Gamma gazette digital edition

2017 JULY EDITION • ISSUE 21

47th ANNUAL SCIENTIFIC MEETING OF THE AUSTRALIAN & NEW ZEALAND SOCIETY OF NUCLEAR MEDICINE 12th CONGRESS OF THE WORLD FEDERATION OF NUCLEAR MEDICINE & BIOLOGY (WFNMB) ANSTO/ANZSNM RESEARCH GRANT 2018

The official publication of the Australian and New Zealand Society of Nuclear Medicine

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IN THIS ISSUE Contents

Page

WELCOME

3

OFFICE BEARERS

4

PRESIDENT’S REPORT

5

BRANCH NEWS

7

SIG NEWS

11

AUSTRALIAN NATIONAL RADIATION DOSE REGISTER

16

WELCOME TO CORPORATE SPONSORS

18

COMMUNITY NEWS

19

47th ASM 2017 HOBART

21

HONORARY LIFE MEMBERSHIP, BRIAN HUTTON

26

ANSTO/ANZSNM RESEARCH GRANT 2018

27

DIARY DATES

37

WFNMB UPDATE

38

CASE STUDY

39

ARTICLES

41

2016 FINANCIAL REPORT

44

2017 AGM MINUTES

47

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WELCOME Welcome to the next edition of the Gamma Gazette for 2017.

The society has been working with the General Manager to look at what the members want from their membership and the improvements to the CPD content for the Gamma Gazette are certainly a good asset. The committee members of the various branches have been working hard to provide regular branch meetings with good quality educational content which is possible due to the ongoing support of our sponsors. If you have any ideas for branch meetings, please contact the chair/secretary of the branch or the ANZSNM secretariat. Thanks to all committee members who work had to provide the branch meetings for members.

The ANZSNM ASM held in Hobart this year was a great success with high calibre international speakers and local scientific content. A review of the meeting is included in this edition of the GG. We look forward to the WFNMB to be held in conjunction with the ANZSNM ASM in Melbourne April 20th – 24th 2018. The ANZSNM ASM will be held on Friday 20th April and will include all award presentations, SIG meetings and the AGM, there will be no scientific presentations as part of this meeting with the exception of award entrants. Abstract submissions for the WFNMB will open August 2017 and the closing date is much earlier being at the end of November 2017, so start preparing early. All abstracts, following the standard peer review process will be accepted as poster only, there will be no oral scientific presentations as part of the WFNMB. Further information is included in this edition of the GG and members will receive regular eblasts with updated information via the ANZSNM secretariat.

I would like to thank the members of the NSW branch committee for their assistance with preparing the content for this edition of the Gamma Gazette. This will be my last contribution to the NSW branch committee as I am standing down as chair of the group and resigning from the committee.

Thanks to all who have supported me in this role and I look forward to continuing to be involved with the society.

JULY 2017 / Issue 21 Editorial & advertising copy Andrew St. John, General Manager ANZSNM Secretariat PO Box 6178, Vermont South, VIC 3133 1300 330 402 (03) 8677 2970 secretariat@anzsnm.org.au

Design & Production Ester Gomez, Creative Director Enovate Marketing ester@enovatemarketing.com.au

Submissions Scientific submissions on all aspects of nuclear medicine are encouraged and should be forwarded to the Secretariat (instructions for authors published at www.anzsnm.org.au).

Letters to the Editor or points of view for discussion are also welcome.

If original or public domain articles are found and considered to be of general interest to the membership, then they should be recommended to the Editor who may seek permission to reprint.

The ANZSNM Gamma Gazette is published three times a year: March, July and November.

Deadlines for each issue of the journal are the first of each month prior to publishing.

Disclaimer The contents in this issue have been compiled by the NSW branch.

The views expressed in any signed article in the journal do not necessarily represent those of the Society. The individual rights of all authors are acknowledged. Š 2017 The Australian and New Zealand Society of Nuclear Medicine Inc. Copyright is transferred to the Australian and New Zealand Society of Nuclear Medicine once an article/paper has been published in the ANZSNM Gamma Gazette (except where it is reprinted from another publication).

Chair NSW Branch

OFFICE BEARERS President Vice President Past President Treasurer Committee

Prof Dale Bailey (NSW) | dale.bailey@sydney.edu.au A/Prof Roslyn Francis (WA) | roslyn.francis@uwa.edu.au Prof Vijay Kumar (IRC) | vijay.kumar@health.nsw.gov.au Mr Dominic Mensforth (SA) | dominic.mensforth@drjones.com.au Ms Marcia Wood (TSIG) | marcia.wood@austin.org.au Dr Divesh Kumar (RRS) | divesh.kumar@health.wa.gov.au Ms Victoria Brooks (NZ) | victoria.brooks@fulford.co.nz Dr Paul Roach (AANMS) | paul.roach@sydney.edu.au Mr David Thomas (VIC/TAS) | david.thomas@austin.org.au Dr Daniel Badger (SA) | daniel.badger@health.sa.gov.au Ms Clare Radley (NZ) | c.e.radley@gmail.com Mr Nicholas Ingold (ACT) | nick@garranmedicalimaging.com.au

General Manager & Secretariat

Dr Andrew St John and Drajon Management Pty Ltd

All Correspondence

ANZSNM Secretariat PO Box 6178, Vermont South, Victoria 3133 Tel: 1300 330 402 | Fax: (03) 8677 2970 Email: secretariat@anzsnm.org.au

Branch Secretaries Australian Capital Territory New South Wales Queensland South Australia Victoria/Tasmania Western Australia New Zealand

Mrs Rachel Prior | rachael1285@gmail.com Vacant Ms Leica Baker and Ms Karen Lindsay | qldbranchsecretaryanzsnm@gmail.com Ms Dai Nguyen | dai.nguyen@sa.gov.au Ms Jessica Welch | jessica.welch@austin.org.au Ms Georgina Santich | wabranchsecretary@hotmail.com Ms Pru Burns | pru.burns@prg.co.nz

Special Interest Groups Technologists Radiopharmaceutical/Science Physics/Computer Science Technical Standards Committee Scientific Advisory Panel International Relations Committee Nurse Member Liaison

Chairperson: Dr Elizabeth Bailey | elizabeth.bailey2@health.nsw.gov.au Chairperson: Dr Divesh Kumar | divesh.kumar@health.wa.gov.au Chairperson: Dr Daniel Badger | daniel.badger@health.sa.gov.au Chairperson: Dr Darin O’Keeffe | darin.okeeffe@cdhb.govt.nz Chairperson: Prof Dale Bailey | dale.bailey@sydney.edu.au Chairperson: Professor Andrew Scott | andrew.scott@ludwig.edu.au Mr Erwin Lupango | erwin.lupango@sessiahs.health.nsw.gov.au

Reporting of Abnormal Behaviour of Radiopharmaceuticals The Society maintains a register of reports of abnormal behaviour of radiopharmaceuticals. Abnormal behaviour can be reported either by telephone fax or e-mail, or in writing to: ARPANSA 619 Lower Plenty Road Yallambie VIC 3085 Tel: (03) 9433 2211 Fax: (03) 9432 1835

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Mr J. Gordon Chan Department of Nuclear Medicine, Austin & Repatriation Medical Centre, Heidelberg VIC 3084 Tel: (03) 9496 3336 Fax: (03) 9457 6605 email: gordon.chan@petnm.unimelb.edu.au

PRESIDENT’S MESSAGE

ANZSNM at 50: still a Work-in-Progress

T

he first meeting of radioisotope users in medicine and biology in Australia was held in November 1968 at the Prince of Wales Hospital, Sydney, where it was resolved to establish a society that would “bring together all of those interested in the use of radioisotopes in medicine and biology” . The Australian Society of Nuclear Medicine came into being the following May. We are therefore on the cusp of the 50th anniversary of the birth of the ANZSNM.

Golden anniversaries are significant events. For the Society it coincides with hosting the 12th Congress of the World Federation of Nuclear Medicine and Biology - the “Olympics” of nuclear medicine. The 50th anniversary also serves as a marker for us to consider what the shape of the society will be over the next 50 years. The founding fathers started the Society with a strong sense of fraternity, demonstrated by the inclusion of all disciplines within nuclear medicine in the membership. In the first 10 years of the Society the presidency was shared equally between nuclear medicine physicians and scientists. Even today the inclusion of all practitioners in a single body remains an unusual model for a professional organisation. It is my belief that this is something that should be embraced and promoted fully, as we will be a more coherent, complete and effective professional group if we have the inclusion of all disciplines represented.

The state-based model of the Society’s organisational structure has demonstrably served it well in the past, by surviving 50 years. However, the changing nature of Australian society, work/life balance, professional accreditation/registration, technology and how we interact has changed enormously since 1968. It is time, therefore, to rethink what the Society should exist for in the future.

A small informal group have been looking at the closer integration of the Society with the physicians/radiologists’ professional body - the Australasian Association of Nuclear Medicine Specialists (AANMS). Unifying the two organisations would make sense on numerous levels: representation by a single organisation, a single point of interaction for government and regulators, collegiality, the bringing together of the medical and physical sciences with the technology that we exploit, efficiencies in the management of the two bodies and so on. More importantly, it would strengthen both existing organisations and return to the original intentions of the Society’s founders, where all of the disciplines in nuclear medicine coexist within a single organisation.

The process of exploring potential future models for a unified body is underway. It may well be time for the state-based, metro-centric organisational structure of the Society to be retired. As pointed out to me recently, this model was conceived at a time when nuclear medicine only existed in the big cities. But today we need to ensure that the needs of all our colleagues are met. Increasingly, more of us will participate in activities related to the Society and our own continuing professional development using online (NBN?) access in the future. We can no longer neglect supporting nuclear medicine practitioners in rural and regional Australia, which has seen other organisations created to fill the void (e.g., RAINS – the Rural Alliance in Nuclear Scintigraphy). It would be the intention for any unified nuclear medicine body to incorporate these other groups as well, as we will all be

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stronger for it.

The alternate would be to disband the Society altogether. The medical specialists, scientists and technologists all have other professional organisations now that they could look to for continuing professional and educational support. This would inevitably lead to a situation where none of these multiple disciplines would ever come together for scientific, technological and clinical discussions.

I think that such a situation would be disastrous and I believe we must do all within our powers to prevent this situation ever eventuating. The future for a unified and tech-savvy, professionally run nuclear medicine organisation in Australia and New Zealand is positive and, building on the World Congress in 2018, could see such an organisation becoming the main body meeting the needs of nuclear medicine professionals beyond our national borders and into our region, where the other two large nuclear medicine associations (EANM and SNMMI) currently do not focus.

We can no longer neglect supporting nuclear medicine practitioners in rural and regional Australia.

It would be the intention for any unified nuclear medicine body to incorporate these other groups as well, as we will all be stronger for it.

Now is an important time for the Society to reevaluate its future. While we can continue as we are this may not be the best option, particularly given concerns about relevance for technologists since the advent of national registration by AHPRA. In an ideal world, Australia and New Zealand would be represent by a single unified professional society representing medical specialists, scientists, technologists and nurses.

We should all now be considering if this is the route that we take. I encourage you to think, discuss and debate to help shape the Society’s role in the 21st century.

Please feel free to discuss with me or any member of the Federal Council.

President AIMS AND OBJECTIVES OF THE AUSTRALIAN AND NEW ZEALAND SOCIETY OF NUCLEAR MEDICINE 1. PROMOTE: 1.

2.

3.

4.

