RADIOACTIVE.html
Review of 2011
In a year characterised by international political turmoil and
economic uncertainty, there are numerous issues which are of simmering
concern to South African radiologists, as political initiatives may
dramatically change healthcare economics. There are also significant
changes imminent in how we become radiologists and aspects of how we
practice.
Congratulations to Professor Savvas Andronikou on again being
elected President of the College of Radiology, and thanks to Professor
Coert de Vries for the time he has served. In recognition of the need
for time to cover the syllabus, some institutions are using the primary
exam as an entrance examination to the registrar programme, while
others are looking to a 5-year curriculum. The unification of the
curricula and the unified examination with dissertation are becoming a
reality. The SAJR continues to
strengthen; it is a vehicle for publication of dissertations, and the
collaboration through the ISR with Professor Eric Stern’s GO RAD
initiative is a welcome enhancement to the international profile of our
journal. Congratulations and thanks to Professor Jan Lotz and all those
involved for the work being done.
The CME Fund, now formally constituted
with trustees Dr Thami Ngoma, Professors Zarina Lockhat and Leon Janse
van Rensburg, and Dr Johan Basson, is fully functional and has healthy
finances. During this year, funds were made available to the academic
institutions for the purchase of books for departmental libraries. I
was able to visit many of these and was impressed by the enthusiasm on
the ground; it is our hope that, through the CME Fund, we will be able
to pursue initiatives that can further strengthen radiology training
and academic radiology within South Africa. The active congress
programme organised by Professor Leon Janse van Rensburg is anticipated
to cover major areas of the syllabus over a 4 - 5-year cycle, giving
all radiologists, and particularly those in training, the opportunity
to continually update knowledge with renowned international speakers
visiting South Africa. The hands-on CT workshops have proved popular
and are excellent learning experience, but the nature of these meetings
is that spaces are limited.
The SORSA-RSSA meeting in Durban is part
of an ongoing collaboration with radiographers, and panel discussions
on contrast injection by radiographer, and radiographer role extension,
were a specific focus this year. The clinical mammography and MRI
course was popular. There were two key messages: BI-RADS should become
the standard reporting format, and breast MRI is assuming an
increasingly important role. An important parallel session was the
Functional MRI of Physiological Processes workshop. The RSSA short
course on Current Ethical issues in Radiology has now been presented in
Cape Town, Johannesburg and Durban.
At the RSSA MDCT congress in Sandton this
year, our prizes for poster and paper presentations were awarded (see
report in this section of the journal). The international judges were
impressed by the high quality of both the paper presentations and the
posters, and all who participated are to be commended. Of the
subgroups, SAMSIG (musculoskeletal) continues to be active, and the
formal formation of SASNI (neuroradiology) and SASPI (paediatric
radiology) was completed this year. It is hoped that the Red Cross
Paediatric Fellowship will be reinstated, and we anticipate new
fellowships in neuro-imaging and musculoskeletal imaging in which the
expertise within these subgroups will play a major role. And it is
anticipated that a breast imaging sub-group will take shape this year!
The RSSA has been invited to participate in the ‘ESR meets South Africa’
programme at ECR 2013, and we look forward to the opportunity to show
work that has been done in South Africa, particularly in HIV and TB.
The ESR continues to extend the hand of friendship to those beyond the
borders of the EU, and visiting fellowships and other educational
opportunities are available via RSSA affiliation with the ESR. The
links are on the website.
If you are a member of the RSSA, please ensure that your details are
up to date so that we can keep you informed of upcoming events; and if
you are not, please join. For those not in private practice, the fees
are low and members enjoy the free journal and cheaper rates at our
congresses. Contact Patricia Trietsch, Radiological Society of South
Africa, email radsoc@iafrica.com, and website www.rssa.co.za, tel. 011
794 4395 and fax 011 794 4313.
For those in private practice, the reference price list
as promoted by the Department of Health on a cost-based methodology is
at an advanced stage of development and, in anticipation of NHI, will
provide a defensible transparent tariff structure. It has become clear,
however, that the HPSCA will not be in a position to publish tariff
lists for 2012; no other body has authority to do so. Other statutory
bodies, such as the Law Society and that for architects, have published
tariff guidelines for many years without any intervention from the
competition commissioner, and it is hoped that healthcare will
eventually have a robust published tariff structure.
