Cardiac Imaging Fellowship (MSH-UHN-WCH)

Supervisor: Dr. Mini Pakkal

The cardiac imaging fellowship program at the Joint Department of Medical Imaging is affiliated with the University of Toronto and fully integrated within the Peter Munk Cardiac Centre (PMCC) which encompasses the Divisions of Cardiology, Vascular Surgery and Cardiac Surgery. This relationship ensures that clinical and research efforts are embedded in cross collaborations across the PMCC. The PMCC has the largest adult congenital heart disease clinic and the largest Red Blood Cell Disorder Clinic in North America; it is a quaternary referral center for organ transplantation, complex cardiac ablations and device implantation. The cardiac imaging fellowship, based primarily at the Toronto General Hospital, is open to radiologists and radiology trainees.

Cardiac MR: There is a large clinical caseload, ~2500 per annum comprising approximately 40% complex adult congenital heart disease, 40% acquired heart disease (viability studies, cardiomyopathies, cardiac masses), the remaining 20% focus on the thoracic aorta.

Cardiac CT: The current clinical caseload, ~1800 cases per annum comprising 85-90% CT coronary angiography and calcium score CT, the remaining 10-15% focus on assessment of pulmonary veins pre and post ablation and complex congenital heart disease (one of the largest adult congenital heart disease CT programs in the world performing 80 such studies a year for this indication).

Equipment: Cardiac CT is performed on a dedicated clinical 320MDCT (Aquilion One, Toshiba Medical Systems) and Cardiac MR is performed on 2 dedicated cardiovascular scanners (3T Skyra fit, 1.5T Avanto fit, Siemens Medical Systems). There are 2 additional 64 row MDCT units (Toshiba) which are available for cardiac imaging. In addition, an Aquilon One 320MDCT scanner will be installed in the Emergency Department with plans underway to develop a chest pain service at Toronto General Hospital. Women’s College Hospital is also the site of the first in Canada Women’s Cardiac Health Program housed in a brand new facility equipped with an Aquilion One 320MDCT and a Siemens Espree MRI scanner. 

Fellowship: There are currently three funded clinical fellowship positions available with the possibility of a self-funded position if there is an appropriate candidate.  The fellowship lasts 12 months with time evenly split between cardiac MR and CT.  80% of the fellowship is clinical and 20% is dedicated to research.  It is the fellow's responsibility, under appropriate supervision, to triage, protocol, monitor and report CMR and CT cases.  The fellows attend and present cases at the weekly, multidisciplinary Adult Congenital Heart conferences. 

The cardiac section is staffed by a happily integrated group of six total radiologists and cardiologists who also have skills and experience in echocardiography, nuclear cardiology and cardiac catheterization in addition to cardiac CT and MRI which contributes to a unique learning environment for fellows. Faculty in the cardiac section provide dedicated weekly cardiac teaching rounds and multiple weekly educational sessions comprised of case-based and didactic lectures, which include exposure to echocardiography. In turn, the fellows have teaching commitments to Medical Students, Radiology and Cardiology Residents and Fellows. There are multidisciplinary cardiac rounds three times per week and the fellows have access to chest rounds that also occur twice per week.

After the initial 6 months of the cardiac fellowship, candidates have an option to be integrated into a busy chest radiology service (38,000 Chest CT, 120,000 chest radiographs per year) for one week every month, for the remaining 6 months of the fellowship to allow concurrent training in thoracic imaging.

Research: Using the 20% dedicated research time, fellows are expected to produce a minimum of one manuscript during the fellowship. Presentation of research work at international scientific conferences is financially supported and encouraged. There is a dedicated research MR (1.5T, General Electric) adjacent to the reporting area and a dedicated research 320MDCT (Vision, Toshiba) is being installed in June 2013. A research integrated MRI-PET system (Siemens) and Cyclotron will be installed in Fall 2013.