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 100 fellows, 50 residents, and over 200 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 Program, its ever-growing structural heart disease program (largest volume TAVI centre in downtown Toronto) and its subspecialty Respirology services including Cystic Fibrosis, Hereditary Hemorrhagic Telangiectasia and Hepatopulmonary Syndrome.

There are 3 positions in this one-year fellowship which will provide excellent exposure to multi-modality imaging of cardiovascular and thoracic disease.  The fellowship is structured with primary emphasis on cardiovascular CTA and MR and a strong emphasis on general thoracic CT.

  1. We currently perform approximately 1800 cardiovascular CTs per year, the majority of which are for coronary imaging, over 300 of which are structural heart CTs (for transcatheter aortic, mitral and tricuspid valve replacement) and 100 of which are for pulmonary vein ablation.
  2. The cardiovascular MR experience encompasses cardiac MR and thoracic MRA, with additional caseload in abdominal and peripheral MRA.  We perform 650 cardiovascular MRI cases per year (550 cardiac, 100 vascular). Common indications at SMH include: ischemic heart disease with viability assessment, myocarditis, cardiomyopathies, infiltrative disorders, aortopathy, valvular heart disease and cardiac masses. We have integrated tissue mapping (T1, T2 and ECV) across our clinical cardiac MRI indications.
  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, Hereditary Hemorrhagic Telangiectasia and Infectious Diseases populations).

We have a 512-slice dual-energy GE Revolution volumetric CT scanner and two 64-detector GE CT scanners. We have 2 cardiac capable clinical 1.5T Philips Achieva dStream Broadband MR scanners (one with complete cardiac tissue mapping package [T1, T2 and T2*]) and 2 cardiac capable 3T Siemens Skyra scanners (one with a full 3T cardiac tissue mapping package [T1 and T2]). Research studies are performed on one of the 3T Siemens Skyra scanners. Postprocessing in CT is performed on TeraRecon, Circle CVI and GE Advantage software installed on multiple workstations, and MRI post-processing is performed on cvi42 (which has tissue mapping, perfusion and strain analysis packages) and TeraRecon.

Our department has excellent interactions with the Divisions 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/ TAVI rounds. The fellow may attend educational and clinical cardiology and respirology rounds. 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 Department’s directive, 80% of the fellow's time will be spent on clinical activities and 20% on research.  There are abundant cardiovascular imaging research opportunities at SMH.  The fellows will be able to work with at least 5 full-time supervisory faculty members in cardiothoracic imaging.