the changes will be addressed; and

• Help identify potential issues, as well as mitigating strategies.

When can I find more information? The DoHAC will be providing information on its website, including FAQs, and is planning to develop a training video and fact sheets to assist sites.

RANZCR is also assisting the DoHAC to communicate relevant details of the MBS changes and facilitate a smooth transition to the new billing item numbers.

While there may be teething problems, timely preparation will help to minimise issues. The College will continue to provide updates as they become available. In the meantime, please direct questions to MBSOncology@health.gov.au.

Changes to MATEC

Changes have taken place within the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC). This committee previously reported to the Board but has transformed into a standing committee, now reporting to both Faculty Councils with both Deans participating as members. While there may be some concerns about this shift, it's crucial to recognise that the committee's success hinges on executing the MATEC Action Plan across the College structure. MATEC must evolve into a proactive committee in order to achieve its objectives. The Deans will act as liaisons to the Board, Councils, and various committees, particularly those focused on education and professional practice. This presents an opportunity for the College’s committees to ensure that an 'Indigenous lens' is applied to all aspects of our endeavours, fostering safe and culturally appropriate training and workspaces. We warmly welcome Dr Keen Hun Tai, our past FRO Dean, as the newly appointed chair of MATEC, and look forward to the group's valuable contributions. IN

Dr Gerry Adams, Dean (FRO)

Welcome to 2024

A look at what’s ahead for the year, including the commencement of the Learning Experience and Outcomes Committee (LEOC).

Wow, 2024 already. I hope everyone had the opportunity to rejuvenate over the break and spend time with loved ones. I had the opportunity to reflect on 2023 and it was certainly a steep learning curve in my first year as Chief Censor. Although it has been challenging, it has been so rewarding working with all the dedicated and engaged Fellows, trainees and staff who contribute to our training program. I also had some time to think about opportunities for this coming year. I hope in 2024 we can improve communication between and among trainees, Fellows and the College so we can all contribute to creating a great learning curriculum and environment for all our trainees.

I’d like to warmly welcome all new trainees and I would also like congratulate all our trainees who are nearing or have just completed training and welcome them to the FRANZCR fraternity/family.

I’m delighted to have Dr Matthew Seel joining the Radiation Oncology Education and Training Committee (ROETC) as Chief Accreditation Officer (CAO). Matthew brings a wealth of experience to the role and will be a fantastic addition to ROETC.

Thank you to everyone who contributed to last year’s AMC visit. So many of you gave your time, energy and expertise in preparation for and during the accreditation visit. As a result of everyone’s hard work, I am pleased to say that the AMC has accredited RANZCR for an additional three years until 31 March 2027, subject to AMC monitoring requirements.

In 2024, the newly formed Learning Experience and Outcomes Committee (LEOC) will commence work. LEOC is responsible for the oversight of teaching and learning activities for radiation oncology trainees. As such, we have an exciting opportunity to make a genuine impact on how all radiation oncologists are trained and ensure they are receiving the best possible learning experiences in these important formative years.

The committee is also looking to

establish a more transparent and agile way to collect and respond to feedback from clinical supervisors, DoTs and trainees ‘on the ground’ to inform our curriculum renewal processes. Thank you to A/ Prof David Kok for leading this committee.

The College launched the Regional and Rural Training Pathway (RRTP) in 2023. The College was provided with funding to support five pilot training positions for a period of 2 years and received an overwhelming number of applications for the pilot with four of the five RRTP places filled, and the remaining posts to be filled this year. IN

As always, I am very happy to be contacted at any time by anyone who wishes to connect, ask questions, give feedback, volunteer, or needs support. Lisa. sullivan@act.gov.au

“I hope in 2024 we can improve communication between and among trainees, Fellows and the College so we can all contribute to creating a great learning curriculum and environment for all our trainees.”

Dr Lisa Sullivan, Chief Censor (FRO)

On the Agenda

A focus on fostering positive changes in professional behaviour, plus new leadership skills learning modules coming soon.

Dr Carol Johnson, CHoPP (FRO)

Greetings. In February, the FRO Professional Practice Committee (PPC) held its first meeting for the year and 2024 looks to be a busy year ahead. The committee successfully submitted its Workplan to Council earlier this month. I’ll take this opportunity to share some goals we are prioritising.

Professional Development in Leadership

The PPC is eager to encourage development of members’ leadership skills in all areas of practice. The committee members have been researching and testing online learning options that we hope will serve radiation oncologists in their leadership goals. The committee is working closely with College staff to find efficient ways to make learning modules accessible and convenient. I look forward to seeing the learning modules launch later in the year.

