Cardiothoracic Fellowship (St. Michael's Hospital)

Supervisor: Dr. Djeven Deva

The Department of Medical Imaging at the University of Toronto is one of the largest academic radiology departments in North America, with approximately 80 fellows, 50 residents, and more than 140 faculty, working across 8 main teaching hospitals.

St. Michael's Hospital is one of the principal teaching hospitals of the University, and is a busy, multispecialty downtown tertiary care centre, known for its Heart and Vascular Programme and its ever-growing structural heart disease program.

This one-year fellowship will provide excellent exposure to multi-modality imaging of cardiovascular and thoracic disease.  The fellowship is structured with primary emphasis will be on cardiovascular CTA and MR and a strong emphasis on general thoracic CT.

  1. The cardiovascular CT experience is broad and will consist of cardiac CT (predominantly coronary CTA) and peripheral CTA (aortic run-offs, thoracic and abdominal aortic aneurysm assessment).  We currently perform approximately 1500 CTA studies per year, including approximately 450 - 500 cardiac CT and 600 - 650 peripheral CTA studies. Preoperative planning for transcatheter aortic valve replacement (TAVR) is primarily conducted utilizing CTA.
  2. The cardiovascular MR experience encompasses cardiac MR and thoracic MRA, with additional caseload in abdominal and peripheral MRA.  We have a fast-growing cardiac MR service, with approximately 600 cases performed per year.  Common indications at SMH include: ischemic heart disease with viability assessment, myocarditis, cardiomyopathies, aortopathy, valvular heart disease and cardiac masses.
  3. Thoracic CT is performed for a wide variety of indications ranging from textbook respiratory medicine indications (interstitial lung disease, sarcoid and lung cancer) to more unique specialized indications (St Michael’s cares for large Cystic Fibrosis, Heriditary Hemorrhagic Telangiectasia and Infectious Diseases populations). The fellowship will include an inteventional component with image guided lung biopsies and pleural drainage.

We have a 512-slice GE revolution volumetric CT scanner and two 64-detector GE CT scanners. From February 2016 we will have 2 cardiac capable clinical 1.5T Philips Ingenia scanners with dStream Broadband MR (one with cardiac tissue mapping) and 1 clinical 3T Siemens Skyra scanners. In addition, research studies are performed on a separate dedicated research 3T Siemens Skyra. Postprocessing in CT is done using a GE Advantage workstation and TeraRecon Aquarius software installed on multiple workstations, and MRI post-processing is performed on CVI 42 (which has full strain, perfusion and tissue mapping capability), Philips ViewForum and Siemens Syngo workstations. We have a 3T MRI research centre with support from an on-site MRI physicist with a special interest in cardiovascular MRI and a research coordinator.

Our department has excellent interactions with the Departments of Cardiology, Cardiac Surgery, Vascular Surgery and Respirology, which will enrich the learning experience of the fellows. The fellow will be expected to present cases at weekly TAVR rounds. The fellow may attend educational cardiology and respirology rounds and also spend time in nuclear cardiology and conventional cardiac catheter angiography (interpretation). The fellow will gain a wide variety of skills by being responsible for managing all aspects of the clinical imaging service in CT and MR.

In keeping with the directive of the Department, 80% of the fellow's time will be spent on clinical activities and 20% on research.  Research opportunities in cardiovascular imaging are abundant with both radiology and cardiology at SMH.  The fellow will be able to work with at least 5 full-time supervisory faculty members in cardiovascular imaging.

Number of positions:  2