5.

the advancement of clinical practice of nuclear medicine in Australia and New Zealand; research in nuclear medicine; public education regarding the principles and applications of nuclear medicine techniques in medicine and biology at national and regional levels; co-operation between organisations and individuals interested in nuclear medicine; and the training of persons in all facets of nuclear medicine.

2. PROVIDE OPPORTUNITIES FOR COLLECTIVE DISCUSSION ON ALL OR ANY ASPECT OF NUCLEAR MEDICINE THROUGH STANDING COMMITTEES AND SPECIAL INTEREST GROUPS: 1.

2.

The Technical Standards Committee sets minimum standards and develops quality control procedures for nuclear medicine instrumentation in Australia and New Zealand.

The Technologists Special Interest Group. With the introduction of National Registration for Nuclear Medicine Technologists / Scientists as of 1st July 2012, the future role of the Accreditation Board was reviewed and federal council made a decision to disband the current Accreditation Board and re-allocate ongoing responsibilities to the ANZSNM – Technology Special Interest Group (TSIG). The PDY and mentor program, CPD program, department accreditation and the overseas qualification exam are now managed by subcommittees of the TSIG.

2) The Radiopharmaceutical Science SIG and a Physics SIG that maintain standards of practice for their particular speciality and provide a forum for development in Australia and New Zealand.

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BRANCH NEWS Australian Capital Territory Hi to all from chilly Canberra. The ACT branch held a great meeting in March to introduce the new committee of myself as Branch Chair, Rachael Prior as Secretary/Treasurer, and Nick Ingold as our Federal Representative. We had a great catch up with representatives from all 5 NM providers in the ACT, and said a sad farewell to Chris McLaren who retired at the end of last year. Chris has been a huge influence not just for the ACT and Canberra Hospital, but across the country, and we greatly miss his experience and wisdom. Chris was kind enough to give us one last presentation on Radiation in the Environment, in his unique style, which was appreciated by all present.

A second branch meeting will be held in the warmer months.

Maree Wright, ACT Branch Chair

Queensland Welcome to 2017 from our new committee in Queensland. As the new QLD Branch Chairperson, I would like to introduce myself for what we hope will be a promising year for the ANZSNM and Nuclear Medicine. I am a Nuclear Medicine Scientist at Royal Brisbane and Women’s Hospital and also the current State-wide Educator for QLD Health Nuclear Medicine. Before my move to Brisbane in 2014, I worked at Wollongong Hospital and served of a number of committees, namely the President of the NSWSNMS. I am looking forward to this new role.

At our QLD Branch AGM in November 2016, we were unfortunate to lose our experienced committee who have done a phenomenal job over the last few years. I would like to take this opportunity to thank the committee for their work and high standard of meetings. Resultantly we have a brand new committee consisting of Lecia Baker and Karen Lindsay, both from RBWH (CoSecretaries) and Karen Eccles from TPCH (Treasurer). Our new committee is eagerly awaiting the opportunity to follow in some big footsteps and we are excited about the ideas and opportunities we hope to bring to our members. The AGM was also the QLD Branch Radpharm Award which brought a high level of competition; the winner was Judy Doung from Princess Alexandra Hospital, congratulations Judy and we look forward to Tasmania this year.

A warm welcome to our New Graduates starting in Queensland and also other colleagues who have taken up residency in the state, we hope to meet you soon. The new committee and I look forward to the developments of 2017.

Suzanne McGavin, QLD Branch Chair

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BRANCH NEWS Victoria and Tasmania It has been a busy few months for the Vic-Tas branch. A few of our committee members headed “overseas” to the Annual Scientific Meeting in Hobart in April. It was a great chance to catch up with other techs from around Victoria and Tasmania, as well as from around the country.

The modified format of this year’s meeting meant we had to fit a lot in during our 2-3 days, but there was still plenty of time for fun and enjoying the sites of Hobart. It also gave us a good chance to chat with members of the ANZSNM about using the AttendO app to full advantage (as we did during the conference) as well as plans for future sponsorship and support of the branches.

Due to the limited overseas speakers for this conference, we were unable to hold a Pre or Post Conference Symposium session. Instead we hosted a “Neurology Master Class” on Saturday May 20th at the Austin Hospital. This was well attended with 34 participants hearing from 3 speakers: Professor Christopher Rowe on “Nuclear Medicine Imaging in Dementia and Parkinson’s Disease”, Dr Victor Villemagne on “Tau Imaging with PET” and Tia Cummins on “Cognitive Causalities of War: Effects of Traumatic Brain Injury & Post-Traumatic Stress Disorder on Alzheimer’s Disease in Australia War Veterans”.

Plans are also underway for our annual Day Seminar, on Saturday September 16th. We have several exciting speakers organised and look forward to another interesting event.

Kim Jasper, VIC/TAS Branch Chair

South Australia The SA Branch has had two meetings thus far this year with both meetings being very well attended.

The student award for outstanding achievement in the Bachelor of Medical Radiation Science (Nuclear Medicine) degree for 2016 was awarded to Jenna La Dru. We would like to congratulation Jenna again for this achievement.

We have introduced the Attendo App and are encouraging all members to use this app to check in to meetings which will enable them to receive an attendance certificate for CPD purposes.

There has been some very interesting presentations at all meetings so far this year and I hope the second half of the year will be just successful with attendance and willing presenters.

There have been no major issues discussed in SA. The next ANZSNM techs group meeting will be a protocol review on gastric emptying studies. This will be a very interesting topic as departments around SA currently have very different protocols. This will be held at the Women’s and Children’s Hospital on September 6th. I encourage you all to attend.

The next Branch meeting will be held on 26th July at Benson Radiology- Modbury Hospital. I hope to see a large number of you there.

Brittany Martin, SA Branch Chair 8 / gamma GAZETTE / July 2017

BRANCH NEWS Western Australia Since the beginning of the year, the WA Branch has had 3 meetings, both of which have been well attended with great presentations and a few first time speakers joining us. SKG radiology hosted the first meeting of the year, with Dr Peter Robins, Dr Daniel Hubble, Dr Jerry Moschilla, Dr Marcus Asokendaran and Lauren Hurn all presenting a variety of interesting case studies and a presentation about an anatomical abnormality found on V/Q scans.

Our second meeting was held at The Harry Perkins Institute of Medical Research in Nedlands, prior to the ANZSNM Annual Scientific Meeting. The WA Branch was fortunate enough to have Dr Hossein Jadvar, Associate Professor of Radiology and Biomedical Engineering and Director of Radiology Research at the University of Southern California, present to us on his way to Hobart.

Dr Jadvar is also the immediate past President of the SNMMI and his research interests include translational molecular imaging, with a particular current interest in prostate cancer which was the topic for his presentation. It was wonderful to host Dr Jadvar in Perth and his presentation was thoroughly enjoyed by all who attended.

Our third meeting was held in June and was hosted by Royal Perth Hospital. We had a number of excellent and diverse presentations. Thank you to everyone who has taken the time to present to the branch so far this year or who plans to present soon. These meetings are always a valuable source of information and we value your contributions.

The WA Branch Committee has been hard at work organising our annual workshop, to be held on Saturday 5th August. This is always an event highly anticipated by the WA Nuclear Medicine community. We have invited a number of speakers from WA to present at our workshop which will be held this year at Trinity on Hampden Conference Centre in Nedlands and we anticipate a great turnout once again. The program for the workshop will be posted on the ANZSNM website once we have finalised the event details.

We eagerly encourage everyone from both WA and interstate to attend and visit our beautiful city.

Finally, the WA Nuclear Medicine community has been engaging in a couple of extracurricular activities recently with a night out in Subiaco earlier in the year and a night out in the city not so long ago. It’s been fantastic to have so many people join us for these nights and to get to know each other outside of regular branch meetings. We look forward to organising more fun as the year goes on.

Shiphrah Tagore, WA Branch Committee Member

CORRECTIONS TO PREVIOUS EDITION OF GAMMA GAZETTE In the notice of Australia day honours in the March GG, Prof Howman- Giles’ title was printed as Clinical Associate Professor; should have been Clinical Professor Robert Howman-Giles

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BRANCH NEWS New Zealand

As the days are getting shorter and the sky greyer, New Zealanders are looking forward to a fantastic month of rugby with the upcoming Lions tour.

Changes to CPD requirements by the MRTB NMT’s are getting their heads around the newly introduced CPD requirements outlined by the New Zealand Medical Radiation Technologists Board. NMT’s no longer have to belong to an approved CPD program; they can manage their own continuing education. In addition, CPD is now hours based, i.e. there needs to be 60 hours of CPD over a triennium.

Hobart 2017 Scientific Meeting A small contingent of Kiwis “flew” to Hobart in April. The feedback has been excellent, so congratulations to the organising team for putting together another successful meeting. Special mention goes to our NZ speakers (NZ branch Radpharm winner Sharyn Bray, Dr Trevor Fitzjohn, Darin O’Keeffe & Dr Stephen Stowers) for their individual presentations. Many of us are now saving our CPD allowance in anticipation of the WFNMB meeting in Melbourne in 2018. See you all there.

2017 NZ Branch Meeting, 16 & 17 September, WINTEC Hamilton – Changing Dynamics – Core Practice to Targeted Therapies

Plans are well underway for our NZ branch meeting in Hamilton on the 16 & 17 of September. This local meeting is an excellent opportunity for NM staff around NZ to come together to network and learn what is going on around the country.

This year visiting from Australia will be Dale Bailey and Geoffrey Schembri. Saturday night has a “Rocky Horror Picture Show” theme … watch out for those photos in the Gamma Gazette later in the year.

Pru Burns, NZ Branch Secretary

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SIG NEWS Shimadzu Award The winning presentation at the ANZSNM 2017 titled “Aqueous Labelling Method for [18F] Aluminium-Fluoride NOTAUbiquicidin (29-41), an Infection Imaging Probe was by Joseph Ioppolo from SCGH. The SIG appreciates the support of Shimadzu and Mr. John Hewetson, Managing Director of Scientific Division of Shimadzu Australasia in promoting quality radiopharmaceutical research.

Special Interest Group News

Masters of Radiopharmaceutical Science at Macquarie University This program recommenced in 2015, and has been gaining in popularity each year, with more than 10 students enrolling within each calendar year. The course is 2yr, or equivalent, coursework Masters, and also includes a research based component.

Of interest: ▶▶ There are currently 2 final semester students completing their projects at ANSTO Camperdown. ▶▶ Two employed RPS have enrolled in the degree as part-time students.

Andrew Katsifis , Convenor

Accreditation and Certification (and registration) of RPS To provide clarity and information around these terms: ACCREDITATION applies to ▶▶ ‘Accredited departments’ - departments or networks accredited to train. There are currently 5 departments or networks accredited to train. A department or network applies to be accredited before applying for DoH -funded registrar positions, or before appointing registrars. ▶▶ Accredited courses (Masters level) - this has not occurred to date.

▶▶ Completed the TEAProgram - which is described by the Clinical Training Guide (CTG), and which identifies 83 Competencies, arranged into 10 Key Areas (KA). The competencies are further defined by :

ӹӹ Levels, where 1 = Knowledge, 2 = Skills, and 3 = ‘higher order thinking’ (demonstrating judgement, analysis) are incorporated within each KA. ▶▶ Applied as an ‘experienced RPS’ by completing a self-assessment questionnaire from the ACPSEM, followed by an interview with the Certification Panel.