Co-payments remain contentious. Co-payments are permissible as a
percentage of the fee for an examination and were designed to ensure
that patients, by assuming responsibility for a part of the fee for an
examination, would not undertake these examinations lightly. However,
funders are increasingly using fixed high co-payments as a tool to
avoid payment for examinations that fall below the co-payment value.
This is contrary to what was originally envisaged and, on an ethical
basis, highly questionable as it amounts to the removal of benefits by
stealth. The patient does not have sufficient knowledge to be involved
in the choice of examination, and co-payment considerations can lead to
inappropriate choice of modality. The Society accepts the principal of
co-payment as a percentage of the examination fee. However, we cannot
countenance the use of co-payments by funders to, in effect, withdraw
benefits from patients. As co-payments increase, the number of
examinations not actually covered increases.
National health insurance, with the
publication of the green paper, is starting to assume a more concrete
form. However, there is still little detail. Risk-adjusted capitation
at the primary level is suggested, with global budgets at the hospital
level. Currently, whether the patient or the funder is responsible for
payment may depend on the patient status as an inpatient or outpatient.
For radiology, this makes little sense. Radiology occupies a unique
space at the cusp serving the needs of inpatients and outpatients, and
many of our investigations determine who will be admitted and who can
be safely sent home. Image-guided, minimally invasive procedures
performed on outpatients may prevent costly admissions altogether.
There does not yet seem to be any indication as to how radiology will
be funded in a future NHI environment or how to ensure a level playing
field. We have an opportunity to comment on the contents before the end
of December this year, and I would encourage all radiologists to read
the document and submit comment to the Society to ensure that all
radiologist concerns are adequately addressed in our formal submission
on the green paper. Universal coverage is a noble ideal that has broad
support. Problems in the public sector should be addressed as a
priority. It is encouraging that the Minister of Health recognises a
role for the private sector, and acknowledges that correcting problems
in one sector should not destroy the other. Expertise, infrastructure
and capacity in the private system should be used to extend quality
health care. There are future opportunities for radiologists to
contribute to training in our own speciality, to service delivery
particularly using electronic image transfer, and by providing a
quality service to a population currently underserved.
Radiology is a referred-to specialty, and it is appropriate that the
clinician requesting the examination does not stand to benefit from the
performance of the examination. Our aim should be to practice
appropriate evidence-based radiology. Bad referrer habits and funding
considerations may work against this ideal. The RSSA has succeeded in
securing the right to use the ACR guidelines, which will be of use to
referrers, radiologists and funders whether private or public.
The attenuation of the Road Accident Fund
has lead to significant increased activity of lawyers touting for
business in the media, with the main focus of the business being
medical litigation. The Medical Protection Society has experienced a
dramatic increase in medico-legal cases in both the private and public
sectors, and this is a trend of major concern. This problem has
previously developed in other jurisdictions in which the MPS operate,
and they have advised that we need to be proactive in two aspects:
Firstly, at the level of the legislative framework in which we
operate, it is important to note that legal contingency fees are a
contributing factor not only to the increased number of cases but also
to the size of the settlement demanded and, if we are to avoid
malpractice insurance becoming unaffordable, it is essential that the
underlying causes are addressed. It is inherently repugnant that, where
a patient has suffered and is justly deserving of a high settlement,
the lawyer involved is entitled to disproportionately high remuneration
that is at the expense of the remainder of the health budget, in the
case of the public sector or those contributing to malpractice
insurance in the private setting. It is hoped that the MPS engagement
with the relevant ministries will be successful.
