RADIATION THERAPY front and centre at Horizon Summit
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Volume 15 No 3 / June 2019
Quarterly publication of The Royal Australian and New Zealand College of Radiologists
RADIATION THERAPY
front and centre at
Horizon Summit
Silicosis:
Also Featured Phase II 2019 Australian
A looming
in this edition healthcare crisis exam tips Federal Election
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Editor’s Pick
5 An agenda for the ages
16 Choosing wisely 43 Radiation Oncology
Quality Corner
6 A doctor's tale
17 RANZCR 2019 ASM heads
45 Acquiring formal
7 New Zealand News Back to the Future speciality recognition –
Interventional Radiology
8 Branch News/ News
in Brief 21 Targeting Cancer
46 News from the professions
23
9 51
Radiation therapy InsideRadiology - IR in focus Accreditation, entering
front and center the final stretch
at New Zealand
25
53
Workshops
Parliment Building a portfolio
investment when
11 27
Exploring New you are time poor
Silicosis: A looming
Assessment Tools in
health crisis
Radiation Oncology
55
Uploading diagnostic
28
images to My Health
12 AI algorithm to compete
in junior radiologist image
quiz
Phase II exam tips Record - What you
need to know
14 Changes to your medical
registration requirements 29 From the Faculty of Clinical
Radiology
57 Creative solutions to
remote medicine –
from the archives
15 2019 Australian Federal
Election Update 37 From the Faculty of
Radiation Oncology
If you have thoughts or comments about one Have you moved
What of the stories you have read in this issue, we recently?
are your want to hear from you. The submission of Log into the MyRANZCR,
thoughts? letters to the editor, articles and news items Portal and ensure your
are encouraged. Please email any submissions contact details are up to
to editor@ranzcr.edu.au date at www.myranzcr.com
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Editorial Staff All rights reserved. No part of this publication may be reproduced or copied in any form or
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Editor-In-Chief Publication of advertisements and articles submitted by external parties does not constitute
Dr Allan Wycherley any endorsement by The Royal Australian and New Zealand College of Radiologists of the
products or views expressed.
Sub Editor Inside News
Mark Grzic © 2019 The Royal Australian and New Zealand College of Radiologists® (RANZCR®)
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Introduction
An agenda
for the ages
The President on the work
of the College board
Dr Lance Lawler
When it meets, the RANZCR Board, intelligence (AI) and, more generally, opposition announcements on MRI
like boards of directors the world over, to devote increased resources to the access and the cost to patients of
works to a prepared agenda. Yet the College’s role as an advocate, primarily radiation therapies for cancer. Thanks
more important job for any board is not to government. Those key decisions are to a cultural shift in how we represent
agenda-following, but agenda-setting, now bearing fruit. our members, RANZCR is now widely
by which I mean our planning for, and recognised as the peak body for clinical
anticipation of, the bigger and longer- radiology and radiation oncology in
term issues facing our members. Australia and New Zealand, and a
“The College needs a respected voice elsewhere.
In our working lives, almost all of us
find it hard to devote the time we continuous approach Increasingly it is evident that, as the
need for long-term planning, and
for asking the big questions, such
on at least two strategic pace of change in our professions
accelerates, the Board cannot allow itself
as ‘What contribution can I make to fronts: ... 'What is the to over-focus on standards of education
the healthcare system’? or ‘What is and practice. These are important
the future of radiology and radiation best we can do?' and functions best managed by the Faculty
oncology?’ And so it is for elected
representatives of our profession. The
...‘How do we remain Councils and the senior management
of the College. If it is to fully live up to
College has its strategic planning days relevant?’” its role as the peak deliberative body
and horizon scanning exercises, but within the organisation, I firmly believe
these are never enough. We also have the Board must be focused on the big
our Strategy to 2021 to guide us in picture, looking to the future, asking
principle but such documents are almost the harder questions and tackling the
We all know AI offers many
out-of-date before the ink is dry. broader issues.
opportunities in imaging and therapy,
The College needs a continuous but it also constitutes a major threat As for our membership, they need to
approach on at least two strategic to patients and practitioners alike if understand the role of their Board and
fronts: the aspirational (‘What is the best implemented poorly. To address the have confidence the Board is doing
we can do?’) and the existential (‘How issues, the College has developed a the right thing. This does not mean
do we remain relevant?’) If the Board draft set of ethical principles for AI in members need agree with the Board
does not tackle this task adequately medicine and today it leads the debate over any specific policy or decision, only
and actively seek answers to the hard on how clinical radiology and radiation to be confident the process is strong
questions, how can we reasonably oncology, and healthcare generally, will and we are headed in the right general
expect this of our members? We just manage a digital health future. direction.
have to do it.
In government advocacy, an intensified That’s an agenda for all our coming
Consequently, the role of the RANZCR effort—which has included over meetings.
