Application for Recognition of Training in CT Colonography To facilitate the application process, applicants should refer to the current version of the RANZCR Requirements for the Practice of Computed Tomography Colonography (CTC) before completing this form. They are available from: https://www.ranzcr.com/fellows/clinical-radiology/quality-assuranceand-accreditation/ctc Applications for recognition of training and any related appeals are assessed by the CTC Accreditation Committee of the RANZCR Abdominal Radiology Group of Australia and New Zealand (ARGANZ). The application fee for CTC Specialist Recognition is $330 (incl. GST). Applicants are advised to submit applications only after careful consideration of the requirements. Applications are subject to random audit; applicants that fail random audit will not be considered for resubmission for a period of twelve months at which time the full application fee will apply. Further information is available from https://www.ranzcr.com/fellows/clinical-radiology/qualityassurance-and-accreditation/ctc Please send your completed application form, supporting documentation, and excel logbook to: Email: CTC.AccreditationCommittee@ranzcr.com 1
Section One: Personal details (Please print) Full name: Email: Phone: Mobile: Address: Section Two: Specialist Qualifications Checklist of Required Evidence you have provided: Relevant Australian Medical Board or New Zealand Medical Council Registration Specialist radiology qualification* *Evidence of RANZCR affiliation by way of: 1. Fellowship; OR 2. Educational Affiliate Membership (or eligibility for Education Affiliate Membership); OR 3. Successful Area of Need or Overseas Trained Specialist assessment. 2
Section Three: Evidence of Training Successful applicants must provide evidence of relevant course work and case work. Part I Course Work Applicants are required to provide information about the CTC courses or supervised training carried out in a practice setting that they have completed. Applicants must include a copy of all relevant documentation demonstrating completion of training. Please indicate the type of training that you have undertaken: Hands-on Workshops Please tick Hands-on workshops include courses conducted under the auspices of RANZCR/ARGANZ, or by recognised overseas programs in Europe, Asia and the United States. Radiology vendors may also periodically hold CTC courses. Evidence Required: Training certificates from workshops and courses attended Abdominal Imaging Fellowship Programs There are many fellowship or advanced training positions in Australia, New Zealand and overseas training positions that may be formally geared to providing accredited training in CTC. This exposure needs to be formally recognised by a logbook. Evidence Required: Detailed letter from fellowship programs that provide advice on details of the training received and whether the training meets the CTC Guidelines of live cases or not On-Site Training On-site training includes training provided to individuals under the supervision of a recognised specialist in CTC. Evidence Required: Letter of attestation from the CTC Specialist supervisor detailing the training that was delivered Other Please provide details about any other training that you have completed and attach all relevant documentation: 3
Part II Case Work Applicants must provide documentary evidence of at least 60 CTC cases. At least 10 of these cases must be "live" cases where the radiologist is personally present for the duration of the examination, and the radiologist's name appears on the report. Radiologists undergoing training in CTC must ensure that their name is noted on the patient's report as the co-reporting CTC Trainee. In circumstances where it is not administratively possible for the CTC Trainee's name to appear in the patient's report, each supervised report produced by the CTC Trainee under supervision must be cosigned by the supervising CTC Radiologist, and must be retained by the CTC candidate. Total live scanning cases: Please enter data here Requirements under Grandfathering arrangement Documentation provided (please tick) Cases personally performed where the radiologist is personally present for the duration of the examination, and the radiologist's name appears on the report. Radiologists undergoing training in CTC must ensure that their name is noted on the patient's report as the co-reporting CTC trainee i. Minimum 10 cases Total Library Cases Maximum 50 cases Total CTC cases 60 cases from within past 3 years Live cases for grandfathering purposes are those where the radiologist is personally present for the duration of the examination, and is the reporting radiologist for the examination which is documented on the patient's report. PLEASE NOTE: 1. Under grandfathering arrangements declared cases must be accompanied by a RIS record, logbook or similar supporting evidence (e.g. course certificate). It is recommended that candidates use the RANZCR CTC Logbook Template Registration to document any or all of the cases claimed. 2. Applications are subject to random audit. If selected for random audit, the applicant will need to show documentary evidence of the cases claimed. 3. Applicants should refer to the RANZCR Guidelines for the Practice of CT Colonography for guidance. 4
4. Once registered, CTC Specialists must interpret a minimum of 30 examinations per year for ongoing competency, which must be recorded in the RANZCR CTC Logbook Ongoing Competency. All cases must be worked up by the applicant on a workstation from raw data. 5. CTC Specialists must record and declare whether or not that have completed their ongoing competency requirements by sending an annual email declaration to: CTC.AccreditationCommittee@ranzcr.com 6. CTC Specialists who do not maintain their ongoing competency requirements will be suspended from the CTC register until such time as they submit a logbook of 30 examinations. Glossary of Terms Live Cases Live cases are those where the radiologist is personally present for the duration of the examination, and the radiologist's name appears on the report. Radiologists undergoing training in CTC must ensure that their name is noted on the patient's report as the co-reporting CTC trainee. Live cases for grandfathering purposes are those where the radiologist is personally present for the duration of the examination, and is the reporting radiologist for the examination which is documented on the patient's report. Library Cases Blind cases with correlation worked up on a workstation from raw data. 5
Section Four: Declaration I, (printed name and address of person making the declaration) Make the following declaration: 1. I have read and understand the instructions on page 1 of this application, and the information in the RANZCR Guidelines for the Practice of CT Colonography. 2. The information contained in this application form is accurate and complete, as is the supporting material provided. 3. I understand and accept that the College may contact a facility, course convener or CTC Specialist declared in my logbook in order to confirm my declared CTC training activity. 4. I agree that upon being recognised by the RANZCR as a CTC Specialist, I will be required to meet minimum ongoing competency and Continuing Professional Development requirements in order to retain such recognition. 5. I have also supplied the following documentation: Please tick: Specialist Qualification evidence Evidence of training Logbook of case work I certify that the statements and information provided in this application are true in every particular. Signature of person making the declaration Date Section five: Payment All payments to the College from individuals are made online via our online portal, MyRANZCR. You will receive an email notification when your invoice is ready for payment. 6