Secondly, we need to re-examine the way in which we practice and
ensure that we do so in such a way that opportunities for medical
litigation are limited. Poor communication, or failure of
communication, is a factor in at least 70% of litigation cases. It is
essential that, as radiologists, we ensure that communication with our
clinical colleagues is above reproach and, in particular, to ensure
that urgent or important results are communicated effectively to the
referring clinician. The continued roll-out of RIS PACS systems brings
renewed problems, with a conflict between considerations of patient
confidentiality and the ability of clinicians to easily view the images
from other clinicians, institutions and systems. Image distribution
systems are critical, particularly as doctors in theatres may be using
images on the systems, and they need to be able to function even when
the supply of power may be unreliable. Proper communication is
sufficiently important in respect of medical malpractice that the MPS
has arranged a series of free workshops which carry ethics CPD points,
and radiologists are actively encouraged to attend these workshops. At
a meeting with the MPS that I recently attended, a representative from
the HPCSA was present, and it is possible that attendance at MPS
workshops may become part of the ethics requirement.
I thank all those within the RSSA who have the ability or aptitude
to contribute in some way and have done so by teaching of registrars,
supporting academic departments, volunteering to become examiners or
reviewers, and contributing to the journal or participating in
subgroups.
Finally; the recent liquidation in radiology is a sober reminder to
hospitals, vendors, investors who may have burnt their fingers, and
funders that, in an industry with high fixed costs, viability can be
precarious.
May I close by wishing all RSSA members, in private and public settings, success in 2012.
Clive Sperryn
President, RSSA
Visit by RSSA President to Stellen-bosch University
Dr Clive Sperryn, President of the Radiological Society of South
Africa, was the guest of the Division of Radiodiagnosis at Tygerberg
Academic Hospital on 1 August 2011. Dr Sperryn joined the Division for
lunch and was an invited speaker at the weekly modular Academic
Programme, during which he made a donation of selected textbooks to the
value of R25 000 to the Division’s imaging reference library.
This formed part of the RSSA’s broader donation of textbooks to
university radiology departments nationwide.
In thanking Dr Sperryn for the very generous donation, Professor
Richard Pitcher, Head of the Division, acknowledged the RSSA’s
sustained support of academic radiology in South Africa. Professor
Pitcher made particular mention of the significant growth, over the
last five years, of the Society’s official mouthpiece, the South African Journal of Radiology,
under the editorship of Professor Jan Lotz. He also cited the
Society’s highly successful Conference Programme convened by
Professor Leon Janse van Rensburg, which had culminated in the
formation of the RSSA’s CME Fund, from which the national library
donations had been made. In addition, over the past years, a number of
Stellenbosch University registrars had been able to attend
international congresses as recipients of CME Fund Travel Awards, made
for prize-winning oral and poster presentations at the Society’s
annual national congress.
Leuven lung imaging
The first of the RSSA/Leuven HRCT lung imaging courses will take
place on 17 - 19 February 2012 at the Sandton Sun Hotel in
Johannesburg, and on 24 - 26 February 2012 at the Spier Estate near
Stellenbosch in the Western Cape.
This hands-on, interactive teaching course on high resolution
computed tomography (HRCT) of the lung is internationally acclaimed and
recognised as the lung course to do, and is in extremely high demand.
The course is conducted by internationally renowned and leading Belgian
radiologists Professors Dr Johny Verschakelen and Walter De Wever, of
the Department of Radiology, University Hospitals, Catholic University
of Leuven, (K.U. Leuven), Belgium. This is the first time that two
back-to-back courses will be conducted and, on behalf of the RSSA, I
extend our most sincere appreciation and gratitude to Professors Dr
Verschakelen and De Wever.
A cost-effective, pragmatic and comprehensive HRCT imaging approach
to patients with lung disease is of particular importance to all
radiologists providing a service to these patients, as well as the
clinicians and therapists caring for them. The human and social impact,
and financial implications, of lung disease are far-reaching,
especially in developing countries.
The aim of the course is to train and update radiologists and
teach those in training in state-of-the-art HRCT imaging of the lung.
On completion of the course, participant should be able to recognise
the different basic disease patterns that can be seen on HRCT of the
lungs, and to make a diagnosis or suggest a differential diagnosis. The
indications and limitations of HRCT in different lung diseases will be
emphasised.
Starting with an overview of lung disease and applied radiological
anatomy, the course will focus upon the HRCT appearance of common and
uncommon lung diseases and the interpretation of findings. Apart from
lectures, practical teaching will be done during workshops where
participants will have the opportunity to test and expand their
knowledge by reviewing clinical cases, with direct tutoring and
feedback from the teachers.
