Royal Australian And New Zealand College Of Radiologists Research Articles

The Royal Australian and New Zealand College of Radiologists (RANZCR), 73rd Annual Scientific Meeting, 19-21 October 2023.

The Royal Australian and New Zealand College of Radiologists (RANZCR), 73rd Annual Scientific Meeting, 19-21 October 2023.

Automated precision localization of peripherally inserted central catheter tip through model-agnostic multi-stage networks

Background:Peripherally inserted central catheters (PICCs) have been widely used as one of the representative central venous lines (CVCs) due to their long-term intravascular access with low infectivity. However, PICCs have a fatal drawback of a high frequency of tip mispositions, increasing the risk of puncture, embolism, and complications such as cardiac arrhythmias. To automatically and precisely detect it, various attempts have been made by using the latest deep learning (DL) technologies. However, even with these approaches, it is still practically difficult to determine the tip location because the multiple fragments phenomenon (MFP) occurs in the process of predicting and extracting the PICC line required before predicting the tip. Objective:This study aimed to develop a system generally applied to existing models and to restore the PICC line more exactly by removing the MFs of the model output, thereby precisely localizing the actual tip position for detecting its misposition. Methods:To achieve this, we proposed a multi-stage DL-based framework post-processing the PICC line extraction result of the existing technology. Our method consists of the following three stages: 1. Existing PICC line segmentation network for a baseline, 2. Patch-based PICC line refinement network, 3. PICC line reconnection network. The proposed second and third-stage models address MFs caused by the sparseness of the PICC line and the line disconnection due to confusion with anatomical structures respectively, thereby enhancing tip detection. Results:To verify the objective performance of the proposed MFCN, internal validation and external validation were conducted. For internal validation, learning (130 samples) and verification (150 samples) were performed with 280 data, including PICC among Chest X-ray (CXR) images taken at our institution. External validation was conducted using a public dataset called the Royal Australian and New Zealand College of Radiologists (RANZCR), and training (130 samples) and validation (150 samples) were performed with 280 data of CXR images, including PICC, which has the same number as that for internal validation. The performance was compared by root mean squared error (RMSE) and the ratio of single fragment images (RatioSFI) (i.e., the rate at which model predicts PICC as multiple sub-lines) according to whether or not MFCN is applied to seven conventional models (i.e., FCDN, UNET, AUNET, TUNET, FCDN-HT, UNET-ELL, and UNET-RPN). In internal validation, when MFCN was applied to the existing single model, MFP was improved by an average of 45 %. The RMSE improved over 63% from an average of 27.54 mm (17.16 to 35.80 mm) to 9.77 mm (9.11 to 10.98 mm). In external validation, when MFCN was applied, the MFP incidence rate decreased by an average of 32% and the RMSE decreased by an average of 65%. Therefore, by applying the proposed MFCN, we observed the consistent detection performance improvement of PICC tip location compared to the existing model. Conclusion:In this study, we applied the proposed technique to the existing technique and demonstrated that it provides high tip detection performance, proving its high versatility and superiority. Therefore, we believe, in countries and regions where radiologists are scarce, that the proposed DL approach will be able to effectively detect PICC misposition on behalf of radiologists.

PSMA-PET-guided dose-escalated volumetric arc therapy for newly diagnosed lymph node-positive prostate cancer: 5 Year outcomes following the FROGG and EviQ node-positive guidelines.

The Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology Genitourinary Group (FROGG) guidelines and online EviQ protocols incorporate prostate-specific membrane antigen (PSMA) positron emission tomography (PET)-guided dose-escalated intensity-modulated radiation therapy (DE-IMRT) for newly diagnosed lymph node (LN) positive prostate cancer. We evaluated late toxicity and efficacy outcomes following the FROGG and EviQ approach. Patients with LN-positive-only metastases on PSMA-PET imaging were offered curative therapy with 3 months neoadjuvant androgen deprivation therapy (ADT) followed by DE-IMRT and 3 years adjuvant ADT. IMRT was delivered via volumetric arc therapy (VMAT). We aimed to deliver 81 Gy in 45 fractions (Fx) to the prostate and PET-positive LNs, and 60 Gy in 45 Fx to elective pelvic nodes, contoured using the PIVOTAL guidelines. Forty-five patients were included. The median number of PET-positive nodes boosted was 2 (range 1-6) and median boost volume 1.16 cc (range 0.15-4.14). Seventeen (38%) patients had PET-positive nodes outside of PIVOTAL contouring guidelines. With 60 months median follow-up, disease-free, metastasis-free, prostate cancer-specific and overall survival were 88.1%, 95.3%, 100% and 91.5%. There were no in-field nodal failures. Late grade 1, 2 and 3 gastrointestinal toxicities occurred in 4%, 2% and 0% of patients, and genitourinary toxicity in 18%, 18% and 4%. Lower limb grade 2 lymphoedema occurred in three patients (7%). Outcomes following FROGG guidelines and EviQ are promising, with high long-term disease control and low toxicity. Contouring guidelines require modification due to the high rate of PET-positive nodes demonstrated beyond recommended coverage.

Does breast biopsy marker cost and availability influence utilisation in radiology practice?

Breast Screen Australia and Breast Screen Aotearoa guidelines recommend breast biopsy marker (BBM) use in indicated patients. This study aims to evaluate whether BBM cost and availability impacts BBM utilisation. An online survey was disseminated to radiologists who identified'breast imaging' as their area of practice in the Royal Australian and NewZealand College of Radiologists (RANZCR) customer relationship management system. Survey questions addressed participant demographics and factors relating to BBM use. Most (92%, 245/266) participants report that BBMs are routinely available at their place of practice. Those employed in private practice were more likely to report that BBMs are not routinely available. 22% (58/266) of radiologists report that BBM cost influences choice of biopsy type (core biopsy vs fine needle aspirate), this finding was more frequent in those employed in private practice. 47% of respondents report that the cost of BBMs is passed on to the patient, with all these respondents employed in a private or mixed private/public setting. Half the respondents (133/266) reported that their decision to use BBMs would be influenced by the availability of insurance coverage to cover BBM costs. Results suggest that BBM cost and availability influences both choice of biopsy type (core biopsy vs FNA) and choice to use a BBM. Radiologists working in private practice or mixed private/public practice report that BBMs are less likely to be available for use, and that BBM cost is more likely passed to the patient; possibly disadvantaging patients who present to private radiology providers with imaging findings or conditions that would indicate BBM insertion under current national guidelines.

Female representation in radiology subspecialty interest groups in Australia and New Zealand.

Women comprise 31% of the Australian and New Zealand radiology workforce, and 35% of radiology trainees. To date, there has been no study of female representation within clinical radiology subspecialties in Australia and New Zealand. This study aims to quantify female representation among the clinical radiology subspecialty interest groups (SIGs) in Australia and New Zealand. A list of SIGs was compiled using the Royal Australian and New Zealand College of Radiologists (RANZCR) website. The executive of each SIG or the RANZCR Standards committee was contacted with a request to provide the number of female versus male members for each subspecialty group and their executive. Six out of 10 SIGs reported a low proportion of female members; this was most pronounced for IRSA (interventional radiology; 7% women), AMSIG (musculoskeletal imaging; 13% women) and CCINR (interventional neuroradiology; 13% women). Female radiologists accounted for >50% of membership in four SIGs: OGSIG (obstetrics/gynaecology imaging; 87% women), BIG (breast imaging; 73% women), ARGANZ (abdominal imaging; 69% women) and ANZSTR (thoracic imaging; 69% women). Female executive representation ranged from 0% (IRSA (interventional radiology) and ANZSNR (neuroradiology)) to 100% (OGSIG (obstetrics/gynaecology imaging)). Female representation within the membership and representative leadership of some SIGs is well below parity and active initiatives to improve female representation should be considered.

Navigating the glass labyrinth: Addressing gender diversity in Australian and New Zealand representative radiology leadership.