CERTIFICATION applies to RPSS RPS Specialists, and refers to those who have either REGISTRATION refers to those Certified RPSS who apply to be on the ‘list’ or register of Certified RPSS. Jennifer Guille, air, RPS Certification Panel Divesh Kumar, RPS SIG Chair

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SIG NEWS

(Continues)

Restructure of the ANZSNM-TSIG The role and responsibilities of the TSIG has slowly been changing over the past 4 years. Accreditation and the PDY program are now overseen by the MRPB. However, membership of the TSIG and roles of the individual members have remained the same during these significant changes. The major role of the TSIG now relates to CPD, OQA, education, reviewing and responding to policies and procedures from the registration board, and in the sphere of international relations with other technologist groups, and professional associations such as the SNMMI-TS, EANM-TS and AOSNMB. We therefore moved forward with the proposal to restructure and change the way in which the ANZSNM-TSIG was functioning to encourage members to be actively involved with the society and to achieve the objectives outlined above. The formation of working groups with clearly defined objectives will ensure better engagement and opportunities for members to be involved in an area that may be of interest such as CPD, webinairs, organising workshops and engagement with other like-minded professionals. The new organisational chart for the ANZSNMTSIG is shown below and the Terms of Reference for each group can be found on the ANZSNM website (http://www. anzsnm.org.au/member-centre/my-society-matters). A summary of the objectives for each group is defined below including membership of the committee and working groups.

TSIG Committee The TSIG Committee exists to ensure the smooth running of each of the working groups structured beneath it and oversee the activities of these providing both tangible and intangible benefits to the technologist members of the ANZSNM. The committee is tasked with the following responsibilities:

• Ensuring that each of the working groups provides regular, direct reports to the TSIG Committee; • Assist the working groups with setting up activities that are achievable and ensure that appropriate resourcing is available; • Identify local, national and global developments that may impact technologist members and progress relevant initiatives via the Federal Council; • Provide technologist representation on the Technical Standards Committee and Scientific Advisory Committee of the ANZSNM; • Increase the profile of the ANZSNM as the pre-eminent body for technologists in Australia and New Zealand; • Ensure that all working groups meet their individual objectives; • Ensure that appropriate dialogue and engagement occurs with non-member stakeholders, including registration boards and other professional associations;

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SIG NEWS Membership:

(Continues)

Elizabeth Bailey (IRC representative & chair) Marcia Wood (Federal Council Representative) James Green (CPD-Education Working Group Chair) Julie Crouch (Technologist Workforce Advocacy Working Group Chair)

CPD-Education Working Group The purpose of the working group is to ensure maintenance and continuity of the ANZSNM CPD Program and to assess the educational needs and future developments for nuclear medicine technologists in accordance with the objectives of the ANZSNM and standards of the MRPBA and NZMRTB. The working group is tasked with the following responsibilities: • • • • • • • •

Monitoring of any changes to the CPD requirements instigated by the MRPBA and NZMRTB, and revision of the program as appropriate to ensure program compliance with regulatory policies; Review content of CPD events and seminars organized independently of the TSIG or ANZSNM if requested; Provide ongoing feedback to the ANZSNM TSIG Committee and Secretariat on the utility of the CPD on-line database and associated tools, and assist with implementation of improvements; Regularly review the educational content for nuclear medicine technologists on the ANZSNM website and provide feedback to the secretariat as required; Organise and develop CPD opportunities for members; Liaise with universities and other educational bodies to propose and develop new education opportunities for the membership; Review and develop advanced practice guidelines in consultation with universities and members to ensure they reflect current practice; Review current practice in line with new technologies and changes in practice relevant to nuclear medicine technologists in collaboration with the TSIG Committee;

Membership:

James Green (ACT & chair) Elizabeth Bailey (NSW) Sarah Gales (Qld) Adam Freeborn (SA) Nick Daw (Vic) Karen Jones (SA) Suzanne McGavin (Qld) Kunthi Pathmaraj (Vic) Madhusudan Vyas (NZ) Erin Kelly (NSW) Chris Morris (Qld) Lauren Kete (NSW)

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SIG NEWS

(Continues)

Technologist Workforce Advocacy Working Group The purpose of the working group is to understand and interpret issues relevant for ANZSNM technologist members from the MRPBA, NZMRTB and other health authorities.

The committee is tasked with the following responsibilities: •

•

•

•

To advise Federal Council and provide feedback and comments on relevant documentation from regulatory authorities such as the MRPBA, NZMTRB and DIAS; Review workforce issues related to nuclear medicine technologists through interactions with the appropriate authorities as requested by the Federal Council; Ensure that an annual meeting is held with the MRPB (Australia) and NZMRTB to provide advice on any proposed changes to registration in conjunction with the TSIG Committee and Federal Council; Meet or correspond with other professional groups, such as the ASMIRT NZIMRT to discuss workforce issues where synergies or combined interests may exist.

Membership:

Julie Crouch (WA & chair) Marcia Wood (Vic) Peter Borham (Qld) Lauren King (Vic) Pru Burns (NZ) Maree Wright (ACT)

Please feel free to send us an email: tsigchair@anzsnm.org.au, we would be very interested in your feedback and comments on the new structure and functions of the group.

Elizabeth Bailey Chair ANZSNMT Committee

International Relations Committee of ANZSNM June 2017 The International Relations Committee (IRC) of the ANZSNM has been engaged in promoting nuclear medicine at a series of international forums, and is actively participating in major projects that are part of the World Federation of Nuclear Medicine and Biology (WFNMB) program leading up to the WFNMB Congress in 2018.

The IRC was involved in a technical meeting of the International Atomic Energy Agency (IAEA) in Vienna in March, aimed at developing a global consensus on minimal training standards for nuclear medicine specialists. A final agreed standard was achieved after 5 days of discussions and presentations, and a White Paper will be published later this year on the outcomes.

Representatives of the IRC also attended the Asian Nuclear Medicine Academic Forum (ANMAF) meeting in Shanghai in May, to engage with advocacy plans for the Asian region, discuss training programs, and promote the WFNMB Congress in 2018.

Further interactions of the IRC with the leadership of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) occurred in June at the SNMMI scientific conference in Denver.

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The close interactions between ANZSNM and SNMMI were emphasised and discussed during the meeting. This close association was also reflected in the President of the SNMMI (Prof Sally Schwartz) attending the ANZSNM conference in Hobart in April.

The IRC has key representatives in the WFNMB Executive Board, which met at the SNMMI conference in Denver. Projects where we are participating include a global project aimed at identifying issues impacting on access and availability of radiopharmaceuticals; advocacy of nuclear medicine with the World Health organisation; global standards for training; enhancing the WFNMB website to provide online access to teaching and training information provided by IAEA, SNMMI, EANM, AOFNMB and other global organisations; and development of databases of evidence based practice in nuclear medicine to facilitate regulatory and funding approvals.

Prof Andrew Scott

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AUSTRALIAN NATIONAL RADIATION DOSE REGISTER The Australian National Radiation Dose Register (ANRDR) in Review.

T

he ANRDR is a database designed for the storage and maintenance of dose records for workers who are occupationally exposed to ionising radiation. Currently the ANRDR is limited to the storage and maintenance of dose records for workers in the uranium mining and milling industry, some mineral sands mining and milling operations and Commonwealth licence holders. Expansion of the ANRDR to include workers exposed to ionising radiation in other industries, such as the medical sector, is in progress.

The ANRDR is administered by the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) as part of its statutory role to protect the health and safety of people and the environment from the harmful effects of radiation, and to promote uniformity of radiation protection. Consistent with this statutory role, the ANRDR provides a single uniform national approach to the management of radiation dose records and ensures the longevity of records beyond the working life of an operation or organisation, for records to remain available to workers.

Radiation dose records are disclosed by organisations and uploaded to the ANRDR through a secure web portal. The disclosure of dose records and retention by the ANRDR is performed in accordance with the requirements of the Privacy Act 1988. The ANRDR currently holds the dose records of over 38,000 individuals with some records dating back to 1988.

BENEFITS TO WORKERS, ORGANISATIONS AND REGULATORS For workers, the ANRDR provides assurance that radiation dose records are maintained and retrievable into the future, including when companies cease to operate.

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AUSTRALIAN NATIONAL RADIATION DOSE REGISTER (Continues) It allows the tracking of a worker’s radiation dose throughout their career to assess compliance with occupational dose limits, including when an individual moves between different employers or jurisdictions.

Workers can request a report of their radiation dose history; this report will contain all past doses received while working for employers registered with the ANRDR. Dose information can be requested by completing and submitting a request form which is available on the ARPANSA website. This dose history service is provided free of charge.

For organisations, the information contained in the ANRDR will assist in improving work practices for occupationally exposed workers in Australia. The ANRDR publishes annual reports which include statistical analysis of the data held within the database for each industry and worker categories available. The annual report provides useful industry-level statistical data on radiation doses received into the ANRDR which will assist in the optimisation of radiation protection for the industrial sector.

For regulators, the ANRDR can provide state, industry or organisational based statistical information on dose records that it maintains. The ANRDR also provides dose reports to regulators when an employee exceeds the regulated dose limit. This is of particular benefit to regulators as the ANRDR links workers between multiple employers.

The ANRDR also facilitates reporting of statistical data to international bodies such as the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) to make comparisons on the overall radiation safety performance of Australian industries against other countries.

WHAT INFORMATION IS DISCLOSED: The ANRDR requires information to be disclosed by the organisation including a breakdown of the doses received. Personal information is required in order to successfully link workers within the register. The personal information required includes: • • • • •

Full name; Date of birth; Gender; Employee number; Employee work classification.

A privacy impact assessment has been completed by the ANRDR to demonstrate its compliance to the Australian Privacy Principles set out in the Privacy Act 1988. Further information on the management of information is provided in the ANRDR Privacy Statement. http://www.arpansa.gov.au/Services/ ANRDR/PrivacyStatement.cfm HOW TO JOIN THE ANRDR: ARPANSA is working with state regulators with the intent to make the submission of dose records to the ANRDR a legal requirement. In the meantime an organisation can still join the ANRDR and submit dose records by the following process; •

Communicating to employees the intent to submit dose records; • Registering with the ANRDR; • Completing a privacy impact assessment; • Updating the organisational privacy policy to include the submission of dose records; • Signing the ANRDR service agreement.

The ANRDR team has information and templates available to assist with each stage of the process.

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AUSTRALIAN NATIONAL RADIATION DOSE REGISTER (Continues) FUTURE OF THE ANRDR ARPANSA’s goal is to implement the ANRDR for all occupationally exposed workers in Australia to ensure that its operation is consistent with international best practice. Occupationally exposed workers in the Medical Sector are encouraged to discuss the benefits of the ANRDR with employers and radiation safety specialists in an effort to facilitate on-boarding prior to proposed regulatory changes. If your organisation is interested in submitting dose records to the ANRDR please contact the ANRDR team at ARPANSA.

Cameron Lawrence, Ben Paritsky Australian Radiation Protection and Nuclear Safety Agency 619 Lower Plenty Road, Yallambie, VIC, 3085 Phone: (03) 9433 2403 Email: anrdr@arpansa.gov.au Website: www.arpansa.gov.au/Services/ANRDR

WELCOME TO CORPORATE SPONSORS A current priority for the Society is to strengthen the relationship between the professional members and those companies which support the Society in various ways. Rather than just being seen as simply providing financial support the aim is for Corporate members to be recognised as an integral part of the Society and to provide them similar benefits to those enjoyed by the profession as well as better engagement with members and particularly key decision makers.

Accordingly the Society has created a new Corporate Sponsor category which incorporates a range of benefits for companies and their representatives. Part of those benefits will be a section of the Society website devoted to Corporate Sponsors that will include an overview of the individual company as well as information about the products and services they can provide to the nuclear medicine profession.

