Cardiothoracic Imaging

Cardiothoracic Radiology Fellowship Director: Elena Pena, MD
Program Administrator: Avril D'Silva

General Objectives:

To solidify and expand knowledge and skills in various aspects of cardiothoracic imaging, to gain academic insight into diagnosis of both common and less common types of cardiothoracic pathology and to acquire expert skills in examinations and image guided procedures. The successful fellow should be able to practice in either an academic or community radiology practice following fellowship training.

Specific Objectives:

The fellow is expected to:

  • perform independently and act as a cardiothoracic imaging consultant to clinicians in cardiothoracic radiography, chest and cardiac CT, MRI and image guided invasive procedures
  • protocol and interpret cardiothoracic imaging scans for various indications including lesion characterization, staging malignancies, trauma, and diffuse interstitial lung diseases. Additionally, the fellow will develop the ability to protocol, supervise and interpret cardiac CT, cardiac MR and CT and MR aortic imaging studies, including adult congenital heart disease and TAVI aortograms.
  • perform fluoroscopic-guided and CT-guided fine-needle aspiration and core biopsies as well as percutaneous pleural drainage under US guidance and also treat post-procedural complications such as pneumothorax.
  • develop a detailed knowledge of cardiovascular anatomy and acquired and congenital cardiac pathology.
  • develop a working knowledge of cardiac hemodynamics.
  • develop a detailed working knowledge of several 3D workstations used in conjunction with the scanners
  • demonstrate the ability to teach technologists, residents and medical students as part of their daily assigned duties
  • prepare and attend multidisciplinary cardiac and thoracic imaging rounds
  • gain experience in research in Radiology through participation in at least one or two  research projects which includes presentation at our Annual Research Day, as well as publication in a scientific journal and/or presentation at a national or international conference

Structure

This is a 12-month clinical fellowship dedicated to Cardiothoracic Imaging. The schedule will vary with six months spent in cardiac imaging and six months is chest radiology, as detailled below:

  1. Thoracic CT and MRI – fellows are expected to read all STAT and high-priority CT cases performed at the General and Riverside Campuses or at the Civic Campus before 5pm. When no priority cases are left the fellow is expected to read routine outpatient chest CTs from all campuses read from oldest to most recent. The fellow is also expected to read all thoracic MRI’s. All cases should be discussed with the staff assigned to CT. All cases reviewed that day are to be dictated prior to leaving the hospital. There will be graded responsibility with the fellow able to dictate cases they feel comfortable with without reviewing with staff depending on assessment of fellow competence.
  2. Procedures and ICU chest radiographs – fellows are expected to review the cases and prior imaging studies of all biopsy patients for biopsy planning, obtain the informed consent prior to the procedure, perform the procedure under supervision, read the post-procedure chest radiograph, assess and manage post procedure complications under supervision, discharge the patient and issue a procedure report.  In between biopsies, the fellow is expected to read the ICU radiographs, followed by high-priority and then routine radiographs. All procedures and radiographs need to be dictated prior to leaving the hospital.  All ICU and high-priority chest radiographs at the assigned campus need to be dictated prior to leaving the hospital.
  3. Cardiac Radiology – fellows will read Cardiac CT angiogram and cardiac MR as well as aortic CT and aortic MR studies at the University of Ottawa Heart Institute. All cross-sectional examinations will be reviewed with staff assigned to Cardiac Imaging that day  and dictated before leaving that day. Fellows will also be expected to dictate the chest radiographs performed at the University of Ottawa Heart Institute every day. There will be graded responsibility for chest radiographs and these will be dictated by the fellow without reviewing with staff depending on fellow competence. All chest radiographs and all STAT and high priority thoracic cross-sectional imaging will be dictated by the end of each day.  Fellows will be expected to actively supervise all cardiac CT examinations and MRI’s performed including fielding all questions from technologists and nurses. They will be also expected to dictate and reconstruct TAVI CT aortogram cases.
  4. Fellows will be actively involved in protocoling cardiac and cardiothoracic CT’s and MRI’s as well interventional chest procedure with staff supervision.
  5. Fellows will be granted an Academic Day once a week that should be used for research projects or preparation of rounds and lectures. The fellows are expected to be in the hospital from 8am to 5pm unless otherwise arranged with the Fellowship Director (see below).

The program director will formally meet with the fellows every two months to discuss the fellow’s strengths and weaknesses and address any outstanding issues brought forth by the fellow.

Evening shift

All fellows hired by OHRIA with the exception of Interventional Fellows, and Neuro-Interventional fellows will participate in an evening shift 2 to 4 times per month.  The fellows are expected to be on-site from 5 -11 pm at the General Campus.  During this time the primary responsibilities of the fellow include:

  1. Reporting of at least 50 outpatient plain films, tri-campus or CTs as agreed with fellowship director. The exams are assigned to the staff covering chest radiographs the following day at the General campus. If there are less than 50 exams tri-campus or if agreed with the staff, the fellow can report cases from their respective specialty (e.g. chest/aortic CTs).
  2. Injection coverage for out-patient MRI and out-patient CT cases at the General campus. This responsibility requires prompt presence of the fellow on site at 5 pm.
  3. Support onsite the radiology resident if needed.  The resident will be directly supervised by the staff radiologist onsite at the Civic Hospital so need for supervision will be exceptional.

Call

Fellows in cardiothoracic Imaging will be assigned to weekend reporting call along with a staff member. Duties will be shared and include reading of all plain films