Board has in recent years begun to 20 submissions in 2018 alone—has
evolve. I did not start the change but I resulted in governments and agencies
am determined to see it continue and regularly consulting with the College
build while President. The change began for its expertise, insight and input on
with decisions to prioritise specific policy-related and other matters. These
issues such as the impact of artificial have included recent government or
Volume 15 No 3 I June 2019 5
Introduction
A doctor's tale
The Chief Executive Officer
discusses storytelling
Ms Natalia
Vukolova
In brief: Doctors underestimate the and, in many cases, still revered. Doctors
power of their stories. Storytelling is must repay patients and the public for
a weapon of mass impact and doctors this trust by recasting themselves from
must seize it for the benefit of patients, an expert to an advocate, a storyteller,
health systems and society. an influencer. For many specialist
doctors, this is anathema – after a
In my experience, clinicians feel more
lifetime spent specialising and valuing
comfortable talking about the science
technical expertise above all else, it
of medicine or its politics than about
must be hard to recast yourself as a
the raw emotions of conversations with
public figure. Why change, you ask? In
patients or the personal impact that
my view, it is because an expert can help
they had on someone’s life. Perhaps
hundreds, but an advocate can help
this unemotional approach is a way
hundreds of thousands. You become
to deal with the difficulties of being a
specialists, not because it is easy (as any
doctor and delivering tough news, or
VIVA candidate will attest), but because
a way to show that your judgement is
it is worth it. This is no different.
based on facts and science, may be
it is anachronistic - from a time when An effective advocate combines their
medicine was a masculine field defined expertise and facts, with powerful
by stoicism. Whatever the case may be, stories from the frontline of healthcare.
I often find that doctors minimise the They work with patients to help them
impact that they have on their patients’ find their own voice. Healthcare stories
lives by speaking of their work in an are relatable – who hasn’t suffered or
impenetrable jargon-filled language. seen a family member struggle with
their health? As a trusted profession,
Storytelling is a powerful tool.
a doctor’s audience is primed to be
Storytelling grabs at our imagination,
impressed. Medicine, after all, is like
it is memorable, it has a chance to
magic to most members of the public.
genuinely influence the listener.
Clinical radiologists and radiation
And the world needs influencing.
oncologists just need to work a bit
Strong, educated, ardent voices
harder than other specialties to get their
are much needed now to battle the
stories heard – which is why the College
rise of pseudo-science, health cuts
invests so extensively in our advocacy
masquerading as health policy, and the
work: with politicians, referrers and the
constant noise of the demagogues on
public. If you are ready to rise to the
social media. Doctors remain one of the
challenge, then find your own story References
most trusted professions1. Where others’ 1 http://www.roymorgan.com/findings/7244-
and become an advocate for better
perceived worthiness has been steadily roy-morgan-image-of-professions-
healthcare and society.
declining, doctors are trusted, respected may-2017-201706051543
6 Inside News
News
New Zealand
Branch News
Dr Gabes Lau
Hello All. The year is now well underway devices available to the public health There is an often-misguided perception
and I hope this finds you well. system. New Zealand could fall behind that AI may lead to the death of
international best practice without the radiology. As we did last year, the
Health and Disability Review availability of current technology. College is sponsoring a booth at the
2020 New Zealand Medical Students
At the April NZ Branch meeting,
Horizon Summit Association Conference. We hope to
the Health and Disability Review was
counteract these rumours and generate
discussed at length. The Terms of I want to take this opportunity to
interest in both radiology and radiation
Reference are broad (only four areas are congratulate our NZ radiation oncology
oncology amongst medical students.
excluded from the review, including ACC colleagues on a wonderful event
However, College members shouldn’t
and private health insurance) but the at Parliament to raise the profile of
be shy about correcting colleagues. We
scope of the review is focused on equity radiation oncology in New Zealand.I
certainly expect that AI will change the
of outcome and ensuring resources are would like to express my appreciation to
work we do but it will not negate the
best utilised in the future. It is expected all involved in this landmark event, which
need for radiologists.
that significant changes to New Zealand’s follows on from the Cancer Crossroads
health system will be based on the event held earlier this year.
2020 New Zealand ASM
Review’s final recommendations.
College accreditation The 2020 ASM for New Zealand is
Therapeutic Products Bill expected to be held in Wellington. An
The AMC (and MCNZ) accreditation
EOI is going out. I would like to extend
The Ministry of Health has been consulting process has begun. The process will
an invitation to radiologists and radiation
on the Therapeutic Products Bill, which is include site visits in New Zealand. The
oncologists in the Wellington region to be
proposed to replace the Medicines Act. accreditation panel is headed by Dr
involved and to showcase their expertise
On the horizon is increased regulation Andrew Conolly (a New Zealander and
in the region. Please email
for devices, including the technology former Chair of the Medical Council of
nzbranch@ranzcr.org.nz or telephone
dear to the hearts of radiologists and New Zealand).
(04) 472 6475 if you have any questions.
radiation oncologists. Members can
also look forward to the regulation of Meeting with ACC
radiopharmaceuticals. The passing of this
The Musculoskeletal Group recently met
bill into law remains a way off. The College
with ACC. ACC has recently undergone
will provide further information as the final Getting involved at the College
a significant restructure and staff
version of the new legislation becomes
turnover so there were many new faces.
more concrete and we can better advise The College is currently seeking
The focus of the meeting was to rebuild
on the impact to your practice. a Training Network Director
the relationship that we have worked
(radiation oncology) and Branch
hard to build with ACC over the last
PHARMAC Education Officer (radiology). This
15 years. Two additional meetings are
is a great opportunity for some new
In other consultation news, PHARMAC, scheduled for this year.
perspectives to come on board from
the New Zealand Pharmaceutical
Registrar recruitment Fellows and Educational Affiliates in
Management Agency, is consulting on
the Branch. Please contact nzbranch@
PHARMAC managing medical devices
As I write this, the annual recruitment ranzcr.org.nz, telephone (04) 472 6475
in the same way it does medications
round for College registrars in New or visit the College website for more
for the public sector. During discussion,
Zealand (radiology and radiation information.