On behalf of the Society I would like to welcome our inaugural Corporate Sponsors, namely:

If you are a Company serving nuclear medicine professionals and interested in our Corporate Sponsorship package please contact the Secretariat.

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COMMUNITY NEWS Chris McLaren Retirement Chris McLaren commenced his Nuclear Medicine career at St George Hospital in 1976. From there he was lured to the bright lights of Canberra in 1980 where he moved in as part of the Nuclear Medicine team at the Royal Canberra Hospital. Chris was employed to look after the computer acquired studies and helped to devise a way in which all the analysis and NM images could be captured for recording off the computer screen utilising a cardboard box and Nikon camera colour slide film.

Chris was also involved with a project with Ross Hanna that pioneered a technique for labelling of autologous white blood cells. It was found that by labelling these cells that it was diagnostically useful for detecting active infection and inflammatory bowel disease. Never to rest, Chris pioneered a method of imaging patients in the 1990’s on a Co-PET system that he devised utilising purpose built collimators with thick crystals.

It was at The Royal Canberra Hospital in his formative years where he was involved in some of the most profession changing discoveries in Nuclear Medicine. Chris worked with talented bunch of clinicians including Bill Burch and Dr. Paul Sullivan who went on to investigate what we now know as Technegas. The breakthrough of being able to change the form of Technetium and giving it gas like properties with a particle size much smaller than an aerosol meant that Technegas could be trapped in the bronchioles allowing for excellent quality imaging of the physiological function of ventilation of the lungs.

In combination with the matching perfusion scan, this technique came to be what we now know as the VQ lung scan.

Chris is particularly enthusiastic about Nuclear Medicine and helped to develop many protocols for optimised diagnostic benefit. One particular study that he was involved in which has had a lasting professional impact was his master’s thesis; a prospective longitudinal study on infants with vesico-ureteric reflux with comparison to x-ray micturating cystourethrogram.

It was perhaps during this time that he honed his exceptional skills in venepuncture of neonates and small children. Chris was always a ‘go to’ for a difficult injection with some patients routinely asking for him by name.

In addition to his research expertise Chris was an extremely passionate clinician and contributed to the field of Nuclear Medicine on many broad issues.

He had significant involvement in the national professional society (ANZSNM) for much of his career contributing to the development of the CPD program, development of the constitution, code of ethics and working to devise competency based standards for the industry. Chris was proactive in advocating for the profession and ensured that our practitioners attained the same high standards with his early involvement in the ACT Medical Radiation Scientists Board now absorbed by AHPRA. Chris has dedicated an impressive 36 years of his career to The Canberra Hospital, much of it held in a management role. He has lead the department through multiple structural changes and has seen great technological advancement of the Nuclear Medicine sciences.

Chris has shared his vision and has supported many new graduates to build impressive careers for themselves. He has a wealth of knowledge and a dedication to the field which make him highly regarded by those throughout the Nuclear Medicine industry. We would like to thank Chris for all of his contributions including the cricket banter and to wish him all the best in retirement.

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VALE - DR. JOHN BALDAS, 1944 -2017 Dr John Baldas passed away peacefully last week. A private funeral was held in Horsham (as per Dr John’s wishes) on the weekend.

John was a gentleman and a scholar’s scholar. He was a world authority on Technetium chemistry and his work impacted the clinical delivery of nuclear medicine in Australia and internationally.

John’s work at ARPANSA revolved around radiopharmacy and the clinical application of radiopharmaceuticals. John’s expertise and knowledge was admired outside the Agency and the Therapeutic Goods Administration frequently requested his advice on many aspects of radiochemistry and radiopharmacy. John was deeply involved with the Australian and New Zealand Society of Nuclear Medicine and regularly presented at their annual conferences. John was employed at ARL and then ARPANSA from 1974 to his retirement as Branch Head, Medical Radiation Services Branch, in Jan 2014. We will all miss his wry smile and dry-as-dry sense of humour.

ARPANSA, 22 May 2017 Dr John Baldas joined the Australian Radiation Laboratory (ARL) on 6th February 1974. He quickly established himself as one of the finest minds, not just in his field of organic chemistry, but in the discipline of medical radiation protection and in other general scientific areas relevant to radiation safety.

John’s path to ARL was an interesting one. His PhD studies were in organic chemistry at the University of Melbourne. He then went to Cambridge as an 1851 Research Fellow working with Prof. Sir Alan Battersby FRS. John was indeed in rarefied academic company; other 1851 Fellows included Baron Ernest Rutherford (Nobel Laureate and father of nuclear physics), Sir James Chadwick FRS (discovered the neutron), Baron William Penney (father of the British atom bomb), and Sir Mark Oliphant (Australian nuclear weapons physicist and humanitarian). After Cambridge, John returned to Australia as a research fellow at the Australian National University (ANU), undertaking postdoctoral research with Prof. Arthur Birch FRS. When John secured a position at ARL and was planning his move to Melbourne, the senior priest at John XXIII College, ANU, wrote in his reference for John for residency as a tutor at the (Methodist) Queens College at Parkville, “I’ll tell them you are sober and industrious, the Protestants will like that”! And so sober and industrious, John arrived at ARL in Melbourne, where he has spent the remainder of his working life [ARL combined with the Nuclear Safety Bureau to form the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) in 1999].

Dr Keith Lokan’s arrival at ARL as Director in 1978 heralded in an era where scientific research blossomed.

John was one of the leaders of a preeminent research group studying the coordination chemistry of technetium.

The research into technetium chemistry, spanning big ranges of oxidation states and ligands, had as its goal advances in nuclear pharmacy. This was quite an achievement for a laboratory of the size and stature of ARL in those days (during the 1980’s). John’s colleagues in the technetium research included John Boas (esr studies), Geoff Williams (structural studies involving single-crystal X-ray diffraction and EXAFS in solution), John Bonnyman (radiochemistry), Silvano Colmanet (synthesis and structural studies), and Zlata Ivanov (synthesis and in-vitro studies of structure and rates of reaction involving techniques of high-voltage electrophoresis and UV/ vis spectrophotometry). The group discovered and reported the first nitrido complex of technetium, and this was the basis of a world-wide patent on what showed some promise as a new form of radiopharmaceutical.

This was a time when safety concerns in university chemistry laboratories were making research into radioactive technetium difficult. The purposebuilt radipharmaceutical laboratory at ARL with its state-of-the-art safety features for working with radioactive isotopes afforded the opportunity for this innovative and exciting chemistry research. There were four acknowledged leading research groups studying the coordination chemistry of technetium at the time. These were the groups

of Professors Alan Davison at MIT, Giuliano Bandoli & Ulderico Mazzi in Padua, Ed Deutsch at Cincinnati (Dept. of Chemistry; Radio-imaging Agents), and the Baldas group in Melbourne.

During this era, John and his group published many research papers on technetium coordination chemistry, in the top chemistry journals including a paper in the prestigious Proceedings of the Royal Society. Perhaps a crowning achievement by Dr John, as he was affectionately known within the technetium research group, was the publishing of a significant review of ‘The Coordination Chemistry of Technetium’ in the international journal Advances in Inorganic Chemistry (vol. 41, 1994).

The research program in those days was exciting, there was a buzz about the radiopharmaceutical lab. at ARL, and John’s great and intuitive knowledge of chemistry, as well as synthetic prowess, was pivotal to the group’s success.

John established himself as a Principal Research Scientist at ARL and became Director of the Medical Radiation Branch at the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA, the successor to ARL) in 1999. John retired from ARPANSA at the end of 2012, but his knowledge and expertise were still available to ARPANSA staff as he continued for several years as a scientific adviser in a part-time emeritus role.

Geoff Williams, 29 May 2017

47th Annual Scientific Meeting of the Australian & New Zealand Society of Nuclear Medicine Due to a change in the format of the conference the opening plenary session was on Friday afternoon in the Concert Hall at the Grand Chancellor Hotel in Hobart. The plenary speakers were Dr John Younger (Consultant Cardiologist from Royal Brisbane Hospital), Dr Sally Barrington (Professor of PET imaging from the UK), A/ Prof Michael Hofman (Peter MacCallum Cancer Centre), and A/Prof Barry Elison (Wollongong Hospital). We gratefully acknowledge Cyclotek for their sponsorship of Dr Trevor FitzJohn (Pacific Radiology, NZ) and Dr Philip Law (Princess Alexandra Hospital) who also gave plenary lectures. The Lowenthal lecture was given by Prof. Vijay Kumar and the Pioneer lecture by Dr Monica Rossleigh. There were also presentations given by international guests including Sara Johnson and Sally Schwarz, both from the SNMMI and Dr Meera Venkatesh from the IAEA.

The pre-conference symposium was held at the spectacular MONA on Friday the 21st of April. The first session was a Cardiology Hypothetical session with A/Prof Nathan Better as the moderator and speakers including Dr John Younger, Dr Samuel Wright, Dr Subodh Joshi and A/Prof Barry Elison. Each speaker gave a talk on their relevant area of expertise which was followed by an interactive panel discussion which proved to be both educational and highly entertaining. The second session was on prostate imaging, with A/Prof Paul Roach as moderator and speakers including Dr Hossein Jadvar, A/Prof Paul Thomas and Dr Geoff Schrembri.

Delegates were then given time to explore the many unusual and varied exhibits within MONA. Social events included the Welcome reception which was held in the Exhibition hall on Friday evening and the Awards dinner was held at Glen Albyn Estate on the Saturday night. The theme was ‘Under the Stars’ as the venue was on the banks of the magnificent Derwent River in an aptly decorated marque.

We would like to acknowledge the great work and professionalism of Phil Plevin and his team, including Rachael, Lucy and Irene. Their knowledge, resources and guidance helped the LOC shape this meeting into the success it was.

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ASM 2017 AWARD WINNERS

AANMS Registrar Research Award: Samuel McArthur

22 / gamma GAZETTE / July 2017 Shimadzu Award: Joseph Ioppolo

GMS Poster AWARD, Tehereh Erfani

Radpharm Case Presentation Award, Judy Duong

Mallinckrodt Award, Lisa Macfarlane

Honorary Membership Award, Brian Hutton

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Radpharm Award Winner Abstract, Judy Duong, The Princess Alexandra Hospital, Bri The Utility of PET-MRI in the Treatment Planning and Management of Meningiomas

B

ackground: A 55-year old male underwent surgical resection of his bifrontal meningioma upon initial disease discovery. In subsequent years, the patient reported of increasing vision impairment and recurrence was suspected following routine monitoring scans. However, a surgical clip has limited the ability of CT and MRI to evaluate the extent of the disease due to significant image artefacts produced by the metallic component. To tackle this issue, a 68Ga-DOTATATE PET-MRI was requested.

A

im: This case study aims to determine the utility of PETMRI in the treatment planning and management of meningiomas and in particular relation to this patient’s presentation, its ability to aid in providing any information surrounding the surgical clip and assist in radiotherapy (RT) planning.

M

ethod: The patient was injected with 118 MBq of 68Ga-DOTATATE. 47 minutes post injection, a 1-bed position PET-MRI was performed.

R

esult: The scan identified multiple areas of active disease including intense abnormal 68Ga-DOTATATE uptake within the susceptibility artefact. While CT and MRI were unable to define the true extent of the disease, PET was able to provide a more accurate assessment. As with stand alone MRI, the MRI component of the PET-MRI was still suboptimal, however, the PET component demonstrated viable tumour in areas obscured by the CT and MRI artefact.

The data was used to help define tumour borders for RT by fusing it to the planning CT and MRI making sure the entire 68Ga-DOTATATE avid regions were included in the gross tumour volume.