Anti-bullying, Harassment and Discrimination

these policies and applying required amendments to update and elevate the College’s voice in this space. This will be a joint venture with our radiology colleagues, with both PPCs working together. The PPCs will consider and implement meaningful action on the matter. Watch this space for more updates. Feel free to contact the PPC with your input and suggestions to ‘get this right’. Please reach out to: professionalpractice@ranzcr.edu.au

RANZCR CPD Program

The PPC is engaged in the continued oversight of the CPD program for 2024 onwards, including addressing the outcomes of the AMC assessment for CPD Homes. Member feedback on the CPD program and ePortfolio has been sought to gain understanding of the user experience. We will continue to support members in this essential part of your professional life.

“The PPC is invested in undertaking the work necessary to elevate the culture in medicine to support all healthcare workers.”

The PPC is invested in undertaking the work necessary to elevate the culture in medicine to support all healthcare workers and reduce incidents of bullying, harassment and discrimination. The PPC has identified a need to put a spotlight on unlawful and unethical behaviours entrenched in the healthcare system and to drive a positive change in culture.

The College has a range of policies and statements regarding professional behaviour which outline the expectation of a high standard of conduct. The PPC will be reviewing

Too many members, however, left it to the very last minute of 2023, resulting in a load of queries landing on the desks of College staff at the same time. It is strongly recommended that members enter their CPD into the ePortfolio on a regular basis, thus ensuring that by 31 December all requirements are met, and you are ready to start your next annual cycle from January the following year. If you have any questions or require support regarding the CPD Program or ePortfolio, please contact the College CPD team at: CPD@ranzcr.edu.au. IN

Message from the New ROTC Chair

Reflections on changes in the trainee landscape and exciting developments ahead.

The beginning of the new clinical year is a time of introspection for many of us; a chance to recalibrate for the challenges and triumphs that lie ahead. Whether it’s stepping into the shoes of a new Phase 1 trainee (congratulations and welcome!), transitioning to Phase 2 (which I’m told is akin to progressing from primary to high school), preparing for exams (wishing you the best of luck!), or charting the course postFellowship (you’re a real Doctor now!). In writing this article, I have been reflecting on what recent changes in training have meant for me and my colleagues.

The year 2023 was marked by significant transformations for radiation oncology trainees. We saw the introduction of new exam formats, the complete transition to e-portfolios, and the pilot of a mentorship program. In this regard, I extend my heartfelt gratitude to Dr Tracy Lim and the entire 2023 ROTC for their dedication, hard work and advocacy within the College. Our 2024 team is excited to build upon your achievements and continue championing trainee interests.

The landscape for trainees has also evolved considerably in recent years. There’s now a more balanced representation of genders within our cohorts, many trainees bring diverse career backgrounds into medicine, and an increasing number of us are navigating the responsibilities of parenthood alongside our training. Fortunately, the training program has begun to adapt to these changes; offering greater flexibility in examinations, part-time training options, and accommodating extended training. Personally, I am grateful to have been encouraged by my home department to take paternity leave following the birth of my daughter last year. Similarly, earlier this year, the department I rotated to warmly

“There's now a more balanced representation of genders within our cohorts, many trainees bring diverse career backgrounds into medicine, and an increasing number of us are navigating parenthood alongside our training.”

embraced my request for an ADO to attend my eldest daughter's first day of school.

While acknowledging that there is certainly more room for improvement, I’m grateful to be part of a specialty that is evolving to improve trainee wellbeing and understands the importance of achieving a balance.

For us trainees, it is also an incredibly exciting time to work in the field of radiation oncology as we watch things evolve so rapidly. Despite the cyclic narratives oscillating from alarmist declarations of “radiation is terrible, and must be avoided at all costs” to the quieter acknowledgments that “radiation is often the better alternative”, radiation oncologists, therapists and physicists worldwide remain at the forefront of innovation.

While I’ll refrain from uttering the cliché “AI will change everything” (oops!), progress is undeniably being made in other areas, such as understanding the radiobiology of dose fractionation and its interactions with the immune system.

Exciting developments like Flash radiotherapy hold promise as potential game-changers, and the proliferation of particle therapy centres globally underscores the expanding horizons of our field.

