Fellowships Offered

Supervisor: Dr. Martin O'Malley

The Abdominal Imaging Fellowship Program at the Joint Department of Medical Imaging includes the full spectrum of Abdominal Imaging with rotations through the following hospital sites that together, make up one of the largest medical teaching institutions in North America:

Mount Sinai Hospital (MSH)
Princess Margaret Cancer Centre (PMCC)
Toronto General Hospital (TGH)
Toronto Western Hospital (TWH)
Women’s College Hospital (WCH)

In addition to general medical and surgical issues relating to the abdomen and pelvis, Fellows will gain extensive experience in the following subspecialty areas: hepatobiliary/pancreas, urology, gynecology, gastrointestinal diseases, oncology, and organ transplantation.

This comprehensive Fellowship program offers extensive training in multimodality cross-sectional imaging. The one-year Fellowship program includes dedicated rotations through MRI, CT, US, image-guided procedures, and CT colonography. Rotations through Obstetrical US and PET can be arranged if desired. There are extensive academic opportunities for Fellows. Involvement in research is an expectation of the Fellowship program and one day per week is provided for Academic time.

All studies are interpreted using a department-wide PACS system. Equipment at all sites is state-of-the-art and includes (March 2020):

60 ultrasound units, all with colour Doppler
13 multidetector CT scanners
10 MRI scanners
Research equipment: CT, MRI and PET/MRI

The combination of state-of-the-art equipment, a large volume of patients, the full spectrum of pathology and a dedicated faculty of approximately 20 Abdominal staff radiologists allows for an exceptional learning experience in all aspects of Abdominal and Pelvic Imaging. This experience is enhanced with twice weekly Abdominal Imaging rounds and participation in multidisciplinary rounds.

There are 8-10 Fellowship positions available per year. Call is divided amongst the Fellows with staff backup resulting in an approximately 1 in 10 on-call schedule covering Abdominal Imaging.

Supervisor: Dr. Chirag Patel

The Sunnybrook Campus offers four fellowship positions in Abdominal Imaging each year. The hospital, located in mid-Toronto, is a busy adult general hospital. It is the largest regional trauma centre in Canada. Another major focus is oncology. Sunnybrook is attached to a Regional Cancer Centre which accounts for a significant proportion of the caseload. This fellowship consists of a combination of CT, MRI and ultrasound. Approximately the same amount of time is spent in each modality. There is one day each week of protected research time. There is some flexibility in this schedule, depending on individual preferences.

A practical hands-on approach is emphasized. Approximately 90 ultrasound examinations are performed each day. The majority are abdominal and pelvic scans, however, all types of examinations are performed, including small parts, deep abdominal Doppler, extremity and neck ultrasound. The department is currently equipped with ten ultrasound rooms.

There are four multidetector CT scanners (General Electric). Approximately 60 abdominal-pelvic scans are done each day.

There are five Magnetic Resonance scanners onsite. Three scanners are dedicated to clinical use (1.5 T and 3 T); two are used in research.

Interventional procedures using ultrasound and CT guidance form another important part of this program. These consist mainly of ultrasound and CT-guided biopsies and abscess drainage.

There is a department-wide PACS system in place.

There is a large imaging research group associated with Sunnybrook. This consists of a group of senior scientists and postgraduate students whose research activities encompass all types of diagnostic imaging. They are located in a research wing that adjoins the Department of Medical Imaging.

In summary, the Sunnybrook site offers a comprehensive Abdominal Imaging fellowship, with state-of-the-art equipment, experienced, enthusiastic staff, excellent case material, and access to outstanding research resources.

Formerly Body Imaging

Supervisor: Dr. Guan Huang

St. Michael's Hospital is one of the principal teaching hospitals of the University of Toronto and is a busy multi-specialty urban tertiary care centre with world-class expertise in gastroenterology, oncology, urology, trauma, transplant, infectious diseases, orthopedic surgery, and rheumatology.

The Abdominal Imaging Fellowship in the Department of Medical Imaging at St. Michael's provides outstanding exposure to multi-modality abdominal, chest, and musculoskeletal imaging with a heavy emphasis on Abdominal MRI and CT. We offer up to 4 one-year fellowship positions in Abdominal Imaging each year.

The Abdominal MRI service at St. Michael's is the highlight of the fellowship program, and encompasses a broad, busy and modern mix of complex clinical cases on state-of-the-art MRI equipment. Abdominal MRI studies (approximately 90% of the fellows’ MRI volume) include MR enterography, prostate MRI, pelvic floor MRI (MR defecography), pancreatico-biliary MRI and MRCP, liver MRI (including MR elastography, assessment of diffuse liver disease, liver iron quantification, and use of liver-specific contrast agents), kidney MRI, staging MRI of gynecologic and rectal malignancies, MRI for endometriosis and benign gynecologic disease, whole-body MRI, MRI of abdominal emergencies in pregnancy, and body MR angiography. Musculoskeletal MRI studies (approximately 10% of the fellows’ MRI volume) at St. Michael's reflect the broad clinical expertise of our referring orthopedic and rheumatology colleagues. All cases are interpreted under the supervision of fellowship-trained University of Toronto faculty radiologists in the Abdominal and Musculoskeletal Imaging divisions. We perform over 150 such MRI exams per week in an MRI department with 4 scanners (2 Siemens 3.0T Skyra wide-bore scanners + 2 Philips 1.5T Achieva dStream scanners), with an additional 3.0T MRI scanner to be installed in 2024.

The Abdominal CT service is a high volume and dynamic mix of chest, abdominal and pelvic studies with a breadth of cases supporting: a Level 1 trauma centre providing care to multisystem trauma patients in our region and province, one of the busiest emergency departments in the country, busy medical and surgical oncology programs, urology, general medical and surgical services, and family practice. Exposure to chest CT is predominantly in trauma and oncology and is approximately 20% of the total CT volume. We perform approximately 250 CT exams per week on 3 GE CT scanners including dual energy scanners. A new replacement CT scanner has been acquired for installation in 2024, and an additional new CT scanner will be sited in our Emergency Department in 2025. In 2024, a new state-of-the-art PET-CT scanner will also be installed.

Approximately 15-20% of the total fellowship time is spent on Ultrasound service, where all types of examinations are performed including abdominal and pelvic studies, small parts, neck, abdominal and extremity Doppler, and obstetrical US.  There are 9 ultrasound rooms encompassing a mix of Canon Aplio500 and Philips iU22 modern scanners.

Our fellows participate in a variety of procedures including ultrasound-guided biopsies, sonohysterography, and MRI arthrography. Fellows also have the potential opportunities to arrange short electives in Interventional Radiology and Neuroradiology to enhance their skill sets depending on their future practice settings.

Clinical and teaching supervision of fellows is done by 7 dedicated faculty abdominal radiologists, enhanced by weekly Abdominal Imaging fellows rounds and numerous multidisciplinary case conferences in all aspects of Abdominal Imaging. After-hours fellows coverage incorporates evening and weekend coverage of emergency and inpatient abdominal imaging studies. Our department has a dedicated in-house Emergency Radiology division that provides overnight coverage, including its own fellowship program.

There is approximately 20% of protected time for research in the fellowship. Research opportunities are abundant, with strong emphasis on Artificial Intelligence (AI) research, deep-learning abdominal algorithms, Human-Computer Interaction (HCI) research, and the department is home to an internationally recognized Research Chair in Medical Imaging Artificial Intelligence. All dedicated Abdominal Imaging faculty radiologists are available to supervise research projects and an on-site departmental Medical Imaging research office including a research program manager, research MRI technologists, and statistical support.

In summary, the breadth of cases, volume, subspecialty teaching, and hands-on experience in our Abdominal Imaging fellowship will prepare trainees exceptionally in all aspects of abdominal and pelvic imaging for independent practice in either academic or community/private practice environments. Our fellowship graduates are in both of these types of environments across all of Canada and around the world.

The Department of Medical Imaging at Unity Health Toronto - St. Michael’s Hospital, University of Toronto is pleased to offer two clinical fellowship positions in diagnostic neuroradiology. This position will include comprehensive focused training in adult neuroradiology, as well as exposure to advanced MR imaging techniques in both clinical and research applications.

Unity Health Toronto - St. Michael’s Hospital provides excellent opportunities for advanced neuroimaging fellowship training. We have a busy service with two state-of-the-art 3T MRI units and 2 1.5 T MRI scanners as well as 3 multi-slice CT scanners. We have two state-of-the-art biplane 3D neuroangiography suites and have recently operationalized a Hyperfine Portable MRI scanner. SMH houses large programs in brain tumor surgery, neuroinflammatory disease, neurovascular disease, trauma and spine.

The over-arching goal of the fellowship will be to provide candidates with outstanding training in adult clinical neuroradiology combined with research experience in the application of advanced neuroimaging including MR perfusion; functional and anatomic mapping; vessel wall imaging and other techniques.

The fellowship will be based at SMH. The two fellows will work with our collegial group of 8 subspecialty trained neuroradiologists and alongside our other trainees including medical students, residents and other neuroradiology fellows from the rotating City-Wide Neuroradiology Program. They will participate fully in all clinical activities in cross-sectional neuroimaging, multidisciplinary neuro-oncology rounds, neuroradiology teaching rounds, neurovascular/stroke rounds and neuroinflammatory rounds. They will also participate fully in all University of Toronto City-wide Neuroradiology Program educational activities (including weekly city-wide rounds and lectures, symposia and courses, and exams) and are eligible to receive a University of Toronto Neuroradiology Fellowship Certificate in Neuroradiology upon successful completion of the program.