Post RT, his deteriorating vision has stabilised and a PET-MRI has been booked for monitoring.

C

onclusion: This case study highlights the strengths of PETMRI particularly in the post-surgical setting providing differentiation between scar tissue and active disease. Without the PET-MRI, it would have proven difficult to determine tumour margins for RT, which subsequently could have under- or over-treated disease and healthy tissue. PET-MRI has the potential to become the next gold standard for imaging meningiomas as it reduces the need for other monitoring scans combining great soft tissue characterisation with tracking of the physiological disease characteristics, thus reducing hospital visits and extra radiation burden from PET-CT.

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HONORARY LIFE MEMBERSHIP, Brian Hutton

A

t the 2017 ANZSNM Awards Dinner in Hobart the ANZSNM awarded Honorary Life Membership to Professor Brian Hutton (PhD CSci FACPSEM MIEEE MIPEM). Although Brian Hutton is now Professor of Medical Physics in Nuclear Medicine and Molecular Imaging Science at University College London (UCL), he has a long history with the Australasian nuclear medicine community and until recently held a part-time appointment at the University of Wollongong.

He has worked in Nuclear Medicine since 1975, based in Sydney where he published extensively on research in nuclear medicine, particularly in the areas of image processing and reconstruction for emission tomography (PET and SPECT). He currently leads a research group at the Institute of Nuclear Medicine at UCL with emphasis on tomographic system design, image reconstruction and solutions to multi-modality problems.

At the conference in Hobart he capped off the Physics SIG Symposium with a fascinating presentation on some of the research being performed by this group, leaving the audience drooling for tomorrow’s developments today.

Brian Hutton joined the Department of Nuclear Medicine at Royal Prince Alfred Hospital (Sydney) in 1975 and headed the Physics group from 1981-1995. He played a central role in the establishment of the National PET Facility at RPA Hospital.

From 1995 until 2004 he was Head of the Diagnostic Physics Group at Westmead Hospital (Sydney) where his research interests included SPECT quantification, image reconstruction and multi-modality imaging problems.

This summary cannot do justice to

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Brian’s involvement in both the local and international nuclear medicine research community. In addition to over 250 published papers in journals and conference proceedings, his co-authorship of over 120 abstracts at previous ANZSNM conferences demonstrates Brian’s commitment to Australasian nuclear medicine research. His local research effort in SPECT reconstruction was recognised in 2014 with Brian being co-recipient of the prestigious IEEE Marie Sklodowska Curie Award for his role in the development of maximum likelihood reconstruction, research undertaken while working at the Royal Prince Alfred Hospital.

Many will know Brian for his steadfast commitment to teaching and training, from syllabus revision committees through to hands-on supervision of students and activities that have enhanced local training of nuclear medicine professionals. He has provided an extensive amount of academic research supervision including the supervision of a number of physicists who now hold key positions in the Australian nuclear medicine physics community. The IAEA Distance Assisted Training (DAT) programme for nuclear medicine technologists is well known to many, but did you know that this started back in 1989 when Brian directed the first South East Asia IAEA Regional Cooperative Agreement ‘train the trainers’ course on “Computers in 99mTc imaging”. Brian played a key role in directing this programme and continues to assist with its coordination today.

This is a much abbreviated version of the significant contribution Brian has made to both the Australasian and international nuclear medicine communities. But all this is not enough

for Life Membership of the ANZSNM. One must also make a significant contribution to the AANZSNM. For Brian there is too much to add to this summary because he had continuous involvement with the ANZSNM from 1977 until 1993, establishing the ANZSNM Physics SIG and Technical Standards group, and topped off in 1994 with his major role as Co-Chairman of the Scientific Programme at the Sixth World Congress on Nuclear Medicine (Sydney, 1994). But it did not stop there and Brian pursued the training of nuclear medicine physicists through liaison between the ANZSNM and ACPSEM. This work led to development of the training and accreditation programme for nuclear medicine physicists that was the forerunner of the successful programme running today.

We thank Brian for his contributions to Australian and New Zealand nuclear medicine and congratulate him on his well-earned Life Membership of the ANZSNM.

RESEARCH GRANT INVITING APPLICATIONS FOR ANSTO/ANZSNM RESEARCH GRANT 2018 Closing date: 6/10/2017 to commence in 2018 For further information on Research Grant Conditions & Applications visit http://www.anzsnm.org.au/resources/awards-grants ANSTO and the ANZSNM (“the Society”) are pleased to offer a competitive grant aimed at encouraging research in nuclear medicine in Australia and New Zealand. The grant is up to the value of $20,000 and is expected to run for approximately one year. ANSTO is Australia’s government-funded nuclear science organisation. Its vision is to deliver excellence in innovation, insight, and discovery through its people, partnerships, nuclear expertise and landmark infrastructure. In assessing applications for the grant, preference will be given to early career researchers in order to provide seed funding for pilot investigations that could lead on to further grant applications. The grant will be offered yearly but the evaluating committee reserves the right to not award the grant if there is no suitable application.

All aspects of nuclear medicine will be considered for this grant including, but not restricted to: ▶▶ novel developments in radiopharmaceuticals; ▶▶ hardware and software innovation; ▶▶ epidemiology and audit activities; ▶▶ pilot clinical trials; ▶▶ retrospective studies on outcomes in diagnostic and therapeutic procedures in nuclear medicine; ▶▶ education, training and professional development activities.

The ANSTO/ANZSNM Research Grant is intended to achieve one or more of the following: 1. Approach a meaningful conclusion in one year; 2. Assist investigators striving to establish new programs or new directions; 3. Fund initial exploratory research for which external funding will be sought subsequently; 4. Address circumscribed clinical problems of a sort unlikely to attract industry funding; 5. Survey groups of patients to assess the success rate, sequelae, safety or any other aspect of diagnostic or radionuclide therapy protocols; 6. Bridge the gap of a year between completion of one external grant and the commencement of another.

The evaluating committee will consist of one representative from ANSTO, one member of the Society’s Scientific Advisory Panel and the ANZSNM President or their delegate.

The successful applicant/team is expected to acknowledge ANSTO’s and the Society’s support in any publications and provide a report to be published in the Gamma Gazette upon completion. The applicant will ideally present the outcome(s) of the research at the next ANZSNM ASM. Fruitful outcome for the last 2 years from the ANSTO/ANZSNM Research Grants: The awardees have successfully carried out research with the seed funding from this award and has presented the findings at the last ANZSNM ASM conference-2017 in Hobart. An abstract of their interesting findings is given below to highlight the importance of seed funding and its benefits in stimulating research, which will lead to getting better funding opportunities.

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RESEARCH GRANT INVITING APPLICATIONS FOR ANSTO/ANZSNM RESEARCH GRANT 2018

(Continues) 2015 Result ANSTO-ANZSNM Research Grant winner was Peter Kench PhD, and he is the Principle Investigator and a Senior Lecturer, Nuclear Medicine Science, University of Sydney, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, NSW, 2141.

His topic of research proposal was “Diagnostic reference levels for FDG PET/CT studies in New Zealand” Background: The integration of positron emission tomography with computed tomography (PET/CT) hybrid systems has revolutionised clinical practise. However, PET/CT may contribute to a higher radiation burden among patients due to radiation exposure from both the PET and CT modalities. Diagnostic reference levels (DRL) allow the comparison of average patient radiation dose from clinical centres with a national standard. If local reference levels exceed the national DRL, there may be need for optimisation of the PET/CT protocol.

Aims: This survey aims to update the 2008 DRL values for fluoride-18 fluorodeoxyglucose (18F-FDG) published by the Australian and New Zealand Society of Nuclear Medicine (ANZSNM) (2009). It also aims to establish a new DRL value for CT component associated with whole-body PET/CT procedures in New Zealand (NZ).

Methods: A survey was sent to PET/CT centres in NZ. Data was collected prospectively for four weeks following the Australian Radiation Protection and Nuclear Safety Agency DRL protocol. The DRL and effective dose (ED) were calculated using the 75th percentile.

Results: Four of the five NZ PET/CT centres participated in this survey. The DRL for 18F-FDG has reduced from 385 MBq in 2008 to 301 MBq in 2016. The DRL for CT dose index volume (CTDIvol) and the dose length product (DLP) were 11.48 mGy and 1117.5 mGy.cm, respectively. The current DRL values for 18F-FDG were in good agreement with international published DRL data. However, the CT DRL was high in comparison to published data due to routine inclusion of a diagnostic CT and a chest breath hold CT in the PET/CT protocol. The 75th percentile ED was 18.88 mSv. Conclusion: A revised national DRL for 18F-FDG PET imaging has been suggested. DRL for PET/CT in NZ have been recommended for the first time.

Applicants: Peter L Kench, Principle Investigator, PhD, Senior Lecturer, Nuclear Medicine Science, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, 2141.

Essam M A Alkhybari, Master of Nuclear Medicine, Research Higher Degree Student, Kathy Willowson, PhD, Medical Physicist, Department of Nuclear Medicine Royal North Shore Hospital.

Mark McEntee, PhD, Senior Lecturer, Diagnostic Radiography, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney.

2016 Result ANSTO-ANZSNM Research Grant winner was Nicholas Forwood and he is a physicist in the Department of Nuclear Medicine at RNSH and a doctoral candidate in the Faculty of Health Sciences at the University of Sydney. His project was on “In Vitro Studies of Cell Survival Comparing External Beam Radiotherapy to Radionuclides”.

The abstract presented at the ANZSNM 2017 conference in Hobart describes the results of their project which was generated from the ANSTO/ANZSNM Research grant.

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RESEARCH GRANT INVITING APPLICATIONS FOR ANSTO/ANZSNM RESEARCH GRANT 2018

(Continues)

Prof Vijay Kumar PhD Member, Scientific Advisory Panel AZNSNM.

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RESEARCH GRANT ANSTO/ANZSNM RESEARCH GRANT 2018 Application Guidelines A. ADMINISTRATIVE ASPECTS 1. TITLE OF PROPOSAL 2. APPLICANT (S) - give name, highest formal qualification, current department, appointment and address, and if different, the proposed appointment and the department in which the project would be carried out. The Principal Investigator must state the number of years of their nuclear medicine experience. Indicate the number of hours per week each applicant expects to devote to this project.

3. ANZSNM MEMBERSHIP – the Applicant or Principal Investigator must be a financial member of the Australian and New Zealand Society of Nuclear Medicine at the time of application.

4. APPLICATIONS FOR RESEARCH SUPPORT CURRENTLY PENDING - itemise by funding agency, project title, and funds requested for each year.

5. CURRENT RESEARCH SUPPORT - itemise for each applicant, giving value of support for each year that support has been granted. Funds from all sources must be included.

6. RELATIONSHIP OF SUPPORT REQUESTED IN THIS APPLICATION TO EXISTING RESEARCH SUPPORT, AND THAT REQUESTED CURRENTLY FROM OTHER BODIES - specify why existing support cannot be utilised to support the research proposed in this application.

7. ETHICAL REVIEW - indicate when ethical review (human or animal) was or is to be sought for the studies in this proposal. Please note that documented ethical clearance must be obtained and forwarded to the Scientific Advisory Panel before the commencement of the grant.

8. CERTIFICATION - all applications must carry certification by the Head of Department/Division “that appropriate general facilities will be available to the investigator if successful and that the project will be carried out strictly in accordance with NHMRC Ethical and Scientific Practice Guidelines”.

9. SCIENTIFIC REFEREES - nominate a minimum of three scientific referees who are expert in the field of this application. Please provide email addresses together with phone and fax numbers and full street addresses.