the New Zealand Branch Committee
oncology) is closing. Disappointingly
was concerned about how PHARMAC
this year has seen a record low in the
might rationalise available devices, as
number of applications for radiology.
well as unreasonable delays making new
Volume 15 No 3 I June 2019 7
News
News in Brief Australian
Branch
News
Prof David Ball published in Attention Trainees! 2019 Varian Queensland Branch news
Lancet. Medical Systems Educational It was a great start to 2019 with the
The former Editor-In-Chief of the Grant application period Queensland Branch holding their first
Journal of medical Imaging and extended! Academic Evening on 12th February
Radiation Oncology, Prof David Ball Each year Varian Medical Systems at St Lucia Golf Links in Brisbane.
has had a paper recently published offers several grants to radiation The house was packed with nearly 70
in The Lancet Oncology pages. oncology trainees to assist in their members to enjoying a good meal and
Stereotactic ablative radiotherapy attending the RANZCR ASM. Held in listening to presentations on a range of
versus standard radiotherapy in stage Auckland this year, these grants assist topics including:
1 non-small-cell lung cancer (TROG first and second year trainees with the • Dr John Grieve - Changing role of IR
09.02 CHISEL): a phase 3, open-label, cost of registration and other expenses. in trauma
randomised controlled trial was If you would like further information,
published in February. please refer to the Awards and prizes • Dr Jason Zhang - Spectral CT in daily
section of the College Website. practice - Abdominal Imaging
Opportunity to take up a Clinical • Dr Patricia Deonarie - Imaging of
Fellowship in the UK adnexal lesions and their mimics
We are very excited to announce It was a very enjoyable evening
that applications are now open for with an opportunity to network with
2020/21 Windeyer Fellowship. The colleagues, earn CPD points and to
Windeyer Fellowship enables a catch up with old friends over some
trainee (post Phase 2 Examination), or fantastic food and wine. It is great to
junior Fellow in Radiation Oncology see college members getting value out
to undertake a Clinical Research of their membership and supporting
Fellowship at the Mount Vernon Cancer the Queensland Radiologist
Centre, Northwood, London, United community.
Kingdom. The Fellowship involves
a wide- ranging clinical experience
working with a number of senior clinical
oncologists, within several subspecialty
sites. Overall supervision will be
provided by Professor Peter Hoskin.
There will be a focus on participation in
clinical research activities.
For further information, please refer
to the Awards and Prizes page of the
College website.
8 Inside News
Features
Radiation therapy front and centre
at New Zealand Parliment
RANZCR CEO, Natalia Vukolova and
several other subject matter experts on
issues including the need to improve
access, the future of radiation oncology,
workforce constraints and the cost
effectiveness of radiation treatment.
The Summit was highly successful,
with those in attendance formulating
a number of key outcomes. This
included a commitment to collaborate
and consult on the national cancer
plan, specifically the future location of
facilities, and a recognition of the need
to urgently implement and invest in a
Dr Madhavi Chikuri with Minister new funding structure and identify and
of Health, the Hon Dr David Clark promote solutions to workforce shortage
and Dr Carol Johnson issues and trainee retention. Another
key priority identified from the Summit
was to work with medical schools to
Improving access to potentially life- groups. Participants at the Summit
increase medical students’ awareness
saving radiation therapy for thousands were pleased to hear the Minister’s
and understanding of a career in
of New Zealand cancer patients was commitment to equity of outcomes for
radiation oncology.
the key message delivered by the Royal all cancer patients and the Government’s
Australian and New Zealand College of aim to reduce the incidence and impact The Horizon Summit was an important
Radiologists at the first-ever Radiation of cancer. step toward raising awareness of
Oncology Horizon Summit, on 9 May at radiation therapy in New Zealand and
RANZCR has been a driving force
New Zealand’s Parliament. creating a plan to improve access for
in advocating for cancer patients to
those that would benefit from the
Hosted by New Zealand Health Minister, have access to the most effective
treatment. The College will continue
the Hon Dr David Clark, the Summit and appropriate treatment for their
to work with decision makers, health
brought together stakeholders from circumstances. The Summit was the first
professionals, consumer representative
across government, industry, and event of its kind in New Zealand and
and the Ministry to ensure high quality,
consumer representatives to discuss the turnout demonstrated that decision
safe, affordable and accessible radiation
improving access to radiation therapy. makers are taking the need for reform
treatment for all who need it.
The event emphasised the current seriously.
underutilisation of this lifesaving
As cases of cancer continue to grow in
treatment and has kick-started the
New Zealand, the Summit shed light on
process of developing policy that If you would like further
the importance of radiation therapy in
ensures patients are always made information, please contact
helping to combat the disease. Today,
aware of their choices when it comes to Steve Williams at
Cancer is the most common cause of
treatment. Steve.Williams@ranzcr.org.nz
death in New Zealand, responsible
The College acknowledges Minister for nearly a third of all deaths and is a
Clark for sponsoring the Summit and leading cause of morbidity.
recognising the importance of radiation
Speakers on the day included Chair of
therapy in the fight against cancer.