The position will be 80% clinical and 20% research, with protected academic time in accordance with the goals and objectives set through the University of Toronto Medical Imaging Fellowship program. Research projects will be developed collaboratively with regard to the trainee’s career interests and with a view to integrating with our existing clinical and research programs. Anticipated research projects include Advanced MR imaging techniques such as functional MR imaging (fMRI), diffusion-tensor imaging (DTI), MR spectroscopy (MRS), and MR perfusion imaging for brain tumors and tumor-like conditions. There are additional research opportunities in quality improvement, imaging utilization and appropriateness, operational processes, trauma, and Hyperfine portable MRI applications.

If you have any questions, please contact Dr. Amy Chen - amy.chen@unityhealth.to

The Joint Department of Medical Imaging at the University of Toronto is pleased to offer a 1-year clinical neuroradiology fellowship position starting (July 1, 2024) with a focus on advanced neuroimaging techniques.  This fellowship is designed for aspiring academic neuroradiologists seeking to expand their expertise in the latest advanced MR techniques while strengthening their clinical neuroradiology skills. Participants will have the opportunity to work alongside world-class experts, gain hands-on experience with state-of-the-art imaging technology, and contribute to cutting-edge research projects. 

Program Highlights: 

1. Comprehensive Training on advanced neuroimaging: The fellow will train on acquisition, post processing and interpretation of advanced MRI techniques, including perfusion MRI (ASL, DCE, DSC and SAGE), CVR, MR spectroscopy, fMRI, DTI, QSM, SMWI and vessel wall imaging.  
2. High volume neuro-oncology and movement disorders clinics: The neuro-oncology clinic at the University Health Network is a national and international referral center caring for 200 patients with newly diagnosed primary nervous system tumors, and around 1,000 patients with brain metastasis each year. The Edmond J. Safra movement disorder clinic is world renowned and receives over 9,000 visits per year. The fellowship presents an exceptional opportunity for fellows to actively participate in MR-guided focused ultrasound treatments for movement disorders, including essential tremor and Parkinson's disease. This hands-on involvement allows fellows to gain invaluable experience in this cutting-edge field. 

3. State-of-the-Art Facilities: Fellows will have access to cutting-edge imaging facilities equipped with the latest technology. From high-field MRI research scanners including a 3T PRISMA to a PET/MR system, participants will gain hands-on experience with the most advanced tools used in clinical and research settings.  
4. Busy neuroradiology service with 14 clinical MRI scanners including four 3T and over 14 CT scanners. The exposure to high volume of complex cases will strongly enhance the clinical skills of the fellow. 
5. Multidisciplinary collaboration: Fellows will actively participate in multidisciplinary rounds, gaining valuable insights from clinicians and learning about challenging cases. The fellowship fosters collaboration with a diverse team of experts, including neuroradiologists, neurologists, neuropsychologists, neurosurgeons, and researchers. Fellows will benefit from engaging with professionals from various disciplines, broadening their perspectives and enriching their learning experience. 
6. Focus on clinical translation: Fellows will be encouraged to participate in ongoing pilot projects focused on the clinical translation of advanced imaging techniques. This includes the implementation of advanced image post-processing in routine clinical practice and the use of AI-assisted diagnosis. Fellows will actively contribute to the advancement of neuroimaging technology in clinical settings. 
7. Research Opportunities: Fellows will have 20% protected research time, enabling them to actively participate in research projects. This emphasis on research allows fellows to make meaningful contributions to the field and stay up to date with the latest developments. Fellows will have opportunities to present their research findings at national and international conferences, expanding their professional network and visibility within the field. 

8. Mentorship and Guidance: Participants will receive personalized mentorship and guidance from experienced faculty members who are at the forefront of neuroimaging research and clinical practice. Mentors will provide valuable insights, support research initiatives, and help fellows navigate their professional growth. 
9. Professional Development: The fellowship offers 10% protected teaching time, which includes engaging in a city-wide neuroradiology case conference and attending staff lectures. We are committed to the professional development of participants and provide access to a wide range of educational resources, including conferences, lab meetings, workshops, and seminars.  
10. Academic Recognition: Upon successful completion of the fellowship, participants will receive a prestigious certificate from the University of Toronto, acknowledging their specialized training in advanced neuroimaging. This recognition will serve as a testament to their expertise and dedication, enhancing their career prospects and opening doors to further research or academic opportunities. 

Supervisor: Dr. Allison Grant

The combined department of Breast Imaging at Mount Sinai Hospital, Princess Margaret Hospital, and Women's College Hospital offers a very comprehensive and integrated multimodality one-year Breast Imaging fellowship.  We offer world-class experience with a very large number of clinical cases, diverse and rare pathology, leading-edge technology, and a comprehensive research and teaching program.  As a result of our large practice and state-of-the-art technology, we are able to offer our fellows in-depth exposure to all aspects of screening, diagnostic, interventional, and academic breast imaging experiences.  Our graduates have come to us from varied continents and have been successful in continuing in either academic or community practices of their choice in different parts of the world.

Fellowship:

There are currently 2 funded clinical breast fellowships. The fellowship lasts 12 months with time evenly split across all 3 sites and modalities. 80% of the fellowship is clinical and 20% is dedicated to research.  The fellowships are recognized and listed in the Society of Breast Imaging (North America). Our training program reflects the Breast Imaging Fellowship Curriculum published (2013) by the education committees of ACR and SBI.

The breast imaging division is staffed by 10 fellowship-trained dedicated breast radiologists with an avid interest in clinical as well as breast imaging research.

Mammography & Ultrasound:

As a breast imaging fellow, you will have exposure to a high volume of diagnostic breast imaging, such as digital screening & diagnostic mammograms, digital breast tomosynthesis, diagnostic ultrasounds including opportunities to explore elastography and contrast-enhanced spectral mammography (CESM). The total number of screening/diagnostic mammograms performed across the three Breast Imaging Centers is over 200 per day. Each site performs an average of 15 – 20 diagnostic ultrasounds per day. All 3 of our centers are authorized center for provincial average risk and high-risk screening programs through the Ontario Breast Screening Program, Cancer Care Ontario.

Breast MRI:

Breast MRI is performed at multiple sites on state-of-the-art 1.5 & 3T breast MRI with post-processing software capabilities for kinetic analysis and rendered MIP assessment.  We are also a busy accredited center for the highly acclaimed provincial high-risk screening program which allows exposure to reporting and work up of high-risk screening MRI. We perform approximately 60-80 MRI per week.

Intervention:

Opportunities for interventional procedures include: stereotactic and ultrasound guided core biopsies (both 14G core and vacuum assisted), stereotactic and ultrasound guided pre-operative and diagnostic needle localizations, ultrasound guided diagnostic and therapeutic needle aspirations ,galactography, MRI guided vacuum assisted biopsy and localization procedures, as well as multimodality guided (stereotactic, US and MRI) marker/clip deployment. There are approximately 3-5 MRI guided interventions per week.

GRDC:

Trainees will have the opportunity to work in our one-of-a-kind Gattuso Rapid Diagnostic Clinic which provides consultations, complete workup, same-day pathology, and clinical consultation for complex cases within the Greater Toronto Area. All examinations are obtained and reviewed with the latest state-of-the-art technology. 

Equipment:

We have a fleet of digital mammography machines Tomosynthesis capability( Hologic & GE), 3 stereotactic core biopsy units (two upright and one prone), state-of-the-art ultrasound machines (Toshiba and Supersonic ultrasound machines (the latter of which has shear wave elastography capabilities) and multiple 1.5 T &  3T Siemens MRI magnets.

Teaching:

There are several multidisciplinary breast imaging rounds occurring regularly with fellows involved in direct review of current cases, presentations of new techniques, and advances in the field of breast imaging. We work very closely with the breast surgeons, pathologists and oncologists and also provide elective rotations into breast pathology, surgery and genetics. Subsidized/free registration opportunities for locally arranged CME and workshops through the year will be available including our annual hands-on Digital Breast Tomosynthesis workshop. In turn fellows have teaching commitments to Medical Students, Breast Imaging residents and oncology fellows.

Research:

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 are numerous opportunities for fellows to develop or continue research within the Breast Imaging Division.  We offer on-site clinical research facilities with many dedicated research staff.  Additionally, interdisciplinary work is also encouraged with several projects performed in collaboration with the Breast Surgery and Breast Pathology divisions.

Holidays:

Two work weeks (10 days) per 6-month block of your fellowship.  (Total 4 work weeks for 12 months)

Conference leave:

One week upon approval.

(Expense [$2000 CAD] paid if presenting an original paper that has not been presented elsewhere)

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.