So, as we navigate all this change, let’s do our best to use it as an opportunity to grow. The ROTC hopes to keep pushing to make things better, for us trainees and for the people we’re here to help. IN

Dr Riche Mohan

Peer Review in Radiation Oncology

Quality Improvement Committee member Dr Matthew Seel shares his thoughts on peer review, and where you can dig deeper to find out more.

Dr Matthew Seel

It is generally accepted1,2 that radiation oncologists are responsible for “the weakest links” in the radiation therapy delivery chain, because of the relatively minimal peer review of the key decisions we make around which patients to treat and what target volume we then delineate to be treated.

Why is good peer review in radiation oncology important?

It is always good to start with WHY, but because of trying to keep this piece brief I’m going to give this question just a very quick skim here.

Some idealistic aims of peer review are:

We may find “random errors” before they cause significant problems or a “process error” that we can improve

Reduce unnecessary/inappropriate variation

General team building, plus peer support in situations of difficult decision making

Learning for anyone in the room with less knowledge in an area

Show evidence of good process. Increased patient confidence and a strengthened defence if challenged.

We do need to be honest about the fairly limited evidence to support the fact that peer review as part of routine clinical practice unequivocally improves patient outcomes, and we also must be mindful that any preferential biases we may have on this topic can lead to a never-ending spiral of the “if some peer review is good, more must be better” problem.

It is also important to apply a principle that Atul Gawande wrote about in his two excellent books on improvement in healthcare, Better and The Checklist Manifesto. Gawande would want us to remember that peer review processes should not be challenging anyone’s desire to do the right thing or their skill set, just acknowledging that all of us working in radiation oncology are human and involved in a complex multi-step process to enable patients to receive radiation therapy so errors of some kind are very likely.

How can we establish good peer review processes?

We should aim to set a culture that is open, collaborative and focused on improving. I won’t dwell on these things here (partly because it could easily start to sound quite preachy) but here’s a few notes:

A. Open to the possibility that:

• We might find a need to improve our skills/knowledge or our processes

• Anyone might make an error in the middle of our complex work

• Anyone might have an improvement idea

B. Collaborative

• Staff must actively engage in the process, but are not expected to be perfect in all their work

• Collegial and non-threatening (trust that it is encouraged to speak up or question)

C. Improving

• Keep trying to get better over time (accept that will be sub-optimal in some areas, then try to improve)

• Action focus consider then decide how to act, otherwise just wasting time

• Peer review is a discipline that may not be fun in the moment, but it is important and beneficial across time

• We want to be forward-looking ... How can we make things better from now on?

There is a lot we can learn about an improvement culture from the commercial aviation industry. An excellent read on this is Matthew Syed’s book, Black Box Thinking Here are a few key points:

• The aviation industry had to decide that it wanted to keep getting safer year-on-year. The healthcare profession is actually struggling to make that adjustment in many areas.

• Made it acceptable for staff to raise concerns real time or report in a confidential manner. Mainly achieved that by creating a good team culture, instead of very hierarchical and threatening.

• There are safety processes for every flight. Build team for every flight and use checklists to ensure routine things are not overlooked,

especially in a crisis situation. The worst aviation accidents are usually due to errors in quite routine things, often repeatedly overlooked as the crisis built.

How can you improve peer review in your service?

A good place to start is to consider what different types of peer review might help your service. Some types include:

• Deep dive peer review detailed evaluation of a few randomly selected patients. The RANZCR Peer Review Audit Tool is ideal for this.

• A short checklist to apply to (essentially) every patient. This can check on the key decisions (usually qualitative and subjective) ROs make in preparing patients for RT.

• A checklist encouraging good multidisciplinary teamwork to maximise the quality of RT care for any patient. This is analogous to the checklists used at various key points in an operating room procedure.

One provider in the US has nicely described3 what works well for them:

• They define peer review as “the process whereby providers evaluate the quality of their colleagues’ work to ensure that prevailing care standards are met”.

• 20-30min daily to review all patients at the start of RT planning process. Review indications for treatment, contoured volumes, proposed RT prescription and also tentative RT technique. Most patients (exact percentage not specified) have at least a minor change recommended.

• 45min weekly meeting reviewing final plans of patients started (or starting) in current week. Approximately 6% plans have a change recommended.

• Multidisciplinary team actively involved. Celebrate those who actively engage, minimising any possible shame some may feel from openly discussing their work.

• Provide good physical environment for optimal peer review multiple computers, displaying to large screens visible to all in the room.

Some suggestions and questions that might help your service explore possible improvements to their peer review:

• Clearly state the purpose of any meetings and the ‘rules of engagement’, and remind everyone of those things often

• How will you resolve split of opinions across the group?