They must not be from your campus, nor associated with the project, nor have collaborated with the applicant(s) scientifically in the past five years. If you require, you may also list one referee who you do not want to assess your project.

B. RESEARCH PROPOSAL The maximum budget which may be applied for is $20,000. Proposals from new Investigators will be given some preference during assessment. Research Grants are awarded for one year – and can only be extended (up to 18 months) by written application to the Chairman Scientific Advisory Panel.

1. AIMS ½ page maximum 2. SCIENTIFIC AND/OR TECHNOLOGICAL MERIT ½ page maximum 3. ETHICAL CONSIDERATIONS ½ page maximum 30 / gamma GAZETTE / July 2017

RESEARCH GRANT ANSTO/ANZSNM RESEARCH GRANT 2018 Application Guidelines (Continues) 4. BACKGROUND and RESEARCH PLAN 3 pages maximum Applicants are reminded this section should generally include clear definition of study end points, statistical methods to be used, power calculations and an explanation of the relationship of the study to the applicants’ longer-term research agenda.

5. REFERENCES 1 page maximum (with up to 6 key references marked with asterisks) 6. SUMMARY OF MAJOR EXPECTED OUTCOMES OF PROJECT ½ page maximum 7. BUDGET 1 page maximum A financial summary of the total amount requested (exclusive of GST), itemised under the headings: Equipment (over $2000) (the Society will not support projects in which the funding sought is primarily to purchase expensive items of equipment); General operating costs (including consumables, minor equipment (under $2000), etc.); Salaries 8. JUSTIFICATION OF BUDGET

½ page maximum

C. PREVIOUS RESEARCH ACTIVITY AND ACHIEVEMENTS OF APPLICANTS 1. PREVIOUS RESEARCH SUPPORT TO APPLICANTS - this should be itemised for the last 4 years, giving the same information as for current research support.

2. PUBLICATIONS OF APPLICANTS - please list a maximum of 8 most relevant recent publications per applicant.

Abstracts should not be listed. ** For a new researcher, with little or no previous support, a brief CV/track record is required.

D. DECLARATION The principal investigator must make a formal declaration, signed and date, as follows: “I confirm that all information included in this application is true and correct. I also confirm that I am a named principal investigator on this application only, and that I am a named investigator on no more than two other applications”

E. APPLICATION SUBMISSION Applications must be presented in a minimum of 12-pitch type face.

Please submit your application by email as a Word document through the ANZSNM Secretariat at secretariat@ anzsnm.org.au by the closing date below.

The original (hard copy) signed application should be forwarded to: Chairman, Scientific Advisory Panel c/- ANZSNM Secretariat, PO Box 6178, Vermont South, VIC 3133.

APPLICATIONS CLOSE 6th Oct 2017 ANZSNM Secretariat Phone +61 1300 330 402 Fax +61 (0) 3 8677 2970 Email: secretariat@anzsnm.org.au 31 / gamma GAZETTE / July 2017

RESEARCH GRANT NEWS ANZSNM 2015 Research Grant – June 2017 Update Diagnostic Reference Levels for Patients Undergoing PET/CT Scans in Australia and New Zealand.

Peter Kench PhD, Essam Alkhybari1, Kathy Willowson1,2 PhD, and Mark McEntee1 PhD. 1. Faculty of Health Sciences, The University of Sydney.

2. Department of Nuclear Medicine, Royal North Shore Hospital This aim of the research is to measure diagnostic reference levels (DRL) for Positron Emission Tomography and Computed Tomography (PET/CT) scans in Australia & New Zealand and to determine the main factors that influence patient dose. We are also interested in examining the methodology used to collect and report PET/CT DRL data.

The ANZSNM research grant largely provides travel support for investigators.

The investigators worked closely with staff from ARPANSA to avoid duplication of effort in acquiring and reporting Australian PET/CT DRLs. As a result, this study has focused on paediatric, New Zealand, and the states of Queensland and Western Australians, which were not well represented in the recent ARPANSA PET/CT study. To investigate factors that influence dose we expanded our questionnaire to also include patient, protocol, equipment details and CT dose length product (DLP).

A major challenge has been obtaining Human Research Ethics Committee (HREC) approvals. Initially, we proposed that the University of Sydney HREC, a nationally accredited Ethics Committee, approved protocol would be used for all centres participating in the study. The University of Sydney HREC approval was used for New Zealand and Western Australian Private Practices which offer PET/CT services.

Multiple HREC approvals, site-specific authorisations (SSA) and research contracts, have been established with public hospital Nuclear Medicine Departments. The proposed research is regarded as low risk, from a human ethics perspective, but because it involved multiple centres and accessing anonymised patient data, this placed increased demands on the investigator’s time resulting in delays. This is an important consideration for this type of research.

At the ANZSNM ASM held in Hobart in April 2017, Essam Alkhybari presented the initial findings of the New Zealand PET/CT DRL. Four of the five PET/CT centres participated in the study by completing a dose survey of 223 18F-FDG studies over four weeks. A comparison of published 2008 and collected 2016 administered dose data showed an overall 22% average reduction from 385 to 301 MBq. The

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2016 administered dose is in good agreement with global published DRL data. The DRL for CT dose index volume (CTDIvol) and the dose length product (DLP) were 11.5 mGy and 1117.5 mGy.cm, respectively. The CT DRL was high in comparison to published data due to the inclusion of a diagnostic and chest breath-hold CT in the PET/CT protocol.

The calculated 75th percentile Effective Dose (ED) was 18.9 mSv. Initial analysis showed that the age of the PET equipment was a contributing factor to increased administered dose.

There was a relationship between dose, CTDIvol and DLP, and CT protocol selection, e.g., tube current, pitch ratio and slice thickness. We are yet to complete the analysis of patient factors’ influence on PET/CT radiation dose. Careful consideration should be given as to what to include in CT dose calculations, e.g., breath-hold chest CT. Much of the PET/CT DRL data collection is now completed for paediatrics, Queensland and Western Australia with only a couple of centres remaining. The next phase of the study will involve the collection of CT dose and image quality data.

Centres that participated in the PET/CT DRL study will be asked to perform the CT scan using their routine PET/CT protocol on the CT dose and CATPHAN 500 image quality phantom. This will allow a comparison of the reported CT DRL to an objective measure of CT dose and image quality.

Fortunately, this part of the study will not require HREC approval.

The grant funding was initially intended to be used to travel to PET/CT centres to assist with DRL data collection training and reduce the workload of local staff. Funding has been used for visiting some centres, facilitating ethics approval, and meeting with ARPANSA staff to discuss the study design, analysis and initial findings. The investigators involvement in data collection was limited due to the ethical requirement of preserving the anonymity of patients. The remaining grants funds will be used to travel to participating PET/CT centres to acquire CT dose and image quality data.

We look forward to reporting the findings of this investigation in full and anticipate it will further the understanding of the factors that influence patient radiation dose with PET/CT studies. We will propose a methodology for acquiring and reporting PET/CT DRL based on findings of this study. We gratefully acknowledge the support of the ANZSNM research grant in facilitating this investigation.

RESEARCH GRANT NEWS ANSTO/ANZSNM Research Grant 2017 WINNER Project Summary

Establishing an Australian reference range for striatal binding in patients with Parkinson’s disease and healthy controls with 6-[18F]fluoro-L-3,4dihydroxyphenylalanine (F-DOPA) PET.

Clinical Professor Soumya Ghosh (left), Nelson Loh (right)

I

Associate Professor Roslyn Francis

diopathic Parkinson’s Disease (PD) is characterized by progressive loss of neurons in the brain. Late stage PD can be clinically diagnosed with high accuracy by experienced clinicians. However, in the earlier stages of the disease, it may be difficult to diagnose PD on the basis of clinical signs and symptoms.

In our proposed study, we will perform F-DOPA PET imaging in ten healthy volunteer controls and twenty patients with typical clinical features of PD to enable us to determine reference ranges for these groups.

F-DOPA PET imaging of the brain is indicated for differentiating PD from non-neurodegenerative disorders and to diagnose early PD when the clinical picture is equivocal.

Once the study is complete, this data will be used in the future interpretation of F-DOPA PET scans at our institution and would be made available to other sites around Australia who wish to establish this imaging technique.

This technique has been employed in Europe and USA for this indication, however, to our knowledge, Sir Charles Gairdner Hospital (SCGH) in WA is one of only two sites in the country using F-DOPA for clinical PET imaging and no Australian data has been published on F-DOPA PET scans for movement disorders.

NOTE: Images not available of additional grant winner recipients Dr Rick Stell & Dr Laurence Morandeau.

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36 / gamma GAZETTE / July 2017

DIARY DATES 5

6

16 16/17 TBC

TBC

TBC

21/25

4 TBC

25

13

21 26 1 Dec

29

37 / gamma GAZETTE / July 2017

WFNMB UPDATE World Federation of Nuclear Medicine and Biology (WFNMB) Congress 2018 – coming to a city near you!

T

he World Federation of Nuclear Medicine and Biology (WFNMB) is the global umbrella for nuclear medicine regional societies throughout the world, linking the practice and promotion of nuclear medicine throughout the Americas, Asia, Africa, Europe and Oceania. It was founded in 1970 and one of its unique features is the integration of developed and developing countries – to create opportunities for shared activities such as research and education in the world.

The WFNMB quadrennial Congress is considered as the “Olympics” of Nuclear Medicine conferences, and has become a major international forum for the presentation of all aspects of nuclear medicine - basic, applied and clinical nuclear medicine research, diagnosis and treatment of various disorders.

The evolution of nuclear medicine practice has resulted in the integration of hybrid imaging and theranostics into the program of this calibre of meetings, with an emphasis on a multidisciplinary approach in this era of personalised medicine.

The 12th Congress of the WFNMB will be held from the 20th to 24th of April, 2018 in Melbourne, Australia. The theme of this congress is to promote “Global Translation of Molecular Medicine”, incorporating the translation of 38 / gamma GAZETTE / July 2017

basic laboratory research to clinical practice, establishment of clinical and technical standards, and the translation of molecular medical technology to developing countries for the benefit of patients worldwide.

This Olympics will be opened by a plenary lecture to be given by Prof Brian Schmidt – The 2011 Nobel Laureate in Physics, the Vice Chancellor and President of Australian National University.

The cutting edge, multidisciplinary scientific program will include an outstanding program of focused plenary sessions, continuing educations sessions, and large poster presentation sessions which will be both enjoyable and educational to attendees. There will be 11 different tracks, including oncology, neurology, molecular imaging, hybrid imaging, theranostics, physics, instrumentation, novel radiopharmaceuticals and emerging/disruptive technologies. The program will contain sessions which will appeal to nuclear medicine physicians, radiologists, medical imaging trainees, physicists, radiochemists, scientists, technologists, nurses, and the broader medical and scientific community.

The 12th World Congress of the WFNMB will be cohosted by the ANZSNM and WFNMB. So, save the date to come and support your Society in this international Congress. Please visit the websites: www.anzsnm.org or www.wfnmb2018.org for more information.

Andrew M Scott, President, WFNMB

CASE STUDY FDG PET/CT SCANNING A useful approach to imaging bladder cancer M Ghasemzedah, EA Bailey, G Schembri and E Hsiao. Nuclear Medicine Department, Royal North Shore Hospital, Sydney Australia

B

ackground: There were more than 2555 cases of bladder cancer diagnosed in 2013 with the number of diagnosis increasing annually. It is more common in males than females and in those over 60 years of age1. The risk of diagnosis by age 85 is 1 in 40 for males compared to 1 in 170 for females1. There are 3 main types of bladder cancer.