Supervisor: Dr. Mini Pakkal & Dr. TaeBong Chung

50:50 Cardiothoracic 1-Year Fellowship 

There are 2 positions within our cardiothoracic division to complete a 50:50 split cardiothoracic fellowship in a one-year period. One of these 2 positions will start with cardiac for the first 6 months and then chest for the subsequent 6 months. The other 50:50 cardiothoracic position will start with 6 months of chest and then 6 months of cardiac. During the cardiac portion of the fellowship, the fellow will be exposed to a high volume of cardiac MR, cardiac CT, and some echo cases. This training will be sufficient to allow a fellow to achieve a minimum of level II training in cardiac imaging and possibly level III training depending on the motivation and work ethic of the fellow. During the chest fellowship, there is ample opportunity to perform lung biopsies as well as be exposed to all aspects of thoracic imaging such as lung transplant, interstitial lung disease, and oncology imaging.

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 (including a mature TAVI program and cutting edge Mitral and Tricuspid programs) and its subspecialty Respirology services including Cystic Fibrosis, Hereditary Hemorrhagic Telangiectasia and Hepatopulmonary Syndrome.

There are 3 positions (2 funded, 1 self-funded/ sponsored) in this one-year clinical fellowship which will provide excellent exposure to multi-modality imaging of cardiovascular and thoracic disease.  The fellowship is structured with primary emphasis on Cardiac CT and MR and a strong emphasis on general thoracic CT.

1. We perform approximately 1800 cardiovascular CTs per year, the majority of which are for coronary imaging, over 400 of which are structural heart CTs (for transcatheter aortic, mitral and tricuspid valve replacement, and minimally invasive mitral valve surgery) 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 Structural Heart 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 6 full-time supervisory faculty members in cardiothoracic imaging.

Supervisor: Dr. Lan Chau Kha

The division of Cardiothoracic Imaging at Sunnybrook Health Sciences Centre, which is affiliated with the University of Toronto, offers a combined Cardiothoracic Imaging fellowship. Sunnybrook is home to Canada’s first and largest regional trauma center, Edmond Odette Regional Cancer Center and Schulich Heart Centre, both leaders in Oncology and Cardiology.

The Cardiothoracic Imaging program is 12 months in duration with time evenly split between the cardiac and thoracic services. However, accommodations may be considered based on the applicant’s previous experience. There are up to 3 qualified applicants accepted each year (2 funded positions and 1 self-funded position). The fellowship is structured to provide comprehensive and advanced training in thoracic and cardiac imaging with services in conventional radiography, computed tomography (CT), magnetic resonance imaging (MRI) and thoracic interventions for practice in academic and community settings.  There are excellent research and educational opportunities as well as the availability of high-level mentorship for fellows pursuing scholarly activities.

The department houses four clinical CT scanners including three 64-detector GE and one research CT scanner (320 MDCT, Aquilion ONETM, Toshiba). There are three new clinical MRI scanners (two Siemens Aera and Sola 1.5T, two Siemens Vida 3T) and three research MRI scanners (GE 1.5T, GE 3T, and a hybrid GE 1.5T- angiography suite), as well as a state-of-the-art hospital-wide PACS system and voice recognition dictation systems.

Thoracic Imaging: 

The fellows are exposed to a high volume of cases approximately 20,000 thoracic CT and 600 MRI studies per year. These studies include level I trauma emergency exams, cancer workup which is multidisciplinary with various treatment modalities (including Stereotactic Body Radiation Therapy as Sunnybrook is one of the largest centers in Canada offering this modality of treatment) and a variety of adult and neonatal pulmonary diseases. There is an active interventional service performing several CT-guided lung biopsies each week. 

In-depth case review occurs daily during readout sessions and throughout the week during a variety of multidisciplinary activities which involves the fellow’s participation. There are close ties with our clinical and scientific colleagues as we attend weekly respirology, trauma, tumor board rounds and several times a month participate in joint conferences, grand rounds and other activities.

At the completion of training the fellow should be an expert in the acquisition, processing and interpretation of thoracic radiography, CT, chest MRI and performance of image-guided thoracic interventions.

Cardiac Imaging:

The fellow will gain exposure to and expertise in the acquisition, post-processing and interpretation of a large number of cardiac CT and MRI studies, with a main focus in the study of coronary arteries, ischemic heart disease and non-ischemic cardiomyopathies. Since the Schulich Heart Centre is a lead in numerous minimally invasive cardiovascular procedures, the fellow will become highly skilled in the preoperative assessment of pulmonary vein ablation, transcatheter aortic and mitral valve implantation and minimally invasive coronary artery bypass graft surgery. Approximately 2,000 Cardiac CT and 1500 cardiac MRI studies are performed annually in the department".

A  variety of clinical, educational and research rounds are held in the Cardiology and Cardiovascular Surgery Departments and the fellow is encouraged to attend and participate

The fellow will also have accumulated the required cardiac CT experience to meet the qualifications for Level 3 certification.

Research:

The fellow will have one dedicated protected academic day a week to conduct at a minimum one, preferably two, thoracic or cardiac research project(s), gaining experience as a principal investigator in clinical research. She/he will participate in the annual research day and present at least one abstract at an international radiology meeting (funding assistance provided) and complete one manuscript for publication.

Supervisor: Sadia Raheez Qamar

The Sunnybrook Campus offers one fellowship position in Emergency and Trauma imaging each year. Located in mid-Toronto, Sunnybrook is the largest regional trauma centre in Canada as well as home to a busy general emergency department. This fellowship consists of a combination of CT, MRI, radiography, and ultrasound with cases encompassing the spectrum of emergency department presentations.  A practical hands-on approach is emphasized with significant contact with emergency physicians, trauma surgeons and patients.  Fellows will learn not only through clinical practice under the direct supervision of dedicated Emergency and Trauma radiologists but also through trauma surgery rounds, emergency department rounds and organ-specific imaging rounds.

There is a large imaging research group associated with Sunnybrook. This consists of a group of senior scientists and postgraduate students whose research activities encompass all types of diagnostic imaging. They are located in a research wing that adjoins the Department of Medical Imaging.

Emergency and Trauma Radiology is a rapidly growing field with excellent career prospects upon graduation.  Our ideal candidate must have excellent clinical, communication, and interpersonal skills as well as an interest in teaching residents and conducting meaningful research.  Short-listed candidates will be contacted to arrange an interview.  We look forward to your application.

Supervisor: Dr. Shobhit Mathur 

Located in the heart of downtown Toronto, St. Michael's Hospital is one of the principal teaching hospitals of the University of Toronto, a busy Level 1 trauma center and stroke referral center.  Currently equipped with state-of-the-art equipment including dual-energy CT and 3T MRI we provide the complete spectrum of emergency, trauma, and critical care imaging including neuroimaging.  We have excellent relationships with our referring physicians and fellows will work in close collaboration with the emergency physicians as well as trauma, stroke, and critical care teams. There are consequently opportunities to attend and present at the trauma surgery rounds, emergency department rounds, and various radiology rounds.

Fellows are actively involved in didactic and case-based resident teaching. In addition, participation in teaching medical students is encouraged. Protected research time of one day per week is provided to fellows to complete at least one research project during the year.  

We are a close and collegial team, and selected fellows will be supported and mentored throughout their fellowship and into practice.

Supervisor: Dr. Tom Marotta

St. Michael’s Hospital, located in the heart of Downtown Toronto, is a major teaching and research hospital with expertise in diverse areas of health care. It is affiliated with the University of Toronto, one of the world’s premier universities, and its Faculty of Medicine ranks among the world’s elite medical schools.

Our Neurovascular Program is a busy multidisciplinary service with staff from Interventional Neuroradiology (INR), Neurosurgery, Neurology, and Neurocritical Care. The INR fellows are provided an opportunity to run the service with full clinical management responsibilities. The purpose of our Fellowship Program is to comprehensively train future neuro-interventionalists for a career in clinical care, research, and teaching.

We are a high-volume referral center for the endovascular management of complex neurovascular conditions. We perform large volumes of endovascular aneurysm repairs, complex vascular malformations, and carotid artery stenting procedures annually. We are a designated Comprehensive Stroke Center and a designated Trauma hospital. We routinely treat acute large vessel ischemic stroke, dural arteriovenous fistulae, brain, and spine arteriovenous malformations, treatment of intracranial hypertension and pulsatile tinnitus, epistaxis, and perform pre-operative embolizations and vertebroplasties.

We have a busy weekly Neurovascular Clinic where fellows see the majority of the new patients and follow-ups under the guidance of the staff physicians. Apart from this, we also have an Acute Carotid Clinic, mainly run by the fellows, that sees patients with carotid artery stenosis and other pathologies referred to us through our dedicated website carotid.ca. These patients are seen urgently and booked for endovascular stenting if deemed necessary. Our clinical service is also supported by our very capable and dedicated Advanced Practice Nurse and highly efficient clerical staff.

We have three main neurovascular conferences. Interesting and difficult aneurysm, arteriovenous malformation, and dural fistula cases are planned for in the Neurovascular rounds with all four INR staff in attendance. Stroke rounds occur every last Monday of the month and are held together with the Neurology service. During these rounds, the latest trends in the management of stroke patients are presented and critically appraised by the INR fellows together with the Stroke fellow. Lastly, we also participate in the St. Michael’s Hospital Brain and Heart Innovation rounds, where the latest technology for the treatment and diagnosis of neurovascular and cardiovascular conditions are discussed.

