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Vascular/Interventional Radiology Fellowships
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Sunnybrook Health Sciences Centre
Supervisor: Dr. Ganesh Annamalai
This is a one year fellowship. Sunnybrook Health Sciences Centre has 400 acute and 650 chronic care beds. The hospital is on the same site as the Odette Cancer Centre and the Reichmann Research Institute. Sunnybrook houses the largest regional trauma centre in Canada.
Vascular work includes:
- Interventional Oncology: transarterial chemoembolization (TACE), transarterial embolization (TAE), portal vein embolization
- Angioplasty and stenting (iliofemoral, SVC and central veins, visceral, hemodialysis grafts and fistulae)
- Embolotherapy: trauma, uterine fibroids, pre-operative (renal cell carcinoma, bone metastases, etc.), AV fistula side-branches, gonadal veins (varicoceles, pelvic congestion)
- Endovascular aneurysm repair (elective training at Scarborough General Hospital, Dr. Sanjoy Kundu)
- AV fistula/graft surveillance and intervention: thrombolysis, angioplasty, side-branch embolization
- Uterine artery embolization
- Pharmacologic and mechanical thrombolysis, including lungs (PE), lower extremity veins (DVT), hemodialysis grafts and fistulae
- Caval filters
- Transjugular liver biopsy
- TIPS
- Venous access: subcutaneous ports, dialysis lines, PIC lines, Hickman lines
- Endocrine stimulation studies and venous sampling (adrenal vein sampling, pancreatic stimulation, etc.)
Non-vascular work includes:
- Interventional Oncology: percutaneous tumour ablation (radiofrequency, microwave, ethanol)
- Vertebroplasty and osteoplasty
- Nephrostomies, antegrade stents
- Feeding tubes (gastrostomies, gastrojejunostomies, primary jejunostomies)
- Biliary drains and stents
- GI stents: esophageal, duodenal, colorectal
- Celiac and splanchnic plexus neurolysis
- Fallopian tube recanalization
- Cholecystostomies
- Intraperitoneal port insertions (for IP chemotherapy)
- Peritoneal dialysis catheter insertions
- Pleural intervention
All non-neuro non-invasive cardiac and vascular imaging (CT and MR) is handled by the division. While the focus of this fellowship is invasive work, VIR fellows are also actively involved in reporting CTA and MRA.
Equipment:
- Angiography: Three suites (one Philips Allura and two Philips Integris units).
- CT: four multi-detector GE scanners (three 64 slice machines, one 4 slice machine).
- MR: three clinical MR scanners, (two GE 1.5 Tesla, one 3 Tesla). There are also two research GE MR units.
St. Michael's Hospital
Supervisor: Dr. Andrew Common
The Department of Medical Imaging at St. Michael’s Hospital is pleased to offer fellowship training in Angiography and Interventional Radiology. St. Michael’s offers a busy and varied interventional experience.
St. Michael's is a busy downtown tertiary centre fully affiliated with the University of Toronto at the undergraduate and postgraduate levels. The hospital strategic plan emphasizes six core programs: Inner City Health, Heart and Vascular Diseases, Trauma (includes neurosurgery), Musculoskeletal, Minimal Access Therapeutics and Diseases of the Digestive System, Diabetes Comprehensive Care.
Vascular work includes:
- Diagnostic angiography: femoral, mesenteric, pulmonary
- Dialysis access
- Neuroangiography
- Angioplasty, vascular stenting
- Aortic stent-grafts
- Thrombolysis
- Embolotherapy
- Venous access
- IVC filters
- TIPS (occasional)
- Venous sampling
Non-vascular work includes:
- Feeding tubes
- Nephrostomies and ureteric stents
- Biliary and renal stone extractions
- Biliary drains and stents
- Abscess drains
- Cyst sclerosis
- Biopsies under fluoroscopic, Ultrasound, and CT guidance
The vascular/interventional radiologists at St. Michael's Hospital maintain strong working relationships with the Heart and Vascular Disease Programs, actively reading cardiac caths, participating in cardiac rounds and helping with the vascular complications of heart catheterisation. Four busy peripheral Vascular Surgeons refer a large amount of work, including aortic stent grafts for thoracic and abdominal aneurysms (3-4 monthly). There are frequent rounds in Hemodialysis Access, Endovascular Repair, and Angio/Intervention in which the fellow is an active participant. The Trauma Program is the only one in the city core, and produces a significant amount of on-call angiography and trauma-related intervention. A busy renal dialysis service generates a large amount of work in venous access as well as graft and fistula monitoring and intervention (angioplasty, stenting, thrombolysis). A lithotripsy program has been established at St. Michael's and this has increased the volume of work in stone-related access and drainage. A busy renal transplant program provides ample opportunity for pre- and post-transplant vascular imaging as well as renal biopsy. The Minimal Access Therapeutics program is driven by world-renowned endoscopists and laparoscopic surgeons, and has augmented the interventional load with regard to pre-operative embolizations and the handling of post-operative complications. The Respiratory Medicine service brings referrals of Cystic Fibrosis and Hereditary Hemorrhagic Telangiectasia (HHT) patients for embolization of bronchial bleeding and pulmonary arteriovenous malformations. A well-established uterine artery embolization program is in place. There is also an opportunity to participate in a busy neuroangiography schedule.