1. Urothelial carcinoma, which is the most common type occurring in 80 to 90% of all bladder cancers 2. Squamous cell carcinoma, with a low incidence of 1 – 2% and tends to be more invasive 3. Adenocarcinoma starting from mucus producing cells in the bladder, is rare with an incidence of approximately 1% and is more aggressive and invasive FDG PET/CT is used in a wide array of indications and regular review of imaging protocols based on indication, pharmacokinetics of the tracer and to continue to obtain high diagnostic quality image data is required. The use of FDG PET/CT in bladder cancer staging and restaging is challenging due to the high concentration of urinary activity in the bladder, even post void.

The use of a standardised catheter

assisted bladder flushing and filling at 1hr post injection has shown improved bladder tumour visualisation but is logistically difficult and invasive2. Early blood flow dynamic imaging has shown bladder lesions obscured by urine activity on later images but can have a significant impact on PET workflow3.

The aim of this review was to evaluate the use of a hydration protocol with early and delay imaging in patients with known bladder cancer.

routine ‘bladder protocol’ included oral pre-hydration with 300mL of water followed by intravenous saline hydration set at a rate of 500mL/hr during the uptake period. The IV saline infusion was stopped 45 minutes after FDG administration and the patient requested to void. A post-void wholebody PET/CT scan was acquired at 60 minutes at 150seconds per bed, 200x200 matrix, reconstructed using Gaussian filter at 5mm FWHM and 3mm slice thickness. The patient was

Figure 1: The RNSH routine ‘Bladder Protocol’ that is used all patients referred for investigation of bladder cancer, except if the patient is on fluid restrictions or cardiac failure

M

ethod: A retrospective review of FDG PET/CT studies performed for staging and restaging of patients with known or suspected bladder cancer acquired using a ‘bladder protocol’ was undertaken. The

then requested to drink a further 1L of fluid over the next 2 hours and void 30 minutes before delayed scan. A single 5 minute bed image of the bladder was taken at 3 hours with a distended ‘cold’ bladder. The protocol is summarised in figure 1.

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FDG PET/CT Scanning A useful approach to imaging bladder cancer (Continues)

D

ata Analysis: early and delayed images were assessed by an expert reviewer to determine primary bladder lesion detection and localisation.

A comparison of the change in SUVmax of the primary lesion(s) between early and delayed imaging time points was determined.

diuretics. It appears to result in improved lesion detection and accuracy of quantitative measures.

R

esult: A total of 25 FDG PET/CT scans acquired on 18 patients with TCC or small cell bladder cancer were included, with 9 studies excluded (7 patients) due to acquisition protocol variation. The remaining 16 studies [11 patients, mean age 68yrs (range: 44 – 84 yrs), M=8, F=3] were acquired using the ‘bladder protocol’. A further 2 were excluded due to primary diagnosis of renal cell carcinoma that was determined after the FDG PET scan.

S

can Findings: There were 5 studies that had no uptake in the primary lesion and 2 showed no difference in uptake between early and delay imaging. Delayed imaging had better visualisation of bladder lesions in 6 cases with 1 study identifying an additional lesion on delay only. Bladder lesion SUVmax increased on delayed in 4 cases and in 2 cases showed a decrease.

Figure 2: A summary of the image findings following review by an expert reader to assess for the presence and localisation of any primary tumours in the bladder.

As can be seen in figures 3, 4 and 5, the use of early and delayed imaging is a non-invasive method for distinguishing normal urinary bladder excretion from tumour uptake without the need for catheterisation and 40 / gamma GAZETTE / July 2017

Figure 3: Examples of FDG PET bladder views acquired at 1 hour post injection (after 45 minute IV hydration and voiding) and the 4 hour delay (after 2L oral hydration, full bladder

C

onclusion: The ‘bladder protocol’ is a non-invasive method for distinguishing FDG urinary bladder excretion from tumour uptake, providing greater reporter confidence in identifying primary bladder lesions. The ‘bladder protocol’ is easy for patients to follow thereby improving compliance and doesn’t impede on the daily PET workflow as it only requires an additional 5 minutes acquisition at 4hr post injection.

The oral hydration protocol dilutes the FDG activity concentration in the bladder allowing imaging with a cold distended bladder resulting in better visualisation of bladder lesions as well as improved accuracy and reproducibility of tumour lesion SUVmax.

References 1.

Cancer Council NSW (2016), Bladder Cancer. Retrieved September 5, 2016, from https:// www.cancercouncil.com.au/bladder-cancer 2.

Mertens, LS., Bruin, NM., Vegt, E., de Bloka, WM., Fioole-Bruining, A., van Rhijna, BW., Horenblas, S., Vogel, WV. (2012), Catheter-assisted 18F-FDG-PET/CT imaging of primary bladder cancer: a prospective study. Nuclear Medicine Communications, 33:1195–1201 3.

Belakhlef, S., Church, C., Jani, C., Lakhanpal, S. (2012), Early Dynamic PET/CT and 18F-FDG Blood Flow Imaging in Bladder Cancer Detection A Novel Approach. Clinical Nuclear Medicine, Vol. 37, Num. 4: 366-368

ARTICLES Nuclear Medicine in the Wild Wild West!

Landing at Kalgoorlie-Boulder airport for the first time in late 1997, I was struck by the calm and stillness compared to normal airports. Kangaroos jumped alongside the landing strip fence as the Royal Flying Doctor Service quietly restocked the air ambulance in an outer hanger, taking cover from the blazing sun. Driving into town I marveled at the width of the roads. Local cabbies all peddle the apocryphal story that the width was an historical necessity, enabling camel trains to u-turn but other locals will tell you it helps to prevent the town from collapsing onto itself on account of the maze of mine shafts dug underneath.

W

hatever the truth, you would be forgiven for mistaking the main strip, Hannan’s Street, for a movie set from a spaghetti western. The Palace, the Exchange, the York and the Australian hotels speak proudly to their history, displaying characteristic federation style with wild west, saloon style swinging doors. US president, Herbert Hoover, left his mark here in 1897 and at its peak “Kal”, as it’s fondly known, had nearly 80 pubs - and they were not for the faint hearted.

Many a tall story is told of mass pub brawls and bawdy, salacious behavior and such stories might be of antics just the weekend before!

This mining hub, 600 kilometers east of Perth, has a population of around 35,000 which ebbs and flows with the vagaries of the global commodity market. Its heritage lies in the gold rush of the late 1800’s and the electorate covers a massive 868,576 square kilometers, one of the largest single-member electorates in the world. There are small townships, isolated Aboriginal communities and cattle stations scattered in all directions up to 5-hours’ drive away. Geographically, it’s a tough place to live but it delivers that quintessential outback landscape which projects us to the

imagination of the world. And it’s full of tough people who tell it like it is. They say you can order a soy latte in Kalgoorlie but it’s a long walk back to Perth for anyone that might dare to.

The weekly, fly-in-fly-out (FIFO), nuclear medicine service to Kalgoorlie has been my Monday ritual for nearly 20 years. Usually out of bed by 3am and home that evening by 9pm, I’m often exhausted by the end of the day but providing our service to this remote community has been one of the most professionally rewarding experiences of my working life. Unlike metropolitan nuclear medicine departments, the FIFO service is subject to high travel costs for staff and isotopes (thanks Qantas!) and the isolation means that engineering support is not readily available. Considerable pre-session planning and checks are necessary to ensure that isotopes actually make it to our destination and that patients arrive on-time.

Any unloaded radioactive cargo, rescheduled flights or poor patient presentation rates significantly impact the commercial viability of the enterprise. In addition, we service a low socio-economic region where imposing any gap payment would prevent many from

undertaking a scan. So, it is a fine margin of error between black or red ink on the P&L and it takes some time to recover from the damage of too many unexpected national airplane strikes (thanks again Qantas!), major equipment failures or network outages.

The concept of a proposed FIFO “telenuclear medicine” operation was completely out of the box in 1997.

It was the vision of the inimitable Dr Johnny Walker who wanted to bring metro standard care to those in rural areas and I was charged with the duty to try and nudge the boundaries a little and seek exemptions for such a plan. Getting it started wasn’t easy. Maybe I’m a little unkind but lateral thinking never seems to be a strong trait of regulatory authorities and bureaucracy. It was certainly a tall order to shift rigid, entrenched mindsets but when confronted with the sobering data of increased mortality and morbidly rates in rural areas we steadily generated much goodwill towards our novel proposal. Our determination to find a way through gathered support and steam.

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ARTICLES Nuclear Medicine in the Wild Wild West! (Continues) Thus, on 17 November 1998, we performed Kalgoorlie’s first three phase bone scan for the investigation of osteomyelitis in an ulcerated, diabetic foot employing a repurposed Elscint Apex 409 ECT at probably the most remote nuclear medicine site on the planet.

I had a love/hate relationship with that scanner and its stability was not helped by the region’s daily mini-earthquake (at 5pm each day there is a blast at the “super-pit” the massive open cut mine close to town). That Elscint scanner forced me to lift the hood and learn the fundamentals of nuclear imaging equipment myself. By the time it was decommissioned, I had personally replaced every part at least twice and could slot in a new circuit board faster than I could toast bread, which was a practical necessity if you wanted to get a patient completed before the return flight home to Perth.

The two local surgeons and a visiting cardiologist originally flanked the department. The regional hospital was well staffed by dedicated general physicians and the everversatile rural GPs. Along with very grateful patients, the medical teams were excited to have this new technology in town, giving them local access to our nuclear medicine staples such as the bone, thyroid, cardiac and renal scans. In the era before multi-slice CT, d-dimer and troponins “when in doubt, fly it out” was often the catch cry, especially if pulmonary embolus or unstable angina was suspected and the RFDS was kept busy shuffling patients to Perth. I am quietly

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confident in saying that over the years, I think we have saved many unnecessary patient air-transfers and, equally, helped many achieve an earlier diagnosis and subsequent treatment. And as a personal plus, I now have an impressive number of pilots as Facebook friends thanks to the protocol which formerly required that we personally check the radioactive load sheet with the cockpit as we boarded.

We all know that in this life you have to sink or swim and for nuclear medicine in the remote areas this meant that sharpening up on scan interpretation was essential.

Despite using the first iteration of teleradiology, in 1998 the data had to travel from Kalgoorlie to Perth via modems which maxed out at 9600 baud rates over unpredictable copper telephone lines. Scans with a processed SPECT, for example, could take over 60 mins! Therefore, offering preliminary results at the end of the day whilst on route to the airport became the norm for the more urgent cases. Nowadays data transfer is almost instantaneous and accessible to all via web based technology but being more closely engaged with the scan findings still remains an important aspect of daily activities.

In relation to Aboriginal health, it continues to frustrate me that despite all our technology and connectivity, large discrepancies in mortality and morbidity persist for many conditions. My time in Kalgoorlie has provided me with an important education on contemporary Indigenous issues.

When you work here these issues are no longer abstract and the health inequality is right there before your eyes. Myocardial infarction ravages the young Indigenous at a rate up to 30 times that of non-indigenous with event rates for males between 35-39 years equivalent to that of non-indigenous males aged 60-64 years (AIHW data). Across a broad spectrum of cancers there remains inferior care and poorer survival rates for regional patients (Australian Journal of Rural Health, Vol.23, 2015) and the Closing the Gap report of 2016 indicated stagnant progress in reducing mortality rates, with some even worsening.

But even without the statistics and regardless of the politics, at a human level it is confronting to witness the poor quality of life experienced by the original inhabitants of the Goldfields, Nullarbor and Central Desert regions.