Currently, we utilize a state-of-the-art Philips biplane flat panel neuroradiology suite. Renovations are already underway for another new Philips bi-plane suite and a hybrid Siemens bi-plane suite. Non-invasive neurovascular imaging is efficiently obtained in our three CT scanners and four MRI machines (two 1.5 T and two 3 T).

Current research and clinical interests of the group include robotic neurointervention, intracranial flow diversion, carotid artery stenting for asymptomatic patients, and technical maneuvers in acute stroke intervention. Dr. Marotta has additional unique experience and opportunities for innovative device evaluations and development. Dr. Pereira is a surgeon scientist who co-leads the RADIS (Robotics, AI, Dynamic flow, Imaging and Simulation for neurovascular disease research) laboratory with our Research Program Manager, Nicole Cancelliere. We also have a research support staff that maintains prospective databases available for the fellow’s research projects. To help disseminate the fellows’ research, we also have dedicated hospital funding to support presentations at international conferences. Participation in ongoing clinical trials and animal research may be arranged. The most recent publications of the group can be found here.

To maximize clinical and procedural exposure, the program only takes in 2-3 fellows per year. Depending on the background training of the applicant the INR Fellowship may be a one- or two-year program. We accept applications from diagnostic neuroradiologists (who have completed at least one year of Diagnostic Neuroradiology Fellowship training), neurologists (who have completed at least one year of Stroke or Neurocritical Care Fellowship), and neurosurgeons. For fellows who have neurosurgical training there is an opportunity to participate in open neurovascular cases in the operating room. Participation in the Diagnostic Neuroradiology and Stroke services can also be arranged depending on the fellow’s goals. The two-year program can be performed at SMH or combined with another site.

The program strives to cultivate a collegial and educational environment that fosters close relationships between faculty and fellows, and encourages meaningful interactions with other clinical departments. We are looking for candidates who are willing to dedicate time and effort into being vital parts of our Neurovascular Team. We want them to learn from us everyday as we learn from our fellows as well. More than technical skills and research, we also strive for our fellows to be excellent clinicians, caring for patients in a multi-disciplinary environment. Their work is also balanced with healthy social and personal activities outside the hospital.

St. Michael’s Hospital Neurovascular program link:
https://www.neurovascularcentre.ca/contact

Supervisor: Dr. Timo Krings

The Toronto Western Hospital (TWH) training program in Interventional Neuroradiology (INR) of the University of Toronto was established in 1984 by Karel terBrugge under the supervision of Pierre Lasjaunias of France. Since then, more than 50 fellows from all over the world have been trained with us, many of whom now lead their own programs. We have trained fellows with backgrounds in neurosurgery, neurology and radiology.

The TWH INR Program will allow the applicants to become proficient in all aspects of Interventional Neuroradiology including the entire spectrum of vascular disorders of the central nervous system and percutaneous minimally invasive spinal procedures.

The TWH is a referral center for complex aneurysms, brain and spinal AVMs, dural AV fistulae and vascular malformations of the head and neck region from all over North America. We manage patients with epistaxis, complex intracranial, head and neck and spinal tumors with preoperative embolization, and have the capability of intraoperative angiography as well as a combined angio /MRI suite. The Toronto Western Hospital is a primary acute stroke center with more than 150 acute stroke treatments each year. Stroke prevention procedures (both extracranial and intracranial angioplasty and stenting) are routinely performed. Management of intracranial aneurysms, including coiling, stent or balloon assisted, flow diversion, intra aneurysmal flow disruptors, or deconstructive techniques are a major focus of our workload. Minimally invasive percutaneous treatments such as spinal biopsy, vertebroplasty, kyphoplasty, nerve and facet blocks are routinely performed. Our program includes exposure to pediatric interventional procedures at the Hospital for Sick Children in Toronto where we manage Vein of Galen Malformation, pediatric AVFs, and AVMs as well as pediatric aneurysms and stroke.

The multidisciplinary team at the TWH includes stroke neurologists and vascular neurosurgeons as well as stereotactic neurosurgeons, and, in association with the Hospital for Sick Children, pediatric vascular neurosurgeons and neurologists. A weekly multidisciplinary AVM and aneurysms outpatient clinic is held where we see between 30-50 patients each week, including new referrals and follow-up visits. At the TWH, we have weekly “Stroke” rounds, Neuroscience rounds (together with Neurology and Neurosurgery), INR-specific teaching rounds, and dedicated neurovascular rounds. In addition, monthly M & M rounds, Neuropediatric vascular rounds, research rounds, and multidisciplinary AVM rounds with Neurosurgery and Radiosurgery are held. These rounds allow the trainees to gain experience on non-invasive vascular imaging and multidisciplinary management of complex vascular malformations. Since 1990, the TWH organizes an annual International Symposium on Interventional Neuroradiology in September attended by more than 200 participants yearly.

Three clinical fellowship positions are available with the diagnostic workload being over 300 diagnostic cerebral and 30 spinal angiographic procedures and 30 angiographies for Gamma Knife planning (that is performed in collaboration with Radiosurgery) per year. Annually, we perform more than 800 interventional procedures, that encompass the entire advanced spectrum of Neurointervention including pediatric neurointerventional procedures that are performed at the Hospital for Sickkids, and percutaneous spinal procedures. Since 1990, we have entered our patient collective into a prospectively maintained neurovascular database that by now encompasses more than 5000 aneurysms and 3000 AVMs of various types..

The TWH has 2 state-of-the-art flat-panel biplane neuroangiographic suites, one of which is physically connected to a 3T MRI facility allowing for easy transfer between MRI and DSA, which may be required during management of patients with certain neurovascular disorders. One of the biplane angiography suites is also OR compatible allowing for combined surgical and endovascular procedures to be performed. In addition, we have two 1.5T and one 3T MRIs on site with the capability of state-of-the-art vascular imaging (including vessel wall imaging and dynamic MRAs) and two 64 slice CTs as well as one 320 slice CT (with the possibility of subsecond dynamic CTA). Two additional 3T MRI systems, one of which is dedicated solely to Research will be opened in December 2020. We have recently performed the World’s first robotic neurointerventional procedure and are currently implementing remote Neurointervention.

Our team has fostered an INR Fellowship Program, which is internationally acclaimed for its academic commitment and scientific output, please click here for our recent publications.  

In addition to one and 2 year INR fellowships, we offer two-year combined diagnostic and interventional Neuroradiological Fellowships as well as combined open neurosurgical/endovascular fellowships in collaboration with the Division of Neurosurgery. A two-year INR fellowship either at the TWH or combined with one year at St. Michael’s Hospital (see below) is available. To apply for the Interventional Neuroradiology Fellowship, please click link below.

If you have any additional questions regarding the fellowship, please contact Dr. Timo Krings.

The TWH INR Fellowship Program is held in accordance with the UEMS recommendations for acquiring particular qualifications in endovascular interventional Neuroradiology and WFITN guidelines for training in Interventional Neuroradiology

The University of Toronto Spine Intervention Neuroradiology Fellowship program is a 6 or 12-month, non-accredited program that offers the opportunity to manage and treat benign and malignant spine conditions in a high-volume academic environment.

Fellows will gain experience in advanced fluoroscopic and computed tomography guided interventional spine procedures. Fellows will evaluate and develop treatment plans for patients in spine clinics under the guidance of their primary supervisors.

Fellows will have the opportunity to participate in weekly multidisciplinary spine rounds and weekly neuroradiology academic half-days (Friday mornings).

FUNDING

• Self-funded, home country funded, or funded by Drs. Smith and Murphy’s Toronto Western Foundation support

Procedural Training

• Planning and performing invasive image-guided procedures
• Direct observation from staff
• Guidelines for basic procedural competence at the end of training are as detailed below:

Additional training in the following procedures is optional but recommended:

• Synovial Cyst Rupture
• Tarlov Cyst Interventions
• Lumbar Drain Insertion
• Digital Subtraction Myelography

Evaluation of Procedural Competence

• Fellows will be evaluated based on an entrustability scale using the O-SCORE framework
• Gofton WT, Dudek NL, Wood TJ, Balaa F, Hamstra SJ. The Ottawa surgical competency operating room evaluation (O-SCORE): a tool to assess surgical competence. Acad Med. 2012;87(10);1401-7.

On-Call Responsibilities

• If current and/or previous diagnostic neuroradiology training, spine intervention fellows will be required to participate in the University Health Network Diagnostic Neuroradiology Fellow call schedule.

Vacation

• 4 weeks per year
• Additional time may be granted to attend relevant conferences, workshops, etc. at the discretion of the primary supervisors

Supervisor: Patrick Veit-Haibach

This one-year clinical-research fellowship is offered at the Joint Department of Medical Imaging (UHN, MSH & WCH).  The fellowship provides experience in molecular imaging research, particularly in the field of hybrid imaging in oncology. The fellow will work with clinical and research staff to gain an understanding of appropriate research methodologies, data collection, and analysis. Fellows will also engage in collaborative meetings with other research groups. Furthermore, they will be encouraged to generate original research ideas and develop proposals for external funding of research activities. It is also encouraged to apply for a second year of fellowship within JDMI (usually the year before the molecular imaging fellowship, but afterwards is possible, too) e.g. for abdominal or chest imaging. This way, the fellow experiences a comprehensive overview of different modalities and a broad disease spectrum.