the New Zealand Radiation Oncology
Cancer continues to have a huge
Executive Committee, Dr Carol
impact on the lives of thousands of New
Johnson, RANZCR Faculty of Radiation
Zealanders every year and outcomes
Oncology Dean, Dr Madhavi Chilkuri,
are worse for Maori and marginalised
Volume 15 No 3 I June 2019 9
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qldxray.com.auFeatures
Silicosis:
A looming health crisis
Silicosis is caused by the inhalation Diagnosis of silicosis upskilling radiologists, we plan to build
of respirable crystalline silica dust relationships with key organisations
contained in manufactured stone There are no current imaging guidelines and medical professionals with whom
products used to make kitchen and for the diagnosis of silicosis. The we can devise a collaborative, patient-
bathroom benchtops. The condition Queensland OIR screening program centered and ongoing strategy for
is progressive, with patients involved a radiograph, read by a NIOSH the management of silicosis and other
suffering lung inflammation and B-reader to ILO standards. The HRCT pneumoconiosis.
fibrosis. Silicosis can be prevented chest was included if recommended
by the radiologist, if the worker was We will be keeping our members
but there is no known cure and lung
symptomatic or had an abnormal informed as our work in this space
transplantation is currently the only
spirometry. Referral to a respiratory evolves, and we will be relying on you to
treatment option.
physician or occupational physician then provide feedback as we make proposals
Manufactured stone contains up to 95% occurred as required. and develop training and educational
crystalline silica while natural stone such materials.
as marble or granite contains between What is the College doing to If you have any contributions,
5 to 50% crystalline silica (WorkCover respond? thoughts or comments, please
Queensland, 2018). Manufactured stone
It is paramount that the College contact Amy Young, Standards Unit at
is much cheaper that natural stone,
responds effectively and efficiently to professionalpractice@ranzcr.com
considered easier to work with and is
subsequently used in high volumes by provide recommendations for accurate,
the industry and tradesmen. Products reliable and timely diagnosis of silicosis.
containing silica are readily available in We are currently working with members
leading hardware stores across Australia of our Professional Practice Committee
and New Zealand, exposing the home (Please see the article on page 32
handyman to the risks associated with of this issue) and the Australian and
the product. New Zealand Society of Thoracic
Radiology (ANZSTR) who are tasked
Rising incidence with developing recommendations
Following the identification of several regarding training requirements for
silicosis cases in Queensland throughout radiologists and diagnostic pathways for
2018, an audit of the stonemason ‘at risk’, symptomatic and asymptomatic
industry in Queensland and screening workers. The College is committed to
program of workers ensued. To date, identifying radiologists with an interest
more than 800 workers have been in occupation dust lung diseases and
screened, of whom 116 have confirmed providing opportunities for them to be
silicosis diagnosis. educated and upskilled accordingly.
Similar incidence rates are expected in The College is currently engaged with
other jurisdictions, with the advent of the OIR, providing recommendations
screening. In the interim, one of the first and support to their Silicosis Medical
workers diagnosed with silicosis died in Working Group of which we have
March this year, aged 36 years. representation on. Complimentary
to our commitment to educating and
Volume 15 No 3 I June 2019 11Features
AI algorithm to compete in junior
radiologist image quiz
An AI algorithm could help radiologists prioritize the review of critical cases
It’s a cold and frosty day in Vienna as “It’s not a question about whether That’s why clinicians are looking for
junior radiologists sit down for the the radiologist is better than the AI opportunities to read STAT chest X-Rays
annual junior image interpretation quiz. or vice versa,” said Mathias Goyen, faster and in a more prioritized manner
It’s one of the main attractions at the chief medical officer at GE Healthcare, to enable a quicker diagnosis. One such
European Congress of Radiology (ECR) who presented the AI case. “If there’s opportunity is the Critical Care Suite* on
and this year is no exception. Six experts a patient with a pneumothorax in the Optima XR240amx, which is designed to
in the field each present a case to the middle of the night when there’s only a identify cases with the critical condition
young radiologists in the room – one few radiologists on call, each one with of pneumothorax at point-of-care to
more complex than the other – and their hands full, having a smart computer enable prioritization of image review.
four possible diagnoses for every case. that can flag that a patient is in need of
“I think the idea and concept about an
The audience then casts votes on the acute care could be the difference of life
on-device alert really gets to the heart
diagnoses they believe to be correct. and death”.
of early warning detection technology,”
But this year presented a twist. There Today, patients who present symptoms said Dr. Rachael Callcut, Associate
was a seventh case. One that had been associated with the condition receive a Professor of Surgery at the University of
assessed by Artificial Intelligence (AI), chest X-Ray, which can take radiologists California, San Francisco (UCSF) Medical
rather than a radiologist. The scan on anywhere between two to eight hours Center and Director of Data Science for
the screen showed a pneumothorax – a to read[2]. If the condition isn’t treated the Center for Digital Health Innovation,
collapsed lung which impacted more fast enough, the patient can develop who worked with GE Healthcare to
than 9,000 people in the UK in 2011[1] tension pneumothorax, or an enlarging develop the Critical Care Suite. “There
and can be deadly if not diagnosed pneumothorax[3], potentially leading to are many opportunities to use early
quickly and accurately. A lung can fatal consequences if not treated quickly. alerts and early warnings and it’s very
collapse if air leaks into the space clear that the sooner the clinician knows
In such cases, patients would receive
between the lung and the chest wall of a potential life-threatening or major
a “STAT” chest X-ray which is reserved
and pushes on the outside of the lung. finding, the more likely they are to be
for potentially life-threatening
It can be caused by trauma, cigarette able to do a timely intervention that
circumstances. STAT portable chest
smoking, certain lung diseases, or by could perhaps change the trajectory of
X-Rays can attribute to more than 60
complications from surgery. a patient.”
