Dr. Narinder Paul
Head, Cardiothoracic Imaging
The Division of Cardiothoracic Imaging comprises faculty members from teaching hospitals in Toronto: The Hospital for Sick Children, Mount Sinai Hospital, St. Michael’s Hospital, Women's College Hospital, Sunnybrook Health Sciences Centre and The University Health Network (Princess Margaret Cancer Centre, Toronto General Hospital, Toronto Western Hospital).
Medical students in the undergraduate program at The University of Toronto receive lectures on CT Anatomy (part of the Anatomy course) in Year 1 and Principles of Chest Radiology (part of Principles of Pathobiology) in Year 2. In addition, they are given numerous seminars at the Medical Sciences Building and in the teaching hospitals, throughout their 4-year program. Many learn cardiothoracic imaging as part of an elective taken at the teaching hospitals.
Radiology residents receive 10 hours of lectures on Chest Imaging during the first (PGY2) and second (PGY3) year of residency, which cover a broad range of topics. During their PGY3 year, they receive an 8-hour series of didactic lectures on Cardiac Imaging that encompass normal and anomalous cardiac anatomy, as well as a broad spectrum of congenital and acquired cardiac conditions. This incorporates a multi-modality approach to cardiac imaging including plain film radiography, angiography, echocardiography, nuclear medicine, and magnetic resonance imaging (MRI). For each of their 4 residency years, the residents are provided with specific goals, objectives and a reading list for that particular year. There are weekly Chest teaching rounds for residents at all of the teaching hospitals. Residents receive cardiac rounds biweekly at Toronto General Hospital and weekly at The Hospital for Sick Children. The residents gain experience with a very large amount of clinical work, with a great variety of pathology, during their rotations at the various hospitals. They perform large numbers of CT-guided lung, pleural and mediastinal biopsies. As well, their cardiac component is unique in that Toronto General Hospital and The Hospital for Sick Children house one of North America’s largest programs of adult and pediatric congenital heart disease, respectively. During their fourth year of training (PGY5), residents can select a one-month rotation in cardiac imaging at Toronto General Hospital. This rotation provides a variety of clinical imaging experience including plain film radiography, coronary and intracardiac angiography, as well as significant exposure to cardiovascular MRI (about 200 cases per year). In addition, they have access to teaching files, both film and electronic, covering all imaging modalities for both the Cardiac and Chest components of the program.
Fellowships in both Cardiac and Thoracic Imaging are available.
Faculty members participate in continuing medical education for radiologists through presentations at the annual University of Toronto Organ Imaging Review Course as well as at international conferences, including the annual meeting of the Society of Thoracic Imaging and the North American Congenital Heart Disease Society Meeting. Faculty members are also invited to speak at other courses and universities.
Many of the staff present their research work at these same international conferences and have it published in peer-reviewed journals, often with collaboration from radiology residents. Many contribute chapters to textbooks, either radiological or related to Cardiothoracic Surgery, Respiratory Medicine or Cardiology. Clinical research in Chest Imaging has focused mainly on staging of bronchogenic carcinoma and on many aspects of lung transplantation. In Cardiac Imaging, faculty are currently working with medical physicists at the Reichmann Research Institute at Sunnybrook, particularly with cardiac MRI using it to advance the non-invasive assessment of the heart and great vessels. Faculty are also collaborating with clinicians and researchers from Stanford University on improving cardiac MRI techniques.