In addition to research-related activities, in order to get a broader understanding of the role of imaging in oncology, fellows will be encouraged to participate in multidisciplinary tumor boards and will also take part in the review of clinical oncology CT and MR cases (allocated clinical time: approximately 25%).  The clinical scope of work can be tailored to the qualifications and needs of the trainee.

UHN is equipped with 2 PET/CT scanners and one research PET/MR scanner (with an adjacent Cyclotron), with numerous industry and local researcher trials. Currently, over 30 different trials have been conducted in the past 2 years. Overall > 4500 cases have been acquired including > 700 research cases last year at the Joint Department of Medical Imaging alone. This infrastructure and volume of research present an outstanding opportunity for clinical and research training at JDMI.

Supervisor: Dr. Robert Bleakney

The Musculoskeletal Imaging fellowship is a one-year post-residency training program. The program provides clinical experience in the full range of disorders affecting both the adult and pediatric musculoskeletal systems, involving both the axial and appendicular skeleton including; traumatic, neoplastic, infectious, articular, hematologic, metabolic, congenital/developmental, and degenerative disease.

In recent years the fellowship has developed into a well-recognised and comprehensive training program attracting high calibre applicants from around the world. There are currently three musculoskeletal imaging fellow trainees within the program each academic year.

In order to provide this comprehensive experience, the program includes rotations at:

• Joint Department of Medical Imaging at Mount Sinai Hospital and the University Health Network (Toronto Western, Toronto General, Women's College, and Princess Margaret Hospitals)
• Hospital for Sick Children
• St Michael’s Hospital

The program emphasizes the application and interpretation of MSK imaging examinations and procedures, including radiography, arthrography, radionuclide scintigraphy, ultrasonography, computed tomography, magnetic resonance imaging, and image-guided percutaneous biopsy techniques.

Fellows are responsible for coordinating and reporting medical imaging for both inpatients and outpatients at each institution and work in close consultation with the staff, fellows, and residents in Orthopedic Surgery, Rheumatology, Oncology, and Emergency Medicine, as well as occasionally interacting with other subspecialists in Medicine and Surgery.

The fellows attend, and along with staff, are actively involved with the coordination and presentation of resident didactic conferences and teaching/image interpretation sessions in MSK imaging. The fellows also participate in interdepartmental conferences with Orthopedic Surgery, Rheumatology, and Oncology.

Participation in rounds for other medical and surgical services will be expected for topics related to MSK disease, and will occasionally include imaging-oriented conferences with medical students and other medical staff.

Dedicated research time of one day per week is available to allow the fellows to pursue and complete at least one substantial research project during the year. The three fellows share an office space with their own network terminal and have access to the full range of office equipment and facilities. In addition, there is online access to the University of Toronto Library with its extensive array of e-journals, e-references, and e-texts.

Program Director - Dr. Matylda Machnowska

Diagnostic Neuroradiology Rotation (MSH-UHN-WCH)

Mount Sinai Hospital - Supervisor:  Dr. Laila Alshafai

This 6-month rotation is in Medical Imaging at Mount Sinai Hospital, a filmless department with an integrated PACS partnered with University Health Network hospitals of University of Toronto. There are 2 GE MRIs and 2 CTs, including a 4 slice GE and a 16 slice Siemens. A 64 slice Toshiba was installed in 2005. Two general fluoros handle occasional lumbar or cisternal punctures or rare myelography. Dacryocystography, sialography, as well as fluoro- or CT- guided biopsies/aspirations are done when indicated.

The hospital's clinical strengths relevant to neuroradiology include a busy emergency room; daily general Otolaryngology Clinic with 2 oncologic surgeons; Ophthalmology service specializing in oculoplastics and orbital mass lesions; extended regional Oral Surgery including mandibular, maxillofacial, and TMJ pathologies; as well as neurology, infectious disease, and internal medicine in/out-patient services. This adds to strength with the balance of neuroradiology- head & neck radiology case material. 

Two weeks of elective time per 6 months of a fellow rotation may be spent (availability dependent) at any of the University affiliated sites, including The Hospital for Sick Children. The purpose may be practical, research or educational, and may be used to complement a Fellow's needs within a wide variety of opportunities. One day/week is allotted for research projects, which may be performed outside the base hospital site.

Princess Margaret Cancer Centre - Supervisor:  Dr. Laila Alshafai

This 3-month rotation is based at Princess Margaret.  But the fellow is responsible for coverage of head and neck imaging cases performed at all sites in the University Health Network and Women's College Hospital.  The rotation focus will be Head and Neck Oncology as Princess Margaret has one of the largest Head and Neck Oncology Programs in North America. Clinical rounds are part of the weekly schedule, including Head and Neck Oncology rounds, Endocrine and Skull Base rounds, Tumor Board rounds (in conjunction with the radiation, medical oncology and surgical oncology groups), and Lymphoma rounds.

Medical Imaging is filmless with an integrated PACs system allowing the easy viewing of images at all University Health Network sites. Facilities include digital angiography (TGH), CT fluoroscopy (TGH).  PMH site includes 3 CT scanners, 1 PET-CT, 2 MRI scanners.  TGH site has 4 CT scanners in the department and 1 in the emergency room, and 2 MRI scanners.

One day per week is allotted as a research/elective day during this rotation.  The elective and/or research can be done at any of the University of Toronto Program sites.  Elective opportunities are varied and include neuropathology, neurology, neurosurgery, and intensive care medicine.  The allotted day per week can also be spent in the ENT oncology and radiation oncology clinics, depending upon availability.  Similarly, the time can be spent participating in oral radiology film reading sessions with the oral radiologist at PMH.

Toronto Western Hospital - Supervisor:  Dr. Alcaide Leon Paula

Exposure, participation, and supervision of neuroimaging modalities are customized depending on a candidate’s level of expertise and previous training. Rotations combine cross-sectional imaging with procedural work including diagnostic catheter neuroangiography if desired by the fellow. 10 neuroradiologists are directly involved with teaching at one of the largest neurosciences centres in North America. The hospital is well equipped with two dedicated neuroradiology biplane digital angiographic suites, 3 clinical MR units including 3T and two 64 slice CTs and one 320 slice CT. State-of-the-art MR with diffusion/perfusion imaging, functional imaging, and spectroscopy. Vascular, epilepsy, neurodegenerative, and spine diseases are special areas of interest. The Toronto Western Hospital team leads in some advanced MR techniques including gadolinium-enhanced MRA, spectroscopy, and functional imaging. Interventional neuroradiology at the Western is world-renowned providing valuable contributions to the knowledge of the natural history of a number of cerebrovascular diseases. The interventional program is active in the management of aneurysms, arteriovenous malformations, arteriovenous fistulae, and stroke. Interventional neuroradiology is active in spine interventions and vertebro and kyphoplasties.

An integrated PACS serves the University Health Network, Women's College and Mount Sinai Hospital. This allows fellows easy access to imaging data to create an encyclopedia of teaching cases for future use. Images can be easily transferred onto a flash drive or "burned" onto CDs.

Participation in ongoing clinical research in MRI, CT and interventional neuroradiology is available to fellows, as well as access to MRI research. Participation in weekly city-wide neuroradiology rounds held at the Toronto Western Hospital is encouraged, as well as attendance at weekly neuroscience, stroke, interventional cerebrovascular, and neurosurgical rounds.

Diagnostic Neuroradiology Rotation (Sunnybrook Health Sciences Centre) - Supervisor: Dr. Matylda Machnowska

This site offers training and research opportunities of an all-around adult hospital plus perinatology including neurosurgery, neurology, otolaryngology, oncology, neuro-ophthalmology, and neuropathology.  Imaging equipment includes three 64-slice CTs, one 4-slice CT, one CT-PET, two 1.5 Tesla MRIs and one 3.0 Tesla MRI.  There is a biplane 3D neuroangiography suite.  The department is entirely filmless with a versatile PACS system featuring remote web-based access. Full-time attending neuroradiologists, Dr. Sean Symons, Dr. Richard Aviv, Dr. Peter Howard, Dr. Robert Yeung, and Dr. Allan Fox, are responsible for the section activities, including diagnostic neuroradiology and interventional therapy.

Highlight activities for neuroradiology include:

• Largest Canadian trauma centre.
• Regional stroke centre.
• Research centre of cognitive diseases.
• Largest research imaging centre, much in brain.
• Neuro-oncology (dedicated neurologist-neuro-oncologist).
• Neuro-otology (renowned neuro-otologists).
• Regional cancer centre (including brain, spine and head & neck).

Neuroradiology trainees are involved with all activities of neuroimaging.  CT and MR studies include attempts to optimize angiography and perfusion protocols. Thorough and fast hyperacute stroke protocols are efficiently acquired and interpreted. Therapeutic neurointerventional procedures include hands-on experience for neuroradiology fellows.

The neuroradiology faculty are involved in numerous collaborative research projects in the areas of stroke, neuro-oncology, head & neck oncology and otology.  Fellows are given an academic/elective day per week to perform research at Sunnybrook under the supervision of one of the Sunnybrook neuroradiologists.  Each fellow must complete a research project at Sunnybrook as a requirement of the rotation.

Fellows are on-call wtih one of the attending neuroradiologists.  Call is from home except for in house read out each weekend morning.  Call frequency is 1 in 3.  Residents take first call ahead of the fellows.