percent of a radiology center’s mobile
74.8% of the radiologists located the chest X-ray volume, almost double that Critical Care Suite will employ a suite of
pneumothorax correctly. of routine exams[4]. AI algorithms, such as pneumothorax
detection, designed to identify this
potentially life-threatening condition in
chest X-Rays with high accuracy (>0.95
AUC). The AI algorithm is hosted on
the mobile X-Ray system – a first of its
kind AI-embedded imaging device –
designed to share the output through an
onscreen notification. Critical Care Suite
on Optima XR240amx is powered by
Edison – a next generation intelligence
platform that helps accelerate the
development and adoption of AI
technology and empowers providers to
deliver faster, more precise care.
12 Inside NewsFeatures
When a pneumothorax condition is *510(k) pending at FDA. Not available for sale. Not
identified, the point-of-care notification CE marked
alerts the clinical team, enabling References
prioritization of image review. The AI [1] https://statistics.blf.org.uk/lung-disease-uk-big-
results are sent to PACS for review of picture
the critical findings by a radiologist. An [2] Rachh, Pratik, et al. “Reducing STAT Portable
AI algorithm could help radiologists Chest Radiograph Turnaround Times: A Pilot Study.”
Current problems in diagnostic radiology (2017).
prioritize the review of critical cases [3] Lorenz, Jonathan, and Matthew Blum.
and bring confidence when diagnosing “Complications of percutaneous chest biopsy.”
difficult cases. Seminars in interventional radiology. Vol. 23. No. 2.
Thieme Medical Publishers, 2006
“AI has the potential to transform the [4] Rachh, Pratik, et al. “Reducing STAT Portable
way we diagnose and deliver care,” Chest Radiograph Turnaround Times: A Pilot Study.”
said Goyen. “I think future radiologists Current problems in diagnostic radiology (2017).
will have more tools like these in
their arsenal, helping them meet the
increased radiology demand and
ultimately, treat patients faster”.
by Pernilla Mello, GE Healthcare
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Volume 15 No 3 I June 2019 13Features
Professional
CHANGES TO YOUR MEDICAL Development
REGISTRATION REQUIREMENTS
Remediation Wellbeing
ARE YOU PREPARED?
Attention Radiation Oncology Fellows:
Are you aware that your CPD requirements
changed on 1st January this Year?
From 1st January this year, the CPD Transition to reforms Resources to help you
requirements for Radiation Oncology
Fellows changed. The changes have The Radiation Oncology Post Fellowship The College has created a CPD Toolbox,
been instituted to accommodate Education Committee (PFEC) have which holds a range of resources to
incoming reforms from the Medical agreed to progressively adopt the new assist radiation oncology Fellows meet
Board of Australia (MBA) and Medical CPD requirements, to allow Fellows the the new CPD requirements. Links to
Council of New Zealand. These opportunity to adapt to the reforms. these resources are provided below;
reforms will see a shift from the This means, that effective 1 January
RO Scope of Practice
usual educational activities such as 2019, all Radiation Oncology Fellows
conferences, courses and workshops to must comply with the following CPD • Professional Development Plan
include multiple modalities as follows; requirements; Template
• Clinical Audit Tool
1. Educational activities e.g. lectures, • Participate in at least one ‘Measuring
• Peer Review Audit Tool
conference, courses, reading, Outcomes’ activity within triennium
• Patient Satisfaction Survey Tool
supervision and workshops (2019-2021)
• Journal Reading Recording Template
• Participate in at least one ‘Peer
2. Reviewing performance e.g. peer Review’ activity in triennium (2019-
review, performance appraisal, peer 2021)
review of medical records, case • Participate in at least on Educational
conference, multi-source feedback activity in the triennium (2019-2021) If you have any questions or
• Accrue a minimum of 180 points concernsabout the upcoming
3. Measuring outcomes e.g. Clinical changes to your Australian medical
for the triennium with the following
audit, review of medical records, registrationrequirements, please
caveats;
review of clinical indicators/standards, send them to cpd@ranzcr.com
o Points must be accrued from a
comparison of comparative data
minimum of 3 or the 7 RANZCR
sets, audit of medico-legal reports,
CPD categories
reflection on professional outcomes,
o Individuals much accrue a minimum
participation in clinicopathological
of 50 points per year
correlations meetings
Further, members are being encouraged
Further information regarding the to have an annual Professional
reforms is available on the RANZCR Development Plan in place that outlines
website the RANZCR website and in the the individual learning needs and
2019-2021 CPD handbook. demonstrates alignment to their scope
of practice.
14 Inside NewsFeatures
2019 Australian Federal
Election Update
On Saturday, May 18, Australians went
to the polls to vote in the 2019 federal College President Prof Lance Lawler and
election. The Coalition government College CEO between meetings at the
under the leadership of Prime Minister Parliament House in Canberra
Scott Morrison was re-elected to
lead the country for another three
years. The College congratulates
the Coalition on their win and looks
forward to continuing our work with the
Government and Opposition over the
next parliamentary term. Throughout
the campaign, healthcare was a
feature of each party’s platform and
as such, prior to the national vote, the
College secured a number of election
commitments from all the major parties.