Gender inequity among representative leadership in Clinical Radiology is a global issue, with the lack of gender diversity in leadership even more marked when compared to workforce representation. Women leaders face a disproportionate magnitude of seen and unseen challenges to leadership engagement and progression when compared to men (a 'glass labyrinth'), which is likely contributing to this discrepancy. The aim of the study was to examine and reflect on the state of gender diversity in representative leadership within the RANZCR Faculty of Clinical Radiology. Review of the 2021 Royal Australian and New Zealand College of Radiologists (RANZCR) Board, Clinical Radiology Faculty Council and local Branch Committees with regard to the numbers of women and men in representative roles. In 2021, the RANZCR Board had no women representatives from Clinical Radiology (one woman representative from Radiation Oncology). 1/5 Clinical Radiology Faculty Council office Bearers were women. Local Branch Committees had 16.3% (13/80) women representatives. Three branches (the NSW, ACT and Victorian branches) had no women representatives. There were no women Committee Chairs, Branch Secretaries or Treasurers, with 2/7 Branch Education Officers women. The issues underpinning gender inequality in representative leadership are complex and diverse, resulting in disproportionate losses of women radiologists along the leadership pathway compared to men. Unconscious biases, including assumptions of inferior capability, capacity and credibility among women radiologist leaders, create unique challenges at organisational, institutional and personal levels. Change cannot be achieved by passive momentum alone: concrete initiatives and active engagement are required. To improve leadership diversity, strategies must be multifaceted and supported at an organisational level.

Evaluating breast biopsy practice and breast biopsy marker utilisation in the clinical setting.

Breast Screen Australia and Breast Screen Aotearoa guidelines recommend breast biopsy marker (BBM) use in indicated patients. This study aims to evaluate breast biopsy practice and BBM utilisation by modality. An online survey was disseminated to radiologists who identified 'breast imaging' as their area of practice in the Royal Australian and New Zealand College of Radiologists (RANZCR) customer relationship management system. Survey questions addressed participant demographics and factors relating to BBM use. Most respondents (72%) place between 1 and 4 BBMs per week. Almost all (99%) respondents perform ultrasound-guided biopsy of the breast or axillary nodes, with 85% performing stereotactic or tomosynthesis-guided breast biopsy and 27% performing MRI-guided breast biopsy. BBM utilisation differs by modality, with 97% respondents always placing a BBM post-MRI-guided breast biopsy, 50% always placing a BBM post-stereotactic-guided biopsy and 3% always placing a BBM post-ultrasound-guided breast biopsy. Almost all radiologists perform breast biopsy using ultrasound, stereotactic/tomosynthesis or MRI guidance. BBM utilisation varies by modality, with 72% of respondents placing between 1 and 4 clips per week. Reasons for placing or not placing BBM aligned with prior studies. This is the first study to evaluate the number of breast biopsies performed by radiologists on a weekly or monthly basis, providing a useful platform for comparison in the local setting.

Untangling the gender pay gap in radiation oncology.

Untangling the gender pay gap in radiation oncology.

Impact of Radiation Oncology Research Grants Awarded by the Royal Australian and New Zealand College of Radiologists Using the “Payback Framework”