Early on, we would often encounter high numbers of DNA’s (did not attend) for Indigenous patients and staff would just shrug their shoulders and eventually give up rescheduling. “That’s just how it is”, I was assured. Sometime later, an Aboriginal Liaison Officer (ALO) taught me that many indigenous people see hospitals as the place where you go to die rather than where you are healed and this prompted us to implement a different approach in arranging bookings. DNA rates are now much lower thanks to the close assistance and co-ordination of the culturally appropriate support centres, particularly in relation

ARTICLES Nuclear Medicine in the Wild Wild West! (Continues) to traditional Aboriginals from the remote “lands’. I’ve learnt about faraway places, previously unheard of by me, like Wingellina, Kiwirrkurra and Warakurna whose inhabitants are flown in by the Ngaanyatjarra aircraft.

These nomadic souls are often accompanied by an ALO who acts as a translator as we attempt venous access on arms adorned with traditional scarification. I have also developed a proper sense of the destructive legacies of the paternalistic laws such the incongruously titled “Aborigines Protection Act” as we often engage with patients who were part of the “stolen generation” (which continued up until the late 1960s) and who are unable to provide much insight into their family’s medical background. Despite the challenges, it certainly has been a privilege to fly the nuclear medicine flag and contribute, however small, towards supporting the aboriginal medical services in the way we have.

I hope to continue to fly that flag but the future is uncertain. Given Medicare rebates remain static and the costs involved in running the operation continually increase it gets more difficult each year. I owe much to Dr Nat Lenzo for his support, mentoring and friendship and we receive a small grant from the Commonwealth.

We are also hopeful for some new assistance from the corporate sector. Whilst it is always exciting to learn of advances with PET/MRI technology, Gallium PMSA therapy and the exotic new radiotracers I fear it will be many years before rural populations enjoy local access to such improvements in healthcare. Reaching a basic standard is difficult enough.

ARTnet Presentation at 2017 SNMMI Meeting, Denver, Colarado, June 10-14, 2017 ARTnet study presented at SNMMI conference, results published in the Journal of Nuclear Medicine.

A multi-centre, prospective evaluation of management impact of 68Ga-PSMA PET/CT in prostate cancer patients was presented by A/Prof Paul Roach on behalf of ARTnet colleagues at the recent SNMMI conference in Denver. The abstract was selected as one of the highlights of the conference, and was included in a press release by SNMMI during the conference.

The study involved 431 patients with prostate cancer from four Australian centres, and management plans were obtained pre and post 68Ga-PSMA PET/CT. 68Ga-PSMA PET/CT led to a change in management in 51% of patients, and the impact was greater in the group of patients with biochemical failure post definitive surgery and /or radiation treatment (62% change in management intent) compared with patients undergoing primary staging (21% change).

Imaging with 68Ga-PSMA PET/CT revealed unsuspected disease in the prostate bed in 27% of patients, locoregional lymph nodes in 39% and distant metastatic disease in 16% of patients.

The manuscript of this study was accepted by the Journal of Nuclear Medicine in record time, and has been published online: http://jnm.snmjournals.org/content/early/2017/06/22/jnumed.117.197160.abstract This is the first study conducted by ARTnet that has led to publication, and the quality of the research is reflected in the priority given for its presentation and publication at major international forums.

ARTnet continues to achieve success with projects, including the recently commenced proPSMA trial. Further updates will be provided in future editions of the Gamma Gazette.

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FINANCIAL STATEMENTS STATEMENT OF PROFIT OR LOSS AND OTHER COMPREHENSIVE INCOME FOR THE YEAR ENDED 31ST DECEMBER, 2016 Note

Revenue Conference, meeting and committee expenses Journal expenses Research grant Management costs Administration expenses Depreciation expenses Sponsorship Website Development and maintenance costs Loss before income tax for the year Income tax expense Net loss for the year Other comprehensive income Total other comprehensive income for the year Total comprehensive income for the year Total comprehensive income attributable to the members of the entity

2016 $

2015 $

2 247,632 335,059 (100,765) (112,079) (11,733) (10,223) (20,000) (20,000) (139,167) (130,327) (26,749) (46,381) (296) (357)

- (5,045) (10,288) (13,847)

2 (61,366) (3,200)

- (61,366) (3,200)

-

-

(61,366) (3,200) (61,366) (3,200)

The accompanying notes form part of these financial statements.

STATEMENT OF FINANCIAL POSITION AS AT 31ST DECEMBER, 2016 ASSETS CURRENT ASSETS Cash and cash equivalents Trade and other receivables Other assets TOTAL CURRENT ASSETS NON-CURRENT ASSETS Property, plant and equipment TOTAL NON-CURRENT ASSETS TOTAL ASSETS CURRENT LIABILITIES Trade and other payables

44 / gamma GAZETTE / July 2017

Note

2016 $

2015 $

3 637,769 827,629 4 13,477 8,613 5

64,580

53,730

715,826 889,972

6 2,288 2,584 2,288 2,584 718,114 892,556

7 6,996 12,200

FINANCIAL STATEMENTS STATEMENT OF FINANCIAL POSITION AS AT 31ST DECEMBER, 2016 Note

Revenue in advance TOTAL CURRENT LIABILITIES TOTAL LIABILITIES NET ASSETS EQUITY Retained earnings TOTAL EQUITY

2016 $

2015 $

8 94,996 202,868 101,992 215,068 101,992 215,068 616,122 677,488

616,122 677,488 616,122 677,488

The accompanying notes form part of these financial statements.

STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31ST DECEMBER, 2016

Balance at 1 January 2015 Loss attributable to the entity Balance at 31st December 2015 Loss attributable to the entity Balance at 31st December, 2016

Retained Earnings $

Total $

680,688 680,688 (3,200) (3,200) 677,488 677,488 (61,366) (61,366) 616,122 616,122

The accompanying notes form part of these financial statements.

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FINANCIAL STATEMENTS STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31ST DECEMBER, 2016 CASH FLOW FROM OPERATING ACTIVITIES Receipts from members & other operating activities Interest received Payments to suppliers and contractors Net cash provided by operating activities CASH FLOW FROM INVESTING ACTIVITIES Payment for property, plant and equipment Payment for intangible asset Net cash used in investing activities Net Increase in cash held Cash at the beginning of the financial year Cash at the end of the financial year The accompanying notes form part of these financial statements.

46 / gamma GAZETTE / July 2017

Note

2016 $

2015 $

145,040 423,457 13,065 20,214 (347,965 (360,468) 9 (189,860) 83,203

-

-

- (189,860) 83,203 827,629 744,426 3 637,769 827,629

2017 AGM MINUTES DATE: TIME: LOCATION:

SUNDAY APRIL 23, 2016 12:30 PM CONCERT HALL, GRAND CHANCELLOR HOTEL, HOBART.

1. ATTENDANCE Eighty attendees were present which under the Constitution is regarded as a quorum. Evidence of these attendees was by way of AttendO app registration or by sign in sheets maintained by the Secretariat.

2. APOLOGIES Apologies from Clayton Frater, Sue O’ Malley and Clare Radley were received at the start of the meeting.

3. CONFIRMATION OF MINUTES OF THE 2016 ANNUAL GENERAL MEETING (AGM) The minutes of the previous AGM at the Bay Trust Forum, Energy Events Centre, Rotorua, NZ on 24th April, 2016 were accepted as a true record.

4. BUSINESS ARISING FROM THE MINUTES No items were raised.

5. PRESIDENT’S REPORT FROM THE COUNCIL 2015/16 The President Dale Bailey commenced his presentation with a diagram of the Society’s structure showing the different groups and committees responsible for the Society’s activities.

He commented on the many new developments occurring in the field leading to what will likely be regarded historically as a “renaissance” in Nuclear Medicine. Australia was in a better position than many countries to take advantage of these exciting developments. However there remained the challenge for these new techniques to be widely adopted and reimbursed by Governments in Australia and New Zealand.

Changes were also occurring in all the professional groups in Nuclear Medicine including the loss of registration powers and therefore the Society must be multidisciplinary and adaptable in its response to these changes. The need to provide up to date continuing medical/professional education/development, particularly for the Technologists, was therefore critical. Material relevant to all members would be appearing on the Society’s new revamped website which would act as a repository of material provided both locally and from pre-existing external sources. However, these resources would have questions and categories curated by a web/CPD group setup by the Society.

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2017 AGM MINUTES The relationship between Industry and the Society continues to grow with several companies taking up the new Corporate Sponsor package and more expected to follow. The Nuclear Medicine Liaison Group comprising of ANSTO, the Society and AANMS representatives was about to commence and would address issues related to the supply and distribution of nuclear medicine related materials in Australia. Volunteers to fill the required positions would shortly be called for.

The President offered the Society’s formal congratulations in the recent Australia Day awards to Professors Rob Howman-Giles, Andrew Scott and Vijay Kumar, and also to Dr Trevor FitzJohn of New Zealand for his Award of an Officer of the New Zealand Order of Merit.

The 2017 meeting in Hobart had been structured differently to those in the past, with a program lasting two and a half days over a weekend. Feedback is welcome on this format to see if it is appropriate.

2018 will be a significant year for the Society with the 50th anniversary of its founding and the World Federation of Nuclear and Molecular Biology (WFNMB) World Congress meeting in Melbourne from April 20 -24; this would include one specific day dedicated to ANZSNM activities of presentations and awards including the Annual General Meeting.

The WFNMB meeting was equivalent to the Olympics with countries vying for the hosting honour and with many top international speakers covering topics of relevance for all facets and levels of Nuclear Medicine. With the event over five days it provided members the chance to experience an international event locally.

The President concluded with his appreciation of thanks to members of Council and the Secretariat.

There were no further points of discussion.

6. TREASURER’S REPORT A summary of the audited accounts for 2016 was visually presented and compared to 2015 which showed a deficit of $61,000; the full accounts were previously available on the Society’s website.

In presenting the Income Statement the Treasurer, Dominic Mensforth advised that the increased loss compared to the previous year was expected and related to the relatively small and planned for revenue contribution from the Rotorua Annual Scientific Meeting 2016. The 2017 and future conferences were likely to deliver greater revenue for membership activities and together with continuing efforts to reduce costs, the Society was planning for a balanced budget in 2018/19. The Treasurer confirmed that there would be no change in membership fees.

There were no matters raised for discussion.

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2017 AGM MINUTES 7. REPORTS FROM THE SPECIAL INTEREST GROUPS The President briefly reviewed all the various Special Interest Groups and Committees as shown in the previous organisational structure and indicated that all were active, contributing to the overall value of the Society and operating in a way that minimised costs.

8. FUTURE MEETINGS 2018/2019 A presentation on the WFNMB 2018 meeting would be given by Profr Andrew Scott at the conference closing ceremony later that day.

It was likely that the 2019 meeting would now take place in Adelaide but that is still to be confirmed.

9. LIFE MEMBERSHIP TO BRIAN HUTTON Hon. Life Membership had been presented to Professor Brian Hutton at the conference dinner the previous evening and the meeting acknowledged Professor Hutton on his achievement.

10. FEDERAL COUNCIL CHANGES Two members had retired from Council in the last year; these were Sue O’Malley and Elizabeth Bailey and the President thanked them both for their significant services and contribution to Council and the Society.

New council members were Nick Ingold (ACT), Victoria Brookes (NZ) and Marcia Wood (TSIG) and they were welcomed to Council.

11. BUSINESS WITHOUT NOTICE There were no further items for business without notice. The meeting was declared closed at 1:00 PM. _________________________________ President Dale Bailey

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