For clinical radiology, the Coalition
has pledged to work with RANZCR to
develop a comprehensive strategy to
prepare Australia for the adoption of
AI in healthcare. Considered to be one
of the most influential factors on the
delivery of healthcare into the future,
we feel that RANZCR’s involvement in
this area will ensure that the College
maintains a strong voice in delivering
future outcomes. The Government also
reiterated its previous announcement
to expand MRI access by investing
$375m in Medicare covered MRI scans.
Further commitments were made by This included modelling for the new The College has developed strong
the Coalition, to working with RANZCR radiation oncology schedule and the relationships with influential decision
to evaluate the impact of its recent radical prostatectomy guidance note makers in the Coalition including Health
delivery of 53 new MRI machines. They in Medicare, which encourages a Minister Greg Hunt. This was evident in
also outlined how they had delivered discussion of treatment options with the strong response we received to our
indexation to 92% of all diagnostic radiation oncologists. election priorities. Though there may
imaging services (commencing July be some changes in the weeks ahead,
Finally, RANZCR received support from
2020), and invested $32m or MRI and RANZCR will continue to maintain these
all major and minor parties for the
PET scans for breast cancer patients. relationships, seek new ones and hold
development of a nationally coordinated
the Government to account for their
For radiation oncology, the government plan for particle therapy, to encourage
commitments to the electorate during
has committed $63.4 million for radiation strong collaboration between States and
the recent election and push for the best
therapy centres in regional Australia and Territories and ensure access to eligible
patient outcomes possible.
supported the introduction of a national patients. We feel that this support is a
incident reporting and learning system testament to efforts of the College in
to improve the overall safety and quality building our reputation as strong, clarion
of radiation therapy. The Coalition also voice in matters of healthcare backed up
committed to working with RANZCR with a professional team that is able to
on the implementation of several of follow through on our promises.
the MBS Review recommendations.
Volume 15 No 3 I June 2019 15Features
Robert “Bob” Hawke 1929 – 2019
Australian Prime Minister
Malcolm Fraser's government during
their subsequent period in office.
In 1979 Medicare benefits were limited
to the difference between $20 and
the scheduled fee. And in 1981 access
to free hospital and medical care was
restricted to pensioners with health care
cards, sickness beneficiaries, and those
Bob Hawke gives the Inaugural Kingsley Laffer Lecture - meeting stringent means tests.
photo courtesy of the University of Sydney Archives
The transformation of Medibank into
Medicare as we know it, came into
Robert James Lee Hawke was born served as a governor of the Reserve operation on 1 February 1984, following
in Bordertown, South Australia, Bank from 1973 until 1980. the passage in September 1983 of
on December 9 1929, the younger the Health Legislation Amendment
In 1983 he toppled the then Labor
of two sons of Clem Hawke, a Act 1983. It differed from the original
party leader, Bill Hayden to become the
Congregationalist minister, and his wife Medibank program only in matters of
leader of the party and thirty-five days
Ellie detail but despite this at the time the
later, led the party to an election win
legislation was considered a radical
In 1969, Hawke was elected ACTU against the Fraser Liberal Government.
social reform that would create a health
president, receiving the left’s support in
In February 1984 Hawke announced insurance system that was simple, fair
what turned out to be a closely fought
Medicare. It was an updated version of and affordable.
contest. During the 1970s, he became
Gough Whitlam’s Medibank program
a towering figure in national political It became Australia’s first affordable and
which had been originally introduced
and industrial life. Hawke was also ALP universal health insurance system and is
by Whitlam but partially dismantled by
president from 1973 until 1978, and he still going strong today.
Choosing More isn’t always better Both Choosing Wisely Australia
and Choosing Wisely New Zealand
Unnecessary tests, treatments or provides specific resources, developed
procedures can be harmful and costly.
Wisely
with specialist colleges, including
By making sure your patients are well RANZCR, to help professionals and
informed, you can make the best health consumers alike. To access these
decisions about their health care, resources and to find out more, visit
together.
Choosing Wisely was first launched in Choosing Wisely Australia
the United States in 2012 and has grown Choosing Wisely campaigns are www.choosingwisely.org.au
into a global initiative with over 20 led by clinicians, but one of their
primary objectives is to engage health Choosing Wisely New Zealand
countries and campaigns now in places
consumers in making decisions about https://choosingwisely.org.nz
such as Australia, New Zealand, Canada,
the UK and parts of Europe. Campaigns their own medical care.
encourage health professionals and Consumers are encouraged to consider
Consumers/Patients to engage in and ask the following questions:
evidence-based conversations about
what tests, treatments and procedures 1. Do I really need this test, treatment
may not benefit them and could cause or procedure?
harm. 2. What are the risks?
3. Are there simpler, safer options?
4. What happens if I don’t do anything?
5. What are the costs?
16 Inside NewsEducation
RANZCR 2019 ASM heads
Back to the Future.