Radiation Oncology (RO) societies which provide research grants from membership dues or charitable donations owe it to their funders to assess value for money, yet very little has been published on the outcomes of such grants. A previous Royal Australian and New Zealand College of Radiologists (RANZCR) survey confirmed significant academic impact from their RO grants. The purpose of this work was to update and broaden the survey using, to our knowledge for the first time in the RO literature, the "Payback Framework", a model employed extensively elsewhere in health research. Between funding years 2010 and 2020, 58 grants were awarded to 41 individuals, median 1 per individual (range 1-4), median AUD $20,000 (US $14,000) per grant (range AUD $5,000-$26,000). Five recipients of failed projects were excluded. The remaining 36 individuals, receiving 51 grants totaling US $660,000, were eligible for a voluntary on-line survey (SurveyMonkey) assessing project outcomes. Data collection and checking extended to 31 January 2022. The survey response rate was 100% (36/36). Objective academic outcomes attributable, at least in part, to the grants included 103 conference presentations, 59 publications, 21 prizes and 18 higher degrees. 27 consequential grants totaled US $4.5M, a 6.8-fold return on investment. Broader impacts included perceived contributions to guideline development (53% of recipients), changes in clinical decision making (72%) or radiotherapy techniques (61%), enabling of subsequent research (56%), development of novel research tools (19%) and recruitment of research assistant(s) (19%). The three most important factors reported to contribute to project success were the RO grant (83%), networking (81%) and local infrastructure (81%). The grant program was rated very positively. This updated RANZCR survey has confirmed continuing significant academic output from its RO research grants but has also revealed broader benefits using the Payback Framework. We would encourage other RO societies to report their grant outcomes using a similar framework.

Survey of brachytherapy training experience among radiation oncology trainees and fellows in the Royal Australian and New Zealand College of Radiologists (RANZCR).

To evaluate brachytherapy training experience among trainees and fellows trained through the Royal Australian and New Zealand College of Radiologists (RANZCR). All current trainees and fellows (who obtained fellowship from 2015 onwards) were sent an online anonymous questionnaire on various aspects of brachytherapy training, including number of cases observed/ performed, opinions on brachytherapy assessment during training, barriers to brachytherapy training and future role of brachytherapy. The overall survey response rate was 24% (40/161 trainees, 30/126 fellows). Of the 70 respondents, 50 (71%), 38 (54%) and 43 (61%) reported to have received formal brachytherapy teaching from radiation oncologists, radiation therapists and medical physicists respectively. Most respondents had exposure to gynaecology brachytherapy - two-thirds of trainees and all fellows have performed at least one gynaecology brachytherapy procedure. Prostate brachytherapy exposure was more limited - by the end of training, 27% and 13% of fellows did not have exposure to LDR and HDR prostate brachytherapy. More than two-thirds indicated there should be a minimum number of brachytherapy case requirements during training, and half indicated that trainees should be involved in ≥6 gynaecology brachytherapy procedures. Barriers affecting training include lack of caseload (70%) and perceived decreasing role of brachytherapy (66%). Forty-three percent of respondents were concerned about the decline in brachytherapy utilisation. This is the first survey on brachytherapy training experience among RANZCR trainees and fellows. It highlighted limited brachytherapy exposure during RANZCR training, and the need to revisit brachytherapy training requirement in the current training programme, along with long-term brachytherapy workforce planning.

The changing radiation oncology landscape in New Zealand.

This paper outlines the New Zealand (NZ) responses to the biennial facilities surveys of The Royal Australian and New Zealand College of Radiologists (RANZCR), Faculty of Radiation Oncology (FRO) from 2011 to 2019. The facilities survey is conducted by the FRO Economics and Workforce Committee (FROEWC) and focuses on equipment, treatment activities and staffing. The number of facilities increased by two to 10, both in the private sector. The total number of linear accelerators (linacs) increased by four; one in public and three in private. The majority of linacs were over 8 years old (62.5%). Treatment courses have increased by 19% and fraction numbers by 13.7%. Courses per linac have remained relatively constant. There was growth in IMRT, orthovoltage, high dose rate brachytherapy and paediatric treatments. There was a slow increase in number of radiation oncologists and trainees. The number of radiation therapists was unchanged with a 20% increase in treatment courses per radiation therapist. Physicist numbers have increased but 61.4% of physicists are overseas-trained and vacancies persist. The survey results indicate a rapidly changing radiation oncology landscape in NZ between 2011 and 2019. The challenges of increases in cancer numbers, treatment courses and complexity of treatments and a need to focus on quality standards against a set of minimal increase in machine numbers, ageing machines, static or slowly increasing staffing numbers and heavy reliance on overseas staffing require a national review of radiation oncology services to ensure a sustainable future.

Structured Reporting in Radiology: what do radiologists think and does RANZCR have a role in implementation.