• What help with administration can you have access to?

• Should record the patients that

are discussed. Close loop by rediscussing any agreed actions at next meeting.

It is a little trite, but here’s a good saying to finish with: “Make the right thing to do the easiest thing to do, and make the wrong thing to do hard to do.”

If anyone is interested in a more detailed list of resources I have compiled on this topic, please feel free to email me at Matthew.Seel@ waikatodhb.health.nz. IN

1 Roques TW. Patient selection and radiotherapy volume definition: Can we improve the weakest links in the treatment chain? Clin Oncol 2014;26:353-355.

2 Marks LB, Adams RD, Pawlicki T, et al. Enhancing the role of case-oriented peer review to improve quality and safety in RO: Executive Summary. Pract Radiat Oncol 2013;3:149-156.

3 Chera BS, Mazur L, Adams RD, Marks LB. The promise and burden of peer review in radiation oncology. J Oncol Pract 2016;12:196-199.

Some excellent resources you may like to access are:

 The RANZCR Quality Guidelines for Volume Delineation (via website)

 The RANZCR document explaining the Peer Review Audit Tool (PRAT) (via website)

 The 2012 ASTRO publication Safety is No Accident

•

•

Changes Ahead

A look at some priorities for 2024. Plus, award nominations are now open.

Kia ora koutou.

I hope you’ve had a relaxing summer break. New Zealand has finally had some decent BBQ weather for a change. I hope you had a chance to rejuvenate for 2024.

At the end of last year, the NZ Branch Office in Wellington saw the departure of Megan Purves and Charlotte Provan, who have joined the Dietitians Board. Both will be sorely missed, and words cannot express the gratitude and appreciation from all involved with the NZ Branch for their contribution and dedication. We wish them all the best for their new endeavours.

As you are probably aware, in November 2023 the New Zealand National Party, ACT Party and New Zealand First announced an agreement to form a coalition government.

While the new government establishes itself, the plan for the first 100 days has included legislation to disestablish Te Aka Whai Ora (Māori Health Authority), repeal the Therapeutics Products Act 2023, repeal Smokefree legislation and allow the sale of pseudoephedrine without a prescription. It has been indicated that changes to the Smokefree legislation, which was a world-first smoking “generation ban” that drew international acclaim, are being introduced to fund tax cuts.

National Radiology Advisory Group (NRAG) and Te Whatu Ora to expand regional training in New Zealand. This is an exciting piece of work, driven by NRAG, and while it’s early days we can look at our cousins across the ditch who have a set up a successful RRTP program. I’ll keep you updated on our progress it’s a great initiative for both patients in regional areas to have access to improved services, and registrars who can train in their local communities.

NZRET Pikimairawea Award 2024

Nominations are now open for the Pikimairawea Award. Winners (one radiation oncologist and one clinical radiologist) will receive their awards at the NZ ASM in Queenstown. Please nominate a Fellow who has demonstrated exceptional commitment to and/or excellence in:

Research

Teaching and education

Any other activity that has benefited clinical radiology/ radiation oncology, their facilities or any of the services they provide.

Nomination forms can be found on the College website: www.ranzcr. com/college/branches/new-zealand

“In 2024, the College will work with the new government to represent our members advocating for our election priorities.”

In 2024, the College will work with the new government to represent our members advocating for our election priorities.

Regional and Rural Training Pathway (RRTP)

We have been working with the

New Zealand Radiology Education Trust (NZRET) Funding

For members that have any research or education initiatives planned for 2024, please consider applying for funding from NZRET. Information is available on the NZ Branch website or you can email trust@ranzcr.org.nz. IN

Dr Gabes Lau, NZ Branch Chair

When to Update Your Details

Have your circumstances changed recently? Whether you’re reducing your hours, taking a break from practice or relocating, we encourage you to inform the College—you may be entitled to reduced membership fees.

Break-in-Practice and Interrupted Training

Fellows and Affiliates

Going on extended leave, parental leave, or experiencing health issues that will stop you from working for 6–12 months? Apply for a break-in -practice by emailing members@ ranzcr.edu.au with the date you will commence your leave and intended date of return to practice, as well as evidence such as an employer letter or medical certificate.

Taking a break for longer than 12 months? You can apply each year for an extension of your Break in Practice, up to a maximum of three years.

Members on a break-in-practice are still required to submit pro rata CPD hours.