Embracing the classic 80’s cult movie Radiation Oncology: In with the
Back to the Future, delegates will be old and new!
transported back in time to look back
at the core elements of where we With the theme this year being Back
have come from and where we will be to the Future we have secured three
heading as Clinical Radiologists and amazing keynote speakers Dr David
Radiation Oncologists. Beyer, Dr Drew Moghanaki and Dr
Arjun Sahgal. Some of the key topics
The Organising Committee have been we plan to cover include management
working on an engaging and thought- of brain metastases, stereotactic
provoking program. Complemented ablative radiotherapy and treatment
by insights into College activities of oligometastases, re-irradiation, post
with input from the special interest ablative radiotherapy imaging, artificial
groups and working committees they intelligence, dealing with physician
promise a holistic program to engage Dr Drew
burnout and social media in medicine.
members and affiliated groups. Artificial Moghanaki
Intelligence will also be a hot topic Dr David Beyer is the past president of
addressed at the ASM. ASTRO and the American Brachytherapy
Society. He will be sharing with
There will be a number of social us insights into management of
program highlights in the 2019 program, Genitourinary malignancies. Drew
but the stand out event will be the Moghanaki requires no introduction for
RANZCR Gala Dinner, where we are those of you who are on twitter, Drew
encouraging you to channel your inner is an expert on lung and Genitourinary
80’s spirit and dress in theme as we malignancies and will be sharing with
dance the night away to some iconic us his experience on social media as
80’s music. It will be a night not to be well as SABR for lung malignancies. Dr
missed! Arjun Sahgal is an international authority
Be sure to add some extra time on your on management of brain and spine
visit to Auckland, either pre or post malignancies and is the director of the
ASM, to explore New Zealand and its Sunnybrook Cancer Ablation Therapy
serenity. program. He will be sharing his insight Dr David
on management of brain metastases Beyer
and spine metastases using stereotactic
ablative radiotherapy.
As always we will have an action packed
social program and the meeting will
be a great opportunity for you to
network with your peers and develop
new collaborations and relationships.
Auckland is a great city with lots of
things to do and explore, we look
forward to welcoming you in October.
Louis Lao & Ramesh Arunachalam
2019 Radiation Oncology Co-Convenors
Dr Arjun
Sahgal
continued over...
Volume 15 No 3 I June 2019 17Education
Clinical Radiology: Highly amateur and professional athletes from
regarded educators and a wide variety of sports across the UK.
specialists joining together in He was involved in the development
Auckland. and provision of sports imaging
services for the London 2012 Olympics,
Clinical Radiology welcomes leading Manchester Commonwealth Games and
experts from the United Kingdom and World Indoor Athletics (Birmingham).
United States to present at this year’s Radiology 6th Edition.
ASM including Dr Paula Woodward,
Professor of Radiology at the University Dr David Panicek serves as Vice Chair for
of Utah and holds the David G. and Faculty Affairs in Radiology at Memorial
Marcia R. Bragg Presidential Endowed Hospital, and Professor of Radiology at
Chair in Oncologic Imaging. In 2014 she Cornell University Medical College and
was given the honor of Educator-of-the- is a recipient of the E. Robert Heitzman Dr Paula
Year by the RSNA. Her area of research Award for Teaching Excellence (from Woodward
and clinical focus is pelvic and fetal radiology residents at SUNY Health
imaging and she holds appointments Science Center at Syracuse) and the
in both the Department of Radiology Robin C. Watson Award for Excellence
and Department of Obstetrics and in Radiology Teaching (from radiology
Dr Andrew
Gynaecology. residents at New York Hospital/
Grainger
Cornell). He was principal investigator
Interventional Radiologist from Reading on a National Cancer Institute multi-
Hospital, USA, Dr David Sacks has institutional grant that compared
authored/co-authored over 120 scientific CT and MR imaging for staging of
publications and book chapters. He musculoskeletal tumours. Dr Panicek
has had an interest in the interventional lectures around the world, and is a
treatment of stroke for nearly 20 two-time recipient of the Outstanding
years and created an interventional Teacher Award in musculoskeletal
stroke treatment program at Reading imaging courses at annual meetings of
Hospital in 2001. He has authored the International Society for Magnetic
or co-authored numerous papers on Resonance in Medicine.
physician training and performance
standards for carotid stenting and Dr Michelle S. Ginsberg, is Vice
stroke interventions, and chaired an Chair for Education and Director of
international writing group to create Cardiothoracic Imaging in the Radiology
outcome benchmarks for intra-arterial Department at Memorial Sloan Kettering
stroke therapy. He is currently president Cancer Center. She is a Professor of
of the Intersocietal Commission for Radiology at Weill Cornell Medical
the Accreditation of Carotid Stenting College. Dr Ginsberg was named
Facilities and serves on the board of the the 2018 New York Roentgen Society
Intersocietal Accreditation Commission. Distinguished Radiologist and served
He also serves on the board of the as President of the New York Roentgen
interventional stroke registry, INSTOR. Society and has been named Castle
He was co-chair of the Society of Connolly Top Doctors, New York Metro
Interventional Radiology CLOTS Area for the past 8 consecutive years
interventional stroke training course, and Top Doctors, New York Magazine
and created a stroke training course for for the past 4 years. Dr Ginsberg’s
the Interventional Radiology Society of research focuses on detection,
Australasia in July 2017. characterization and measurement of
thoracic malignancies and improving Dr David
Consultant musculoskeletal radiologist techniques to assess tumour response. Sacks
and Honorary Associate Professor to She has authored more than 133 original
the University of Leeds, Dr Andrew peer reviewed publications, invited
Grainger will also look to join us in reviews and chapters.