Weekly rounds include neurosurgery, neuroradiology, head/neck cancer, spine, clinical neurosciences, stroke, and brain tumour.  Monthly rounds include ENT and morbidity/mortality. 
 

Diagnostic Neuroradiology Rotation (St. Michaels Hospital) -Supervisor: Dr. Amy Chen

The diagnostic neuroradiology trainee at St. Michael's Hospital will participate in all cross-sectional imaging examinations of Brain, Head & Neck, and Spine; whereas the neurointerventional trainee will participate in all diagnostic angiographic procedures and endovascular interventions.

The site has three 1.5 Tesla MRIs, three multi-slice CTs and a bi-plane angiographic unit with 3-D capability.  The rotation at St. Michael's Hospital is under the supervision of 4 neuroradiologists: Dr. Bruce Gray, Dr. Tom Marotta, Dr. Walter Montanera and Dr. Lyne Noël de Tilly.  Dr. Marotta and Dr. Montanera are interventional radiologists. Dr. Gray has dual certification in radiology and nuclear medicine.

There are 7 neurosurgeons at St. Michael's Hospital, including a skull base surgeon, a spine surgeon, and two vascular neurosurgeons.  One of them, Dr. Spears, is actively participating in the neurointerventional service.  Eight neurologists work at St. Michael's Hospital.

The neuroradiology experience at St. Michael's Hospital is quite broad with this hospital being a trauma centre and the largest MS clinic in Canada.  A large number of brain tumours are being treated including a wide variety of skull-base lesions. The cardiovascular program is very strong at St. Michael's Hospital.

Rounds and teaching: There are weekly Neuroscience Rounds where neurologists, neurosurgeons, neuropathologists and neuroradiologists are scheduled to present a topic of their choice in a relatively collegial atmosphere. The neuroradiology trainee is expected to participate in these rounds.  Neuroradiology rounds are also given to the radiology residents every Wednesday.  They are given by the neuroradiology attendees and the diagnostic fellow is more than welcome to participate.

Diagnostic Neuroradiology Rotation (The Hospital for Sick Children) - Supervisor: Dr. Helen Branson

As a major referral base for Canada and abroad the experience and exposure at HSC are unmatched.

Fellows work closely with fellowship-trained pediatric neuroradiologists.

Four on-site MRs, three MR-3T and one MRs 1.5 T allow time for clinical activities while one on-site state of the art MR 3T is utilized for research. Also on-site is one CT and one PET/CT. Myelography and both diagnostic and interventional angiography are performed at the Hospital for Sick Children.

Fellows actively participate in all clinical rounds, cover both CT and MR with staff support by reviewing all CTs and MRs throughout the day, and spend time performing diagnostic angiography and myelography. Opportunities for research are vast due to the high volume of interesting case material as well as 20% protected research time.

Dr. Oscar Navarro
Paediatric Radiology Program Director

Fellowship Information  *See new application deadlines under Applications*

The Clinical Fellowship Program in the Department of Diagnostic Imaging at The Hospital for Sick Children provides training for those radiologists interested in pursuing a career in paediatric imaging. The candidates must have already completed a four-year training in a diagnostic radiology residency program or be board-certified as radiologists in their country of origin and meet the minimum eligibility requirements for licensure with the College of Physicians and Surgeons of Ontario. The program is within one of the largest and busiest paediatric radiology departments in the world, performing approximately 130,000 examinations per year, allowing exposure to practically the entire spectrum of normal and pathologic imaging findings one can encounter in paediatric practice. The Clinical Fellowship Program is open to both Canadian and international applicants and as of April 2023 we have fellows from Canada, Costa Rica, Panama, Chile, Brazil, United Kingdom, France, Switzerland, Spain, Nigeria, South Africa, Saudi Arabia, India and Australia.

The Clinical Fellowship Program in our department is part of the Fellowship Program of the Department of Medical Imaging of the University of Toronto. Our program offers fellowships in Paediatric General Radiology, Paediatric Neuroradiology, Paediatric Interventional Radiology, Paediatric Cardiac Imaging and Paediatric Nuclear Medicine. We have a variable number of funded and self-funded positions available, starting in July and sometimes also in January of each year. The funded positions are paid for by our department whereas the funding of the self-funded positions should be arranged by the candidate either through international grants or sponsoring institutions in their home countries.

Most of our fellowships are one-year in duration. In Paediatric General Radiology, there is some flexibility and interested candidates may apply to one-year or two-year programs depending on the particular needs of the applicant or of the institution sponsoring the candidate. At the time of application, the candidate can apply to more than one fellowship program, for example, one year of Paediatric General Radiology and one year of Paediatric Neuroradiology. However, each application is treated separately by the Fellowship Committee and most of the time the applicant will only be accepted to one fellowship with recommendation to apply to the other fellowship by the next year.

The clinical fellowship in Paediatric General Radiology includes rotations in the following areas: plain radiographs (including in-patient studies from the pediatric and surgical wards, neonatal and paediatric intensive care units as well as outpatient and emergency room examinations), fluoroscopy (gastrointestinal and genitourinary), ultrasound (including neuro-sonography), body CT, body MRI (chest, abdomen and musculoskeletal), neuroradiology (including CT and MRI), and nuclear medicine. Fellows have protected time to attend multiple one-hour teaching sessions every week and periodically participate at clinical case rounds in general surgery, oncology, emergency, non-accidental injury and gastroenterology.

Our training program in Paediatric General Radiology is accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) as a one-year Paediatric Radiology Residency Program. This means trainees who have completed a diagnostic radiology residency program in Canada and/or are certified by the RCPSC in Diagnostic Radiology and enter our program in Paediatric General Radiology will be recognized as PGY6 paediatric radiology residents. These trainees may be eligible for certification with examination in Pediatric Radiology by the RCPSC following successful completion of our program. Fellows who are not part of the RCPSC track may also take the RCPSC examination in paediatric radiology through the Subspecialty Examination Affiliate Program (SEAP) to become a subspecialist affiliate with the RCPSC.

In July 2024, our clinical fellowship in Paediatric General Radiology will begin implementing Competence by Design (CBD), a specific model of competence-based medical education supported by the RCPSC. This is characterized by 4 well-defined stages of training, clear learning objectives called entrustable professional activities (EPAs), observation of trainees completing EPAS, documentation of observations in an electronic portfolio, and regular reviews of documented observations by the Competence Committee which will provide recommendations for progression to the next stage of training. Benefits of CBD include clear learning expectations for trainees, more opportunities for feedback and coaching, more control over learning by trainees, prevention of gaps in knowledge, and promotion of feedback in lifelong learning.

The clinical fellowship in Paediatric Neuroradiology provides training in diagnostic pediatric neuroradiology, including CT and MRI of the brain, head, neck and spine, and covers a wide range of congenital and acquired conditions. Fellows gain competence in protocoling, monitoring and reporting CT and MRI studies from the fetus through to the age of 18 years, including neonates. Multiple teaching and clinical rounds are held every week. Fellows are actively involved in the presentation of clinical case rounds and in the preparation of lectures and presentations for meetings. Fellows become part of the neuroradiology team and take part in on-call services in pediatric neuroradiology. Fellows actively interact with many clinical services especially neurosurgery, neurology and otolaryngology/head & neck surgery.

The clinical fellowship in Paediatric Interventional Radiology provides training for radiologists with previous training in paediatric radiology or adult interventional radiology interested in pursuing a career in image-guided paediatric interventions. Our Division of Paediatric Interventional Radiology is one of the largest and busiest in the world, performing a wide variety of procedures, including but not limited to central venous access, biopsies, gastrointestinal access, management of post-surgical and post-transplant complications, angiography, and management of vascular anomalies. Fellows attend weekly theorical lectures on the above mentioned topics. Fellows are exposed and actively take part in numerous procedures under the supervision of staff interventional radiologists and it is expected that at the end of the fellowship they will be the main operators in the majority of interventions. Fellows are also actively involved in morning huddles, clinical rounds, clinic consults and post-procedure patient management as well as in-house, national and international conferences presentations.

The clinical fellowship in Paediatric Cardiac Imaging provides training in MRI of congenital and acquired cardiovascular disease in children. With the recent acquisition of new CT equipment in our department, we expect  training will also extend into cardiac CT. The program is a combined program for radiology and cardiology fellows. Fellows gain competence in designing, protocoling, monitoring, post-processing and reporting MRI. Importantly, the program is set in such a way that fellows work closely together with technologists to acquire basic knowledge and skills on MRI. In addition, radiology-based fellows learn basic cardiology concepts through daily interaction with colleague cardiology-based fellows. Fellows are also provided with ample opportunities to participate in clinical discussions and rounds, to attend a number of lectures organized by the Department of Diagnostic Imaging and the Division of Cardiology, Department of Paediatrics. Fellows are actively involved in research projects and presentations at scientific meetings.

The clinical fellowship in Paediatric Nuclear Medicine provides training for board-certified nuclear medicine physicians or radiologists that are interested in paediatric nuclear medicine. The program enables fellows to learn a wide variety of nuclear medicine imaging techniques and procedures in children including PET/CT and SPECT imaging as well as radionuclide therapy. Upon completion of training, the fellow is expected to be competent in performing and interpreting common paediatric nuclear medicine examinations. Fellows are actively involved in teaching and participation in clinical rounds.