Student Members

If you are planning to take a breakin-training (including parental leave), first discuss and approve with your Director of Training, then submit a request for a period of interrupted training through the ePortfolio to be eligible to apply for a reduced rate of training fees and member subscription fees.

Part-time

Fellows and Affiliates

Are you practising 20 hours or less per week? If so, you may be entitled to a reduced rate of your membership subscription, provided you inform the College in writing of your part-time status via members@ranzcr.edu.au, attaching evidence such as an employer letter or contract. If you then return to full-time practice, please inform the College.

Student Members

If you are training part-time between 0.5 and 0.65 FTE, you may be entitled to a reduced rate of your membership subscription. First, discuss and approve with your Director of Training, and make sure you report all changes of your training status (full-time/part-time) through the ePortfolio to be eligible for a reduced rate of fees.

Retiring from Clinical Practice

Once you retire from active clinical practice, you are entitled to access all member benefits on a complimentary basis as a retired Fellow, and we encourage you to remain actively involved in College activities. Simply email us

at members@ranzcr.edu.au with the date on which you will cease clinical practice and confirm whether you would still like to remain connected to the College during your retirement.

Moving Overseas

Have you relocated outside Australia or New Zealand? To access a reduced member subscription rate for overseas members, simply update your home and work address on the MyRANZCR member portal and email members@ranzcr.edu.au with the date you intend to move and an expected return date (if you have one). If you then move back to Australia or New Zealand, please update your details on the member portal.

Have you moved between Australia and New Zealand?

In order to pay your membership fees in your local currency, update your home and work address on the MyRANZCR member portal and email members@ranzcr.edu.au with the date you moved. IN

To check and update your contact information, log in to your My RANZCR profile via www.myranzcr.com/my-profile/

Vale

Dr Denis William O’Brien passed away peacefully, surrounded by his family, on 11 July 2022 from acute myeloid leukaemia. Here is a tribute prepared by Dr O’Brien’s family and work colleagues.

Dr Denis William O'Brien was born at The Royal Hospital for Women in Paddington in March 1945. After the war, Denis’s family returned to Blayney in Central West NSW before settling in Sydney. Denis completed his Intermediate Certificate, leaving school to work at EMI Group and study for an Electrical and Radio Trades course.

Working with Electrical Engineering students, Denis realised he had greater ambition. He decided to complete his Leaving Certificate and apply for university. Denis worked at an insurance company and studied at the Sydney Technical College in the evenings. Influenced by his sister Colleen Moroney, a graduate nurse at St Vincent’s Hospital, and her anaesthetist husband, Dr Neil Moroney, Denis settled on a medical degree.

Denis graduated MB BS from the University of NSW (UNSW) in 1969, the third year of UNSW’s medical school. Denis gained a residency at St Vincent’s Hospital and after completing his junior and senior residencies, joined St George Hospital in 1971 as a Radiology Registrar. He finished his training at St Vincent’s in 1972.

The decision to study radiology was a calculated one as it pulled together many of Denis’s interests. Denis was the first graduate of UNSW to obtain his Australian radiological qualifications in 1973, a DDR (Sydney University), the DRACR and then a MRACR.

Denis moved his young family to Tamworth in 1974 to join the practice of Wherrett, Hardcastle, Cairns and Kemp. The practice had private

“Denis was a gentle, wise and unassuming man who made a difference to so many people during his extraordinary life.”

rooms in Tamworth and Inverell, as well as hospital appointments at Tamworth and the regional hospitals of North and North West NSW.

Denis’s group became the first radiology practice outside Sydney, Newcastle and Wollongong to install an ultrasound machine. His move to Tamworth also coincided with the installation of the first EMI CT scanner in Sydney. While it would be several years before Denis’s practice would have a CT scanner, they planned meticulously for its eventual acquisition, with Denis travelling to Sydney weekly for six months to become proficient in CT.

The availability of ultrasound and CT had a significant impact on the

IN MEMORIAM

Dr Judith Anne Cox, Fellow, QLD

Dr Susan Jane Mincham, Fellow, WA

Dr Bernard Francis Vaughan, Fellow, SA

North West NSW rural communities, with Denis providing lectures to GPs in the country towns.

In 1980, Denis exchanged positions with Dr Andrew (Andy) Saunders, a consultant radiologist at Guy's Hospital, London for six months.

The radiological workload in North West NSW was spread across the smaller local country hospitals involving many hours of driving. So, Denis learnt to fly. Flying initiated a great interest in all things aeronautical for Denis and two highlights were piloting a plane along the Côte d’Azur, and a flight, as a passenger, in an MiG-15.

