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 80 fellows, 50 residents, and more than 140 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 and its specialty Respirology services including Cystic Fibrosis, Hereditary Hemorrhagic Telangiectasia and Hepatopulmonary Syndrome.

This one-year fellowship 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. The cardiovascular CT experience is broad and will consist of cardiac CT (predominantly coronary CTA). We currently perform approximately 750 cardiac CT per year. Preoperative planning for transcatheter aortic valve replacement (TAVR) is primarily conducted utilizing CTA.
  2. The cardiovascular MR experience encompasses cardiac MR and thoracic MRA, with additional caseload in abdominal and peripheral MRA.  We have a fast-growing cardiac MR service, with approximately 650 cases performed per year.  Common indications at SMH include: ischemic heart disease with viability assessment, myocarditis, cardiomyopathies, infiltrative disorders, aortopathy, valvular heart disease and cardiac masses.
  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 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 a 3T Siemens Skyra scanner. In addition, research studies are performed on a separate dedicated research 3T Siemens Skyra. Postprocessing in CT is performed on TeraRecon Aquarius 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), Philips ViewForum and Siemens Syngo workstations. We have a 3T MRI research centre with support from an on-site MRI physicist with a special interest in cardiovascular MRI and a research coordinator.

Our department has excellent interactions with the Departments 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 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 directive of the Department, 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 fellow will be able to work with at least 5 full-time supervisory faculty members in cardiothoracic imaging.