The Royal Australian and New Zealand College of Radiologists (RANZCR) established a working group to explore how the college should engage with the future development of structured radiology reporting in our region, particularly in the context of a broader move to digital healthcare. Phase 1 of the project surveyed college members and affiliated interest groups about how they are using structured reporting currently and might like it to evolve. Member and interest group questionnaires were based on previously published studies and posted to the Survey Monkey platform. Responses were analysed descriptively. There were 114 members and 58 affiliated group responses. There is clearest support for RANZCR developing guidelines around structured report quality, for improvements in report content, particularly tailoring to clinical context and study parameters, and for improved integration of structured reporting and RIS/PACS systems. Phase 2 of the structured reporting working group project will aim to develop guidelines for structured report quality and processes through which RANZCR can implement them.

The 'Sic Vos non Vobis' of Interventional Radiology - Rebranding and modernising the Interventional Specialities of Radiology in Australia and New Zealand.

The 'Sic Vos non Vobis' of Interventional Radiology - Rebranding and modernising the Interventional Specialities of Radiology in Australia and New Zealand.

The impact of radiation therapist-led structured peer review meetings on compliance to Radiation Oncology Practice Standards.

Regular tumour-specific peer review meetings (TPRMs) were established by our group during 2016. A dedicated Quality Assurance Radiation Therapist (QART) was employed in 2018 to co-ordinate the meetings and for each patient, complete the Peer Review Audit Tool (PRAT) of the Royal Australian and New Zealand College of Radiologists (RANZCR). The aim of the current quality assurance study was to investigate the impact of the TPRMs and appointment of the QART on compliance to relevant RANZCR Radiation Oncology Practice Standards (ROPS). Tumour-specific peer review meetings for eight tumour sites were assessed across our group's three hospitals from January 2017 to December 2019. Data from meetings were collected using the PRAT or from paper-based minutes and assessed against four ROPS (ROPS 3, 4, 8 and 9). Compliance with each of the four standards was measured by presence of the required documentation and presentation at TPRM, as recorded by the PRAT. There was an increase in the overall number of peer review cases audited from 173 in the 2017 calendar year to 469 in 2018 and 619 in 2019, representing 7%, 18% and 22% of all treatment courses started during these years, respectively. Staging was the most incompletely documented item across all years for audited patients. The request for radiation treatment plan modifications increased year-on-year: modifications were requested for 5% of plans in 2017 (8/172), 18% in 2018 (81/452) and 19% (119/619) in 2019. This study has shown that an increase in the number of cases for peer-review audit corresponded to the QART-facilitated TPRMs. Application of the PRAT has identified radiation treatment plan modifications that would otherwise go undetected and without opportunity to improve the quality of patients' treatment or avoid harm.