Auckland. Dr Grainger works closely with
a team of seven other musculoskeletal
radiologists providing MSK imaging Gabes Lau
services across all modalities. Within the
sub-speciality he has particular interests Clinical Radiology Convenor
in sports imaging and imaging arthritis
and has been involved in imaging
18 Inside NewsEducation
Trainee Learning Days
Dr Michelle
S. Ginsberg The Clinical Radiology and Radiation
Oncology Trainee Learning Days will be
held Saturday 19 October to encourage
as many trainees and registrars to
attend the day. The Clinical Radiology
day will once again focus on VIVA’s
and preparation for exams, whilst
the Radiation Oncology program will
look at Fellowships and Leadership/
Mentoring programs as part of the day’s
proceedings.
The day provides an opportunity
for both disciplines to meet with
fellow Trainee’s and gain insights into
preparation for examinations and share
experiences and networks.
Anna Gubbins, Radiation Oncology
Trainee Representative
Acrane Li, Clinical Radiology Trainee
Representatives
Dr David
Panicek
FLINDERS MEDICAL CENTRE
PATHOLOGY COURSE
15 & 16 FEBRUARY 2020
The Division of Medical Imaging at Flinders Medical Centre
will offer a two day Pathology Course, consisting of
lectures and “pots” sessions to be held on Saturday 15 and
Sunday 16 February 2020 at the Adelaide Convention Centre.
The course will be of particular value to registrars and
candidates preparing for the Part II FRANZCR examination. It
will also provide an overview of pathology for practising
radiologists who are encouraged to attend.
Closing date for registrations is: Friday 29 November 2019
For registration form and further information please contact
Helen Sainsbury: helen.sainsbury@sa.gov.au / (08) 8204 4405
Volume 15 No 3 I June 2019 19SPEND
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hr@idxgroup.com.auAdvocacy
Targeting Cancer
under an Italian Sun
Targeting Cancer at the European ESTRO/CARO/RANZCR With Course Director A/Prof Sandra
Society for Radiotherapy and Leadership Course Turner and Dr Lucinda Morris part of
Oncology Conference 2019 the international teaching faculty, the
RANZCR, ESTRO and CARO have College is well represented in this
The European Society for Radiotherapy collaborated to put together an important area. The course is being
and Oncology Conference (ESTRO) met interdisciplinary Foundations of presented in Sydney for the first time
in the historic, beautiful and stylish city Leadership course for RO trainees/ this August. Find our more about it on
of Milan, Italy in late April. There was a junior ROs, RTs and physicists. 36 page 25 of this issue.
significant Australia and New Zealand participants from over 20 countries were
radiation oncology presence at the in attendance. The Leadership course
conference, showcasing research from ran for its second year at ESTRO, with
our region, our College’s contribution to a program covering leadership theory
global leadership development and of and styles, personal and relational
course the widely acclaimed Targeting awareness, effective team building
Cancer campaign. and change management as well
as skills in quality improvement and
communicating a vision for change. A
series of interactive teaching sessions
and group activities over 3 days are
tailored to the specialty of radiation
oncology with relevant case studies to
bring the theoretical concepts to life.
Volume 15 No 3 I June 2019 21Advocacy
Joint Symposium Targeting Cancer – Fun Run
RANZCR and ESTRO also collaborate by International Reach ESTRO’s annual fun run buzzed with
co-hosting joint symposia in alternative The Faculty of Radiation Oncology excitement and featured a large New
years at our respective scientific Dean, and clinical leads on Targeting Zealand and Australian presence.
meetings. This year it was ESTRO’s turn Cancer, A/Prof Turner and Dr Lucinda Twelve relay teams made up of RANZCR
to host, with two European speakers Morris met with representatives from members, international friends and
and two from our region. The topic the European Cancer Foundation (ECF), supporters competed together under
of radiotherapeutic management of a charity established by ESTRO to help the Targeting Cancer banner. Branded
oligometastatic disease was chosen due ensure that all cancer patients who need gear and temporary transfer tattoos
to the rapid and broad acceptance of it radiation therapy receive it. RANZCR ensured that the Targeting Cancer
in recent years. FRO Dean Dr Madhavi attendees provided an overview of message was heard in Milan and was
Chilkuri chaired the session alongside how the strategy behind Targeting spread far and wide across social media.
Prof Yolande Lievens from Belgium. Cancer has evolved over its first five
A/Prof. Jarad Martin from NSW years and outlined resources that both
presented first on use of SBRT for organisations could share.
oligometastatic prostate cancer. He The ECF campaign focuses on removal
was followed by Dr Suresh Senan from of barriers to treatment, including
the Netherlands who covered SBRT perceptions or lack of awareness and
for oligometastatic non-small cell lung adequate resourcing of care. The
cancer. Next up, Prof. Tomas Kron, ECF last year launched the Marie
a medical physicist from Melbourne Curie Legacy initiative with a resulting
provided an overview of challenges white paper calling on governments,
of SBRT in physics and related clinical policymakers, health professionals,
issues to watch out for. The final patients and societies to help address
speaker, Prof. Ruggero Ruggieri, the gap in radiation therapy access.
provided hints on optimal dose and
fraction number from lung SBRT.
RANZCR looks forward to welcoming FRO members are encouraged
ESTRO to our ASM in Auckland this year to take a look at the Marie Curie
and to the next joint symposium at the Legacy initiative from ESTRO. If
2020 ASM. consumer advocacy is something
you would like to get involved in
locally, please contact Phil Munro
of the Targeting Cancer team at
faculty@ranzcr.edu.au.
22 Inside NewsYou can also read