The department is equipped with three angiography suites: an OR compatible Philips V5000 suite, a Siemens Multistar T.O.P. suite and a new Philips BV5000 biplane neuroangiography suite. All have rotational DSA capabilities.
University Health Network and Mount Sinai Hospital
Supervisor: Dr. John Kachura
This is a one year fellowship designed for trainees to acquire the principles and advanced techniques in Angiography as well as abdominal interventions in adults. At the end of the training, the trainee will have acquired the necessary knowledge, skill and experience to act as a Vascular and Interventional radiologist in a community or teaching hospital.
Currently, two combined Angiography and Interventional fellowship positions are offered per year. A third fellowship position is available for self-funded candidates.
Training Sites and Equipment
The Department is staffed by seven full-time Vascular and Interventional radiologists and serves four sites within two kilometres of each other: Toronto General Hospital, Toronto Western Hospital, Mount Sinai Hospital and the Princess Margaret Hospital.
With the exception of the Princess Margaret Hospital, all sites are equipped with the state-of-the-art angiographic units; two at Toronto General, one each at Toronto Western and Mount Sinai Hospitals. Interventional rooms are equipped with C-arm fluoroscopy and colour flow doppler ultrasound units. Access to high-speed CT scanning is available for CT guided interventional work.
The imaging modalities (Ultrasound, CT, MR, angiography & Chest imaging) at all sites are electronically linked and archived. The Department is currently operating as a filmless department with the exception of plain film radiography and GI fluoroscopy (these two modalities will become part of the PACS by end of 1999)
Workload and Case Mix
Approximately 3,000 non-angiographic interventional and 4,000 angiographic procedures are performed per annum in the Department (all sites included).
Non-vascular work includes experience in:
- Abdominal biopsies
- Esophageal stent insertion
- Gastrostomies
- Abscess drains from all approaches
- Tumour and cyst ablation in the liver or kidneys
- Biliary drains and endoprosthesis insertions
- Bile duct dilatation and stone removal
- Gallbladder interventional procedures
- Biliary endoscopy including: percutaneous choledochoscopy, cholangioscopy, gallbladder endoscopy
- Nephrostomies, stone removals and stent insertions
All types of non-neurologic and non-cardiac angiography are performed and include:
- Venous access line insertions: Portacath, Uldall lines, Hickman lines and PICC lines
- Fibrinolytic therapy
- Embolization techniques
- Angioplasty and atherectomy
- Stent insertion including aortic graft stents
- TIPS
- Caval filter insertions
The trainee will also gain experience in non-invasive vascular imaging.
Responsibilities
The trainees have hands-on training with close, one to one supervision by staff. The trainees spend 2/3 of their rotation at The Toronto General Hospital and the remaining 1/3 at the Toronto Western or Mount Sinai Hospitals.
Each work week includes four clinical days and one research day. In addition to interventional work in the Department, the trainee is expected to follow up on patients and maintain a database of mortality and morbidity (M&M) of all procedures at the assigned site. He/she is also expected to present the data at the Departmental bimonthly M&M rounds. After hour calls are shared with staff and are allocated weekly, once every three weeks.
Teaching rounds for interventional fellows and staff are scheduled biweekly and research rounds monthly. Trainees are expected to attend clinical rounds with related subspecialties such as vascular surgery or hepatobiliary rounds.
Fellows are expected to complete at least one research project under the supervision of staff. Financial support for presentation and publication is available from the department.