TB MASQUERADING AS LUNG MALIGNANCY

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Radiological manifestations of pulmonary tuberculosis (TB) tend to be heterogeneous. [1] In this report, we highlight one such atypical manifestation that posed a diagnostic dilemma and necessitated a biopsy. CASE PRESENTATION: A 67 year old male with no known medical illness presented with a 3 month history of dry cough to a hospital in southern India. The cough was associated with night sweats, appetite loss, fatigue and intermittent fever. He reported no episodes of breathlessness or hemoptysis. He denied any sick contacts, was a non smoker and had no family history of malignancy. On examination, his vital signs were stable and he was not in respiratory distress. There were no palpable lymph nodes Cardiopulmonary examination revealed no abnormal findings. Blood examination showed hemoglobin of 11.9 g/dL and ESR of 54 mm/hr, with normal blood cell counts. Chest radiograph revealed opacities in the right middle zone. A high resolution computed tomography (HRCT) of the thorax was done, and findings raised suspicion of neoplastic changes.HRCT revealed a patchy consolidation with necrotic areas and irregular margins in the superior segment of the right lower lobe, extending up to the costal pleura. Multiple ground glass opacities with nodular thickening of the oblique fissure were noted in the right lower lobe as well. Due to their typical appearance, these features were attributed to a neoplastic etiology. Interestingly, a homogenously enhancing lobulated mass was noted in the prevascular compartment of the superior mediastinum. It was also seen abutting the SVC posteriorly, where it caused a focal compression on the left brachiocephalic vein. This was thought to be a lymph nodal mass. Computed Tomography (CT) guided biopsy of the right lower lobe lesion was conducted. Histopathology revealed granulomatous inflammation with epitheloid and giant cells surrounding areas of caseous necrosis. The patient was started on Anti Tuberculous Treatment and responded well. Follow up imaging six months later revealed fibrotic changes with calcified granulomas. DISCUSSION: Clinical and radiological manifestations of TB are heterogeneous and include a variety of benign and malignant diseases. [1] Diagnostic dilemmas can delay appropriate treatment, favoring Mycobacterium tuberculosis transmission. Up to one third of TB cases have an atypical appearance on radiograph or CT imaging. [2] Thus, despite demographic features and symptoms typical of TB, our patient's HRCT posed a diagnostic dilemma. The consolidation with necrotic areas and superior mediastinal mass raised suspicion for lung malignancy. CONCLUSIONS: An extensive workup is required to differentiate TB from lung malignancy. HRCT and biopsy can be critical. Comprehensive awareness and knowledge of atypical TB manifestations can help in early diagnosis and start of therapy, increasing the probability of clinical and microbiological cure. REFERENCE #1: Collu C, Fois A, Crivelli P, Tidore G, Fozza C, Sotgiu G, Pirina P. A case-report of a pulmonary tuberculosis with lymphadenopathy mimicking a lymphoma. Int J Infect Dis. 2018 May;70:38-41. doi: 10.1016/j.ijid.2018.02.011. Epub 2018 Mar 1. PMID: 29477363. REFERENCE #2: Jeon KN, Bae K, Park MJ. Atypical radiologic appearances of pulmonarytuberculosis in non-HIV adult patients. In Proceedings: The RoyalAustralian and New Zealand College of Radiologists (RANZCR) 63rdAnnual Scientific Meeting, and Asian Oceanian Congress of Radiology(AOCR), 30 August–2 September 2012, Sydney, Australia;http://dx.doi.org/10.1594/ranzcraocr2012/R-0200 DISCLOSURES: No relevant relationships by Arup Ganguly, source=Web Response No relevant relationships by Vinayak Jain, source=Web Response No relevant relationships by Adithya Shetty, source=Web Response

The Royal Australian and New Zealand College of Radiologists (RANZCR), 71st Virtual Annual Scientific Meeting, 16-19 September 2021.

The Royal Australian and New Zealand College of Radiologists (RANZCR), 71st Virtual Annual Scientific Meeting, 16-19 September 2021.

Ethics and standards in the use of artificial intelligence in medicine on behalf of the Royal Australian and New Zealand College of Radiologists.

IntroductionThe Royal Australian and New Zealand College of Radiologists (RANZCR) led the medical community in Australia and New Zealand in considering the impact of machine learning and artificial intelligence (AI) in health care. RANZCR identified that medical leadership was largely absent from these discussions, with a notable absence of activity from governments in the Australasian region up to 2019. The clinical radiology and radiation oncology sectors were considered ripe for the adoption of AI, and this raised a range of concerns about how to ensure the ethical application of AI and to guide its safe and appropriate use in our two specialties.MethodsRANZCR’s Artificial Intelligence Committee undertook a landscape review in 2019 anddetermined that AI within clinical radiology and radiation oncology had the potential to grow rapidly and significantly impact the professions. In order to address this, RANZCR drafted ethical principles on the use of AI and standards to guide deployment and engaged in extensive stakeholder consultation to ensure a range of perspectives were received and considered.ResultsRANZCR published two key bodies of work: The Ethical Principles of Artificial Intelligence in Medicine, and the Standards of Practice for Artificial Intelligence in Clinical Radiology.ConclusionRANZCR’s publications in this area have established a solid foundation to prepare for the application of AI, however more work is needed. We will continue to assess the evolution of AI and ML within our professions, strive to guide the upskilling of clinical radiologists and radiation oncologists, advocate for appropriate regulation and produce guidance to ensure that patient care is delivered safely.