The course will be held at the modern, impressive and conveniently
situated Sandton Sun Hotel in Johannesburg and again at the historic,
beautiful and tranquil Spier Estate, surrounded by the verdant
mountains and vineyards of the Stellenbosch area Owing to the technical
and logistical requirements in presenting such a course, and to ensure
interactivity with the teachers, enrolment is limited to 80 RSSA member
participants per course. Please go to
http://www.rssa2012lungcourse.co.za/registration for course and
registration details.
The organization of such an event is challenging and no small feat.
I extend my sincere appreciation to the RSSA congress event organiser,
ConsultUS and the audio-visual team Presentation Staging, for making
this possible.
I take great pleasure and pride in welcoming Professors Dr Johny
Verschakelen and Walter De Wever to South Africa, and wish them an
enjoyable visit.
Leon Janse van Rensburg
RSSA Congress Chair
RSSA MDCT course – August 2011
The first RSSA Essentials in MDCT/CTA Course was held at the Sandton
Convention Centre from 26 - 28 August 2011. The central location, easy
access from the airport via the Gautrain, and the international faculty
of four exceptional international radiologists contributed to a record
attendance of 340 of whom 270 were radiologists. Congratulations to
Professor Leon Janse van Rensburg who was able to persuade
distinguished Professor Elliot Fishman of John Hopkins University
School of Medicine, USA, to co-ordinate the course.
The course focussed on 64-slice MDCT and newer systems including
dual-source CT scanners. The programme consisted of a series of
40-minute lectures that concentrated on specific topics in depth,
including state-of-the-art technology and software. Participants had
the opportunity to expand their knowledge of the latest concepts and
principles of spiral/helical CT, with Professor Fishman emphasising the
importance of studying the volumes and interacting with the datasets to
optimise image interpretation. Professor David Naidich elucidated HRCT
and provided a fascinating insight into imaging of the sub-solid
nodule. Professor Jill Jacobs highlighted the intricacies of cardiac CT
and CTA. Professor Karen Horton emphasised the complementary 2D and 3D
techniques in CT colonography and imaging of small-bowel neoplasms. The
use of CT in the GI tract, including the liver, spleen and kidneys,
were all extensively covered.
There were anxious moments for the visiting faculty who had their
return travel arrangements disrupted by Hurricane Irene on the east
coast of the USA. Our thanks to them all for making the trip to South
Africa, and we hope that they will return.
Congratulations to all those who participated in the poster and
paper presentations. Our esteemed international judges were extremely
impressed, and confirmed that these presentations were of an
international standard. The prizes were awarded as follows:
2011 RSSA Travel Award: R40 000. To Dr
Lizelle Clark: The role of multi-detector CT angiography as an
adjunctive tool in the evaluation of paediatric cardiac disease in an
African setting.
2011 RSSA Travel Award: R20 000. To Dr Braham van der Merwe: How we eyeball the small bowel: Newly introduced CT enteroclysis at Tygerberg Hospital.
2011 RSSA Best Poster Prize R15 000. To Dr Vicci du Plessis: Baseline chest radiograph appearances of HIV-infected children eligible for anti retroviral therapy.
2011 RSSA Poster Prize R10 000. To Dr Werner Steyn: Vanishing white matter disease, MRI imaging over four years.
2011 RSSA Poster Prize R5 000. To Dr Nishentha Govender: Adequacy of paediatric renal tract ultrasound.
Thanks to the Scientific Committee of Professor Victor Mngomezulu
(chairperson), Professor Zarina Lockhat and Dr Christelle Ackermann; to
Sune van Rooyen and the ConsultUS team for seamless organisation; and
to all our sponsors for their support. We greatly appreciate their
commitment to radiology training and teaching.
Clive Sperryn
President, RSSA
Dr Clive Sperryn, President of the
Radiological Society of South Africa (centre), with members of the
Division of Radiodiagnosis at Stellenbosch University, surveying the
Society’s recent book donation.
(From left to right) Professors Leon Janse van
Rensburg, Jill Jacobs (USA), Margaret Kinsana (Univ. Limpopo), David
Naidich (USA), Zarina Lockhat (Univ. Pretoria) and Elliott Fishman
(USA).