Fellows are trained and evaluated in all aspects of the CanMEDS competency framework (medical expert, communicator, collaborator, leader, health advocate, scholar and professional roles). Fellows gain competence through a process of graded responsibility by which they take on increased responsibility as they acquire greater experience under the ongoing supervision of staff radiologists. This is supplemented by daily teaching sessions in all areas of paediatric imaging, participation in clinical rounds, and presentation at quality assurance rounds and journal club. Fellows are also expected to cover MRI evening shifts and to do after hours and weekend shifts on a rotating basis with the other fellows. As the fellows gain more familiarity with paediatric imaging and with the department, they are put in a more supervisory role over diagnostic radiology residents who are performing “in-house” call during their paediatric imaging rotation in our hospital. Fellows are expected to reach the level of junior staff colleagues before they leave the department.

Protected academic time is provided to the fellows so they can work on research or quality improvement projects and prepare presentations during the year. Fellows are supported in all academic activities and in the past, this has led to numerous presentations at national and international paediatric imaging meetings as well as the publication of scientific papers, educational exhibits and book chapters. Fellows are expected to be productive and the Department of Medical Imaging of the University of Toronto requires production of at least one original research article or completion of an approved quality improvement project per year of fellowship in order to issue a certificate of completion of fellowship.

Paid vacation is 20 working days per fellow, per year. Additional time is provided to all fellows to attend conferences and/or courses. Some funding is available for travel and accommodation to one conference for each year of fellowship.

Goals and Objectives

• Paediatric General Radiology
• Paediatric Neuroradiology
• Paediatric Cardiac Imaging
• Paediatric Interventional
• Paediatric Nuclear Medicine

Applications

Applications – New Deadlines*

Following the current recommendations by the Society of Chairs of Academic Radiology Departments (SCARD) and supported by the Society for Pediatric Radiology (SPR), we are postponing the application process we had initially stated on our previous posting. This applies to fellowships starting in January or July 2025.

* For international applicants, explicitly those who are not enrolled in an ACGME- or RCPSC-accredited program, the application process will open on October 1, 2023 and will close on November 10, 2023.

* For applicants who at the time of the application are enrolled in an ACGME- or RCPSC-accredited program, the application process will open on November 1, 2023 and will close on November 10, 2023.

The application process for all fellowship programs (Paediatric General Radiology, Paediatric Interventional Radiology, Paediatric Neuroradiology, Paediatric Cardiac Imaging and Paediatric Nuclear Medicine) is similar, including funded and self-funded positions.

In the application form, there is updated information regarding available funded and self-funded fellowship positions at the time of application. A completed application form, curriculum vitae, statement letter and three recent reference letters should be submitted by email before the deadline. All reference letters should be dated in 2023 and addressed to Dr. Oscar Navarro, Paediatric Radiology Program Director. In the preparation of the curriculum vitae, the candidate should clearly identify publications (peer-reviewed and non-peer-reviewed), oral presentations, posters and research work still in progress. All published work should be listed following standard format:

Grealish J, Haaland E, De Bruyne K. Effect of high intensity sport activities in the metaphyses of long bones in prepubescent children. J Pediatr Sports Med 2023; 65:731-738.

The candidate’s name should be in bold font. Always use the standard abbreviation of a journal’s name according to the ISSN List of Title Word Abbreviations (see ISSN.org LTWA).

Candidates can apply to two different fellowships (i.e. Paediatric General Radiology and Paediatric Neuroradiology, etc) using one single form. The Fellowship Committee will review all applications within 4-8 weeks of the deadline and will select a small number of candidates that will be called for an interview. We plan to hold remote interviews using a videoconference platform in January 2024. The final decision about acceptance will be made within a few weeks of the interview.

It is expected that all fellowship candidates have advanced English language proficiency, both oral and written. Although we do not require that the applicant pass an English language exam, the candidate’s fluency in English will be evaluated at the time of the interview.

Fellowship Application Form 

Orientation Handbook for New Residents and Fellow

The 2022 Orientation Handbook for New Residents and Fellows at the University of Toronto is currently available and we expect the 2023 version will become available in July 2023. This downloadable booklet/ offers up-to-date information about topics such as registration, health care coverage, cost of living, accommodation, and child care and schooling, to help new learners, especially those from outside Canada, achieve a successful transition to residency and fellowship training at the University of Toronto.

For more information regarding Paediatric Radiology fellowships or the application process, please contact: 

Katherine McLaren
Fellowship Program, Applications Process
Department of Diagnostic Imaging
The Hospital for Sick Children
555 University Avenue
Toronto, Ontario M5G 1X8
email: katherine.mclaren@sickkids.ca

Audrey Onugha                                            
Paediatric Radiology Program Administrator
Department of Diagnostic Imaging
The Hospital for Sick Children
555 University Avenue
Toronto, Ontario M5G 1X8
email: di.educationcoordinator@sickkids.ca

Oscar Navarro, MD                                              
Fellowship Program Director
Department of Diagnostic Imaging
The Hospital for Sick Children
555 University Avenue
Toronto, Ontario M5G 1X8
email: oscar.navarro@sickkids.ca

Supervisor: Dr. TaeBong Chung

The Thoracic Imaging division is one of the largest in North America with 14 staff radiologists working with state-of-the-art equipment. The hospitals are fully affiliated with the University of Toronto. The University of Toronto Centre of Excellence in Thoracic Surgery is located at Toronto General Hospital. 

The Thoracic Imaging fellowship offers a comprehensive multi-modality clinical experience in diagnostic and interventional techniques with over 500 MR, 40,000 CT, 118,000 CR/DR chest examinations and over 550 CT-guided lung biopsies each year.

Thoracic CT:  The current clinical caseload, ~40,000 cases per annum provides a wide spectrum of advanced thoracic imaging from one of the largest lung transplant centers (Toronto General Hospital) and one of the largest oncology centers (Princess Margaret Cancer Center) in North America. Research and clinical translation of low dose and ultralow dose thoracic CT has been a key feature of the thoracic program since 2004.

Lung Biopsies: There is a steady volume of CT-guided percutaneous lung biopsies -550 per annum performed using CT fluoroscopy and fine needle aspiration ± core biopsies. On-site cytopathology is present for every case.

Thoracic MR: There is a large clinical caseload, ~500 per annum reflecting the full clinical spectrum of oncologic and non-oncological disease.

Equipment: There are 12 x 64MDCT and 4 x 320MDCT (Toshiba Medical Systems) and 6 x 1.5T and 3 x 3.0T systems (Siemens Medical Systems and General Electric). There is a dedicated research MR (1.5T, General Electric) adjacent to the chest reporting area and a dedicated research CT (FLASH, Siemens) in the O.R. setting. Additional research equipment; X-Ray (Carestream Health), a second dedicated research CT (320MDCT, Vision, Toshiba), an integrated MRI-PET system (Siemens) and Cyclotron (GE). 

Research: There is an active multi-disciplinary research program with clinician-scientists and clinician-teachers, all fellows have 20% dedicated research time and are expected to produce at least one manuscript during their fellowship. Presentation of research work at International scientific conferences is financially supported and encouraged.

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. 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 CT and MR cases.  Lung biopsies are performed under graded supervision. The fellows attend the weekly Thoracic Oncology Tumour Conference and present at the weekly multidisciplinary Radiology-Respirology-Pathology rounds. 

The thoracic section is staffed by a group of fourteen radiologists. Faculty provides dedicated weekly thoracic teaching rounds and multiple weekly educational sessions comprised of case-based and didactic lectures. In turn, the fellows have teaching commitments to Medical Students, Radiology and Respirology Residents, and Fellows. 

After the initial 6 months of the thoracic fellowship, candidates have an option to be integrated into a busy cardiac radiology service (1800 Cardiac CT, 2500 Cardiac MR per year) for one week every month, for the remaining 6 months of the fellowship to allow concurrent training in cardiac imaging (CT and MR). Thoracic fellows are also eligible for complimentary participation in the Level 2 Cardiac CT course run by the University of Toronto Advanced Imaging and Education Center (AIEC) located within the Medical Imaging Department at Toronto General Hospital. The cardiac schedule provides Level II training in cardiac CT and a foundation in cardiac MR.

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. The 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 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

Supervisor: Dr. Andrew Common

St. Michael’s Hospital is a 600-bed downtown trauma centre. Long recognized for teaching excellence, we offer a single fellowship position with high-volume hands-on experience in vascular and non-vascular intervention and the benefits of excellent working relationships with other specialties, particularly vascular surgery, nephrology, urology, and cardiology. Graded supervision by 3 staff interventionalists is provided.