Implementation of 3D conformal radiotherapy technology at the National Cancer Centre Mongolia: A successful Asia-Pacific collaborative initiative.

Mongolia has a population of 3.3 million and is classified by the WHO as a lower middle-income country. Cancer is now a major public health issue and one of the leading causes of mortality. Within the framework of an existing national cancer control plan, the National Cancer Centre of Mongolia (NCCM) aimed to implement 3D conformal radiation planning and linac-based treatment delivery. In 2018, anopportunityarose for collaboration between the Mongolia Society for Radiation Oncology (MOSTRO), the National Cancer Centre Mongolia (NCCM), the Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) of the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Asia-Pacific Special Interest Group (APSIG) of the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) and radiation therapists (RTTs) from a range of Australian centres. We describe here the results to date of this collaboration. Despite a number of significant technical and practical barriers, successful linac commissioning was achieved in 2019. Key factors for success included a leadership receptive to change management, stable bureaucracy and health systems, as well as a synchronised effort, regional cooperation and mentorship. Future directions for ongoing collaborative efforts include a continued focus on education, practical training in radiotherapy planning and delivery and postgraduate education initiatives. Radiotherapy safety and quality assurance remain an ongoing priority, particularly as technological advances are sequentially implemented.

Adjuvant radiotherapy for endometrial cancer with cervical stromal involvement: A patterns of practice survey in Australia and New Zealand.

The purpose of this study is to describe the patterns of practice in Australia and New Zealand for post-operative radiotherapy in endometrial cancer with cervical stromal involvement. A ten-item survey including five clinical case scenarios in endometrial cancer with cervical stromal invasion was emailed to Royal Australian and New Zealand College of Radiologists (RANZCR) radiation oncologists in 2018. Responses were analysed to determine relative frequency distributions and preferred adjuvant treatment modalities for the clinical case scenarios. A total of 65 respondents initiated the survey with 27 respondents treating more than 11 endometrial cancer cases annually. Only 31 respondents answered all five clinical case scenarios. Preferred adjuvant radiotherapy modalities varied for the Stage II cases between vault brachytherapy (VB), pelvic external beam radiotherapy (EBRT) or a combination. For the stage IIIA and IIIC1 cases, the majority recommended pelvic EBRT with or without VB boost (79% and 77%), and of these, most combined with chemotherapy (61% and 88%). For 4 of the 5 case scenarios, when pelvic EBRT was offered, most recommended a VB boost. This patterns of practice survey suggests variability in adjuvant radiotherapy recommendations in endometrial cancer with cervical involvement, particularly in cases where there is lack of randomised data and discrepancies in consensus guidelines.

Trends and applicant characteristics in New Zealand: Radiation oncology versus radiology

Introduction: Previous research has projected future shortages in radiation oncologistsin Australia. Anecdotal evidence also suggests a similar pattern in New Zealand, howevershortages in the radiology workforce have not been forecast to date. The present study aimed to examine the trends in applications for radiation oncology and radiology positions in New Zealand.Methods: Data were collected on vocational training applicants and senior medical officer (SMO, consultant) positions from 2009 to 2016. Data were obtained from publicly-available data on the New Zealand Ministry of Health and Royal Australian and New Zealand College of Radiologists (RANZCR) websites.Results: Compared with radiation oncology, applications to radiology significantly outnumbered the available positions—a trend that escalated between 2009 and 2016. In addition, the radiation oncology SMO workforce in New Zealand attracted progressively fewer local graduates (i.e., more international medical graduates) compared with radiology over the period studied.Conclusions: This is the first study to shed light on trends in applications to the two specialties overseen by RANZCR in New Zealand. Future efforts should focus on attracting more trainees to radiation oncology and addressing factors underlying the apparent discrepancies between the two specialties, as well as the mental health and wellbeing of trainees.