Work in Tamworth for Denis provided a pleasant balance between office radiology and more invasive procedures. Returning to Sydney in 1994, Denis joined Pittwater Radiology Partnership working at many of its practices including Tamworth and Moree. Following a sabbatical at St James’s Hospital, Dublin, Denis retired in 2010.

Denis and his wife Felicity spent time each year in France indulging in the art, language, history, museums and immersing themselves in everyday French life. Denis had a wonderfully wide range of interests and hobbies—from trekking in many parts of the world, sailing in Sydney’s Pittwater and bushwalking in the Blue Mountains, to woodworking and working with model trains, classical music and, latterly, a great enthusiasm for international tennis.

Denis was a gentle, wise and unassuming man who made a difference to so many people during his extraordinary life. He is very much missed. IN

Meet a Staff Member

In this new regular column, we’ll get to know some of the staff working behind the scenes at the College. This issue, we meet Dr Lisa Milner—Project Officer for Research & GAPS in the Member Engagement and Services Unit.

How long have you worked at the College and how would you describe your role?

I joined the College workforce in September 2022. My role, Project Officer within MESU, sees me with two main portfolios. The first is the GAPS for the College—grants, awards, prizes and scholarships (all of these currently totals about 60).

I coordinate and drive the College’s GAPS program through its annual round of activities, from the launch of my program to presentations at the ASM. My second portfolio is to coordinate and drive the College’s research activities. This includes overseeing the work of the JMIRO Editorial Board.

Tell us a bit about your professional background.

I came to the College from academia. I was a long-term university Head of Department. Because research (not clinical) was always my favourite part of my academic career for decades, I’m happy to be still connected with advancing knowledge at the College.

What are you currently working on?

Towards the end of 2023, a new Research Action Plan for the College was approved, and I’m busy trying to help staff and members achieve the aims of the plan. I’m also very busy with the roll-out of the 2024 GAPS schedule: fielding enquiries, accepting applications and lining up all the various committee and other meetings required to get through the program.

What do you like about working at RANZCR?

The best thing about my job is that I get to return some of our members’ fees back to them in the form of our grants, awards and prizes. While it’s sometimes a challenge to get busy clinicians to put aside time for research, it’s the only way that our professions are going to advance, so it’s very important for me to encourage them.

Name one College highlight from the past year.

The highlight for me was working at the ASM in Brisbane. It was wonderful to meet so many of the members that I had only talked to on the phone or online. And the excitement of all the various sessions was terrific.

Email Lisa via gaps@ranzcr.edu.au or research@ranzcr.edu.au

“The best thing about my job is that I get to return some of our members’ fees back to them...”

What’s something that members might be surprised to know?

In my after hours, I play bass and keyboard in a number of bands and combos. I have always been a musician (generally for love, not for money). IN

Lisa at the 2023 ASM in Brisbane.

Member Rewards Program

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?

To discover your travel discounts, visit The Accommodation Brokers website, www.theaccommodationbrokers.com. au and register to become a member or email your request to bookings@ theaccommodationbrokers.com.au

KPMG

KPMG Enterprise is a specialist division of KPMG Australia, dedicated to advising the emerging, private and mid-market.

KPMG works with established and emerging entrepreneurs, family business, private clients, not-for-profit and fastgrowing companies to build successful organisations.

College members can access the following benefits:

• An initial meeting with a Partner or Director free of charge;

• A minimum 40 per cent discount on KPMG standard rates for the engagement period with all College members;

• Access to a dedicated national KPMG Enterprise team to support your members, across all service areas.

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

See all Member Rewards offers in:

Australia

New Zealand

PETALS FLOWERS

Petals Network is one of Australia and New Zealand’s premier flower delivery services, proudly connecting customers with the world’s best local florists for almost 30 years.

All of Petals’ flower arrangements are artistically arranged and hand-delivered

using only the freshest flowers available through its network of talented local florists.

College members receive 20 per cent off the value of flowers purchased. This discount applies to the flower value only. An additional delivery fee will apply.

Please register your details by scanning the QR code to access the online catalogue and discount.

BMW & MINI CORPORATE

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.

To find out more:

Visit www.bmw.com.au/corporate or www.mini.com.au/corporate

Phone: Call 1800 635 750

Email: Write to corporate@bmw.com.au

When you’re ready to make a purchase, you will require an authorisation letter from the College to access the corporate benefits. Email the College to request this letter.