Vascular work includes:

• Peripheral vascular intervention, including angioplasty, stenting, and thrombolysis
• EVAR/endoleak management and combined surgical/endovascular procedures in the OR
• Embolization for trauma, GI bleeding, PAVMs, uterine fibroids, varicoceles, pelvic congestion
• AV Fistulae/Graft assessment and intervention: plasty, stenting, lysis, side-branch embolization
• Central Venous Access: dialysis lines, Hickmans, ports, PICCs
• Venous Sampling: renal, adrenal, parathyroid
• IVC Filter insertion and removal
• Mesenteric and Renal angioplasty, stenting, and embolization
• Thrombin ablation of Pseudoaneurysms

Non-Vascular Work includes:

• Cryoablation for Renal Cell Tumours
• Radiofrequency Ablation for Renal and Hepatic Tumours
• Percutaneous Nephrostomy, Ureteric Stenting
• Biliary Drainage and Stenting. Cholecystostomy and Stone Extraction
• Gastrostomy, Gastrojeunostomy, and Cecostomy tube management
• Abscess Drainage: percutaneous and endocavitary. Pleural/peritoneal drainage
• Biopsies: lung, liver, kidney, nodes
• Fallopian Tube Recanalization
• Peritoneal Dialysis Catheter insertion/removal

Equipment:

• Two new Philips Allura Clarity Xper FD 20 units are dedicated to body intervention alone.

Vascular CTA may be read by our fellow as time and interest allow.

Supervisor: Dr. Elizabeth David

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, RFA assisted vertebroplasty and osteoplasty.
• 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)
• 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 (Three Philips Allura units, one of which is biplane).
• 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.

Supervisor: Dr. Allison Grant

Positions available:  3 per year

This one-year fellowship includes breast, obstetric, and abdominal/gynecologic imaging. 80% of the fellowship is clinical and 20% is dedicated to research. 

Fellows rotate through 5 hospital sites:

• Mount Sinai Hospital (MSH)
• Princess Margaret Cancer Centre (PMCC)
• Toronto General Hospital (TGH)
• Toronto Western Hospital (TWH)
• Women's College Hospital (WCH)

The Women's Imaging fellowship consists of:

• 6 months breast imaging
• 2 months obstetrical imaging
• 4 months abdominal imaging (2 months body MRI, 2 months body CT/US).

Breast Imaging:

The fellowships are recognized and listed on the Society of Breast Imaging (North America). Our training program reflects the Breast Imaging Fellowship Curriculum published (2013) by the education committees of ACR and SBI.

Mammography & Ultrasound: The total number of screening/diagnostic mammograms performed across the three Breast Imaging Centers is over 200 per day. Each site performs an average of 15 – 20 diagnostic ultrasounds per day. All 3 of our centers are authorized center for provincial average risk and high-risk screening program through the Ontario Breast Screening Program, Cancer Care Ontario.

Breast MRI and intervention: Approximately 60-80 Breast MRI are performed per week. Opportunities for interventional procedures include: stereotactic and ultrasound-guided core biopsies (both 14G core and vacuum assisted), stereotactic and ultrasound-guided pre-operative and diagnostic needle localizations, ultrasound-guided diagnostic and therapeutic needle aspirations , galactography, MRI guided vacuum-assisted biopsy and localization procedures, as well as multimodality guided (stereotactic, US and MRI) marker/clip deployment. There are approximately 3-5 MRI-guided interventions per week.

Abdominal Imaging:

There may be some flexibility in the obstetrical and abdominal imaging rotations, and there may be the opportunity to spend a week in the abdominal imaging biopsy centre and prostate centre, depending on the interest of the candidate and our ability to accommodate. 

Obstetric Imaging: The obstetrics rotation is spent in the MSH CEOU (Centre for Excellence in Obstetrical Ultrasound), which is a multidisciplinary centre where radiologists work closely with obstetricians and geneticists.  The obstetrical population includes routine first and second trimester obstetrical imaging (early pregnancy, nuchal translucency and anatomic studies) and a high-risk referral population.  Depending on the interest of the fellow there is the opportunity to become involved with fetal MRI.

Abdominal Imaging: The abdominal rotation offers comprehensive training using multimodality cross-sectional imaging including CT, US and MRI. The combination of state-of-the-art equipment, large volume of patients and range of pathology, as well as the dedicated abdominal faculty makes this an outstanding learning opportunity. Exposure to transplant imaging, subspecialty oncology and complex pathology. During the year, there are many educational and multidisciplinary rounds in all areas.

On Call:

There are 6 months of abdominal call.  Call is divided among the fellows resulting in approximately 3 weeks of call per fellowship year.  Fellows always have staff backup. There is no call during the breast rotation.

Research:

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 are numerous opportunities for fellows to develop or continue research within the Abdominal and Breast Imaging Division.  We offer on-site clinical research facilities with many dedicated research staff.  Additionally, interdisciplinary work is also encouraged with several projects performed in collaboration with the other divisions.

Holidays:

Two work weeks (10 days) per 6-month block of your fellowship.  (Total 4 work weeks for 12 months)

Conference leave:

One week upon approval.

(Expense [$2000 CAD] paid if presenting an original paper that has not been presented elsewhere)

Fellows are granted one full day a week of protected academic time and are required to complete and submit an academic paper by the end of the fellowship.  There are many interesting research opportunities available, in breast, obstetrics, and abdominal imaging.

Supervisor: Dr. Franklin Goldberg

Positions available: 3 per year.

This 1-year fellowship includes breast and abdominal/pelvic/ OB imaging at St. Michaels Hospital. St. Michael's Hospital is one of the principal teaching hospitals within the University of Toronto and is a busy, multispecialty downtown tertiary care Centre.

The duration of each rotation is flexible, depending on the interest and background of the candidate. Generally, the candidates will do 4-6 months of Breast Imaging with the remainder in Abdominal / Pelvic /OB Imaging.

The Breast imaging rotation includes a high volume of screening and diagnostic mammography, breast ultrasound and breast MRI. Imaging guided procedures include stereotactic / ultrasound and MRI guided core biopsies and pre-operative localizations.

The Body rotation’s includes abdominal and pelvic imaging using ultrasound, CT and MRI. Interventional procedures are not a principal focus of this fellowship. Small part ultrasound biopsies and sonohysterograms may be included during the ultrasound rotation.

The obstetric rotation is an elective and is usually one month in duration. This rotation takes place in a dedicated Obstetric Ultrasound department within St Michael’s hospital.

During the year, there are many educational and multidisciplinary rounds in all areas. Breast Multidisciplinary rounds are once per week and the Women’s Fellow generally presents the Breast imaging.

Fellows are given the equivalent of 1 full day/week of protected academic time and are required to complete and submit an academic paper by the end of the fellowship. 

Supervisor: Dr. Carrie Betel

Positions available: 2 per year

This 1-year fellowship includes breast, obstetric, and abdominal/gynecologic imaging at the Sunnybrook Health Sciences Centre campus, which is affiliated with the University of Toronto, and is one of the principal teaching hospitals of the University of Toronto.  This is a large academic 1325 bed hospital and growing in Central Toronto, with dedicated subspecialty radiologists.  We offer a large number of clinical cases, dedicated educators, state of the art technology, and a strong research program.

The duration of each rotation is flexible, depending on the interest and background of the candidate. These include:

6 months breast / 6 months OB/gyne & abdominal
5 months breast/ 7 months OB/gyne & abdominal
4 months breast / 8 months OB/gyne & abdominal

Breast Imaging:

The breast rotation includes a high volume of screening and diagnostic mammography, breast ultrasound and breast MRI. Mammography is digital, and we perform tomosynthesis (including tomosynthesis-guided biopsies on dedicated state-of-the-art upright and prone units). Our center is an authorized center for the provincial average risk and high risk screening programs through the Ontario Breast Screening Program, Cancer Care Ontario.  Our center offers a busy Rapid Diagnostic Unit for complex breast cases in the Greater Toronto Area.  Imaging guided procedures include stereotactic and ultrasound guided core biopsies, vacuum-assisted biopsies, fine needle aspirations, clip placement, galactography, and pre-operative magnetic seed localizations. MRI-guided procedures include vacuum-assisted biopsies and pre-operative localizations. We perform 60 breast MRI studies a week with 6-8 MRI guided breast biopsies per week.  We maintain close ties with the medical biophysics department allowing many varied research opportunities to be available. 

Abdominal Imaging:

The abdominal rotation includes a full spectrum of gynecologic and abdominal imaging during ultrasound, CT and MRI rotations.  Fellows will gain extensive experience in the following subspecialty areas:  trauma, hepatobiliary/pancreas, urology, gastrointestinal disease, and oncology.  We are the largest regional trauma center in Canada.  We also perform state-of-the art CT colonography.  Our abdominal program performs all image guided procedures including ultrasound and CT guided solid organ biopsy and abscess drainage and sonohysterography; these are embedded in our program and fellows will become proficient in these procedures during their fellowship. 

The obstetric rotation is flexible in duration and can be up to 2 days/week, depending on the background of the candidate. This rotation takes place in a dedicated Obstetric Ultrasound department within Sunnybrook Hospital, which includes a multidisciplinary team and the opportunity to work closely with obstetricians. During this rotation the fellows will be exposed to both routine screening obstetrical ultrasound (including first trimester nuchal translucency screen, early anatomy, routine anatomic studies, and third trimester biophysical profile studies) as well as a high-risk referral population. Depending on the interest of the fellow, there is the opportunity to become involved with fetal/placental MRI and neonatal imaging.

During the year, there are a variety of educational and multidisciplinary rounds in all areas.

Research:

Fellows are given 1 full day/week of protected academic time and are required to complete and submit an academic paper by the end of the fellowship.  There are many interesting research opportunities available in breast, obstetrics, and abdominal imaging including opportunities to work in collaboration with the Sunnybrook Research Institute.