September 2000

Polyclinic imaging director prepares for Olympic challenge

Dr. Jock Anderson explains how the Polyclinic in Sydney has benefited from technological advances over the past four years

Thousands of Olympians will arrive in Sydney this month in peak athletic condition, their muscles and joints primed to redefine the ultimate in physical performance. With medals and records hanging in the balance, if ever there was a bad time for an injury or illness, this is it. So as director of medical imaging at the Polyclinic, where the athletes and other Olympic guests will go for diagnoses and treatment during the Games, Dr. Jock (Ian F.) Anderson has his work cut out for him.

Sports imaging has long been a way of life for Anderson, a graduate of Sydney University Medical School, who lectures at his alma mater and at the University of New South Wales in addition to running his practice as a partner at North Sydney Orthopaedic & Sports Medicine Centre. Or at least he did until recently, when planning for the Polyclinic took over his professional life.

Anderson spoke with Diagnostic Imaging about the challenges and rewards of his position, and he provided a sneak preview of the ways the 2000 Polyclinic has benefited from technological advances over the past four years.

DI: How did you become director of medical imaging at the Sydney Olympics, and what does the position entail?

Anderson: About three years ago, I was approached by Dr. Danny Stiel, who had just been appointed director of medical services for SOCOG. This is an unpaid, volunteer position. Danny explained that my task would be to plan, equip, staff, and administer an imaging service within the Polyclinic. We will care for 25,000 people during the Games, including 10,500 elite athletes; 5000 coaches, trainers, team medical staff, and administrators; and 10,000 volunteers working in the village. The Polyclinic will be in service from Sept. 2, when the athlete’s village opens two weeks before the Games start, until Nov. 2, the day after the Paralympics closing ceremony—a period of about 60 days.

Danny Stiel told me that funds were limited but it would be a great challenge and a unique opportunity. It took me about two seconds to make up my mind and so here I am.

DI: What do you consider your strengths and weaknesses for the job?

Anderson: I have had a long association with sports medicine and sports medicine imaging, and I have been in a specialist practice in a large sports medicine clinic for 15 years. I am the author of two textbooks on sports medicine imaging and have contributed to a number of other texts. I lecture at the two major universities in Sydney and recently was awarded an honorary fellowship from the Australian College of Sports Physicians, after a long history of teaching at that college. I am also the honorary medical officer for New South Wales Swimming.

However, I have no previous experience in large events. The whole experience is untried ground for me, which is both stimulating and scary. When I was first appointed, I spoke to Dr. Boyd Eaton, who administered the Polyclinic in Atlanta, to get a feel for what it was like to be part of such a big event. He told me what he would have done differently but also inspired me by telling me what a great experience the Olympics had been. I have incorporated his suggestions and taken aboard other advice that he gave me.

Another weakness is my lack of experience in administering such a large staff. The imaging team comprises 127 volunteers, including 60-plus radiographers (technologists), 40-plus radiologists, 10 nursing staff, 10 medical typists, porters, and couriers. Just the rostering has been incredible, with many of the volunteers coming from other states in Australia and requiring special rostering considerations. In directing the day-to-day work, it’s important for me to remember that the staff are volunteers and that their experience has to be both enjoyable and interesting. This may present an administrative challenge.

DI: How will the medical imaging at the Sydney Olympics differ from Atlanta?

Anderson: One change is that the two weeks from Sept. 2 to the opening ceremony on the 15th will be rent-free for the national teams. This wasn’t true in Atlanta, but the organizers included that benefit to make Sydney’s bid attractive. We expect most countries will take advantage of this offer, and so we anticipate that we will be quite busy during the run-up period as the athletes prepare for competition. The same Polyclinic medical crew will continue on for the Paralympics, which also wasn’t the case in Atlanta.

Another difference is that elite athletes have become more dependent on high-quality sports medicine, which of course can’t be effective without high-quality imaging. The athlete is now a far better consumer and usually has a fairly good idea of the nature of an injury and the management options. This change has taken place over the last 10 years, but has become more apparent in the last five years. Consequently, we expect the service to be heavily utilized, and we will probably be seeing at least 100 patients a day. For efficiency, instead of sending images to other sites for reporting, we are providing a comprehensive service within the Polyclinic, fully staffed by an excellent group of volunteers, operating from 7 a.m. until 11 p.m.

