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Vascular/Interventional Radiology Fellowship (MSH-UHN-WCH)

Supervisor: Dr. John Kachura

We now have two different tracts for fellowship training in VIR; a one year clinical fellowship and a two year research/clinical fellowship.

The one year fellowship is 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, four to five Angiography and Interventional fellowship positions are offered per year.

The two year fellowship is fully funded with one year dedicated to research activities (Black Fellowship) within the division. Projects can be self initiated. Candidates should possess a strong research background to be considered. Range of prospective studies includes basic science work to advanced clinical intervention applications. Following this first year, the candidate will complete a clinical year in VIR. One position is available yearly.

Training Sites and Equipment

The Department is staffed by eight full-time Vascular and Interventional radiologists and serves five sites within two kilometers of each other: Toronto General Hospital, Toronto Western Hospital, Mount Sinai Hospital, Women's College Hospital and the Princess Margaret Cancer Centre.

With the exception of the Princess Margaret Cancer Centre and Women's College Hospital, all sites are equipped with the state-of-the-art angiographic units; four at the Toronto General (one room contains a mutislice CT for advanced oncological and vascular interventions), one each at Toronto Western and Mount Sinai Hospitals. Interventional rooms are equipped with C-arm fluoroscopy and color flow Doppler ultrasound units.

Workload and Case Mix

Approximately 6,000 non-angiographic interventional and 6,000 angiographic procedures are performed per annum in the Department (all sites included). We have multiple ongoing clinical trials, both investigator driven and industry sponsored.

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 (using RFA, microwave and IRE)
  • 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, dialysis lines, Hickman lines and PICC lines
  • Fibrinolytic therapy
  • Embolization techniques (including oncological embolization not limited to portal vein embolization, chemoembolization and Y90)
  • Angioplasty and atherectomy
  • Stent insertion including aortic graft stents (including advanced techniques with investigational devices and advanced EVAR with branched endografts)
  • TIPS
  • Caval filter insertions
  • AV fistula/graft surveillance and intervention: thrombolysis, angioplasty, side-branch embolization
  • Uterine artery embolization
  • Transjugular liver biopsy
  • Renal Denervation
  • Complex AVM embolotherapy

The trainee will also gain experience in non-invasive vascular imaging and spend two weeks on clinical service with Vascular Surgery.

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 four-five 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