Four years is a long time in technology, and these last four have been no exception. Fortunately, I have received state-of-the-art equipment from Kodak, while GE has supplied a general x-ray room, a spiral CT, a 1.5-tesla MRI, and a mobile machine. Two ultrasound machines are coming from ATL. (In Australia, ultrasound is used much more for musculoskeletal work than in the U.S., and we also depend on this modality for many soft-tissue diagnoses.) Everything is the latest model, capable of acquiring images rapidly. Computed radiography is faster, the transfer of electronic images is faster. We expect these advances in equipment will allow us to be much more efficient.

A further difference in service is the use of intervention under imaging control, which has become a way of life in elite sport. Ultrasound is the modality most commonly used for the accurate placement of injections and aspiration of hematomata. We are also introducing a new concept in communication with the teams’ medical officers. There will be two interview rooms where the healthcare person looking after an athlete can discuss the imaging changes with a radiologist and decide on management strategies with a sports physician.

DI: Could you tell me more about the interview room concept?

Anderson: Two hundred countries will be represented at the Games, with 90% of the athletes hailing from only 11 of them. The large teams bring with them an adequate medical infrastructure, but most countries send small teams with little medical support.

I am told that in past Games, the imaging facility becomes the place where much of the discussion about diagnosis and management takes place, and questions commonly arise about management problems. So to help these smaller countries, we will provide a facility to address this problem. The two interview rooms will be used for consultation, where an athlete’s images can be called up on a monitor and the significant changes demonstrated and discussed with the person responsible for the athlete’s management. Additional imaging may be indicated to help establish the diagnosis, or perhaps an interventional procedure may be helpful. An Australian sports physician will be working in the imaging department and will be present at these consultations to suggest management pathways.

DI: Do you have any regrets about taking on the job?

Anderson: The position has required considerable work and endless meetings over the last three years, but I have enjoyed every minute. I have met people from all walks of life, from vice presidents of large American corporations to people who manufacture the bits and pieces we need for an imaging service. As deadlines are met and tasks concluded, the wonderful feeling of achievement more than makes up for the occasional frustration. I have made numerous friends, a number of whom will become lifetime friends. The infectious enthusiasm of the large army of volunteers, and the excitement of everything coming together as the Games approach, keeps me on a high.

I had to cut back my other radiology work to allow more time for Olympic work, and last year I retired from my practice to free up time. As the Games approach, I will be working full time. For the duration of the Olympics and Paralympics, I will be living at the Polyclinic. The days will begin at 6 a.m. with a directors’ meeting and will finish about midnight. To prepare for the new routine, I’ve increased my workouts at the gym and am doing some running for fitness and endurance. Yes, I’ll be carrying the Olympic Torch as part of the torch relay. Back in 1956, when the Games were held in Melbourne, I also carried it. This time, I will need all the fitness I can muster.

DI: How did you attract your volunteers and how will you train your staff?

Anderson: I was inundated with applications by radiographers from all over Australia. Since the volunteers have to pay their own airfare and find their own accommodations, this im-pressed me. I also approached radiographers and sonographers with special talents, particularly radiographers whose work I was familiar with. The radiologists were also very generous with their time. Many ofS the radiologist volunteers belong to a national musculoskeletal imaging group and have special skills in bone and joint imaging. The nursing staff and medical typists were largely handpicked, and I believe that we have assembled an exceptional team. The general x-ray room, MRI, and CT personnel will work three shifts a day, with ultrasound personnel working two shifts in both rooms.

My textbook on radiography of sports injuries was published last month as a special Olympics edition. It discusses the routine film series for each area, how I would like the views to be taken, and extra views needed depending on the clinical presentation and mechanism of injury. Copies have been sent to all the volunteers working in the general room to standardize the images and methods. Kodak’s application specialists will train all radiographers to use the computed radiography equipment. Application specialists from GE will help with training for MRI and CT, and experts from ATL have already made certain that all radiologists and sonographers are comfortable with the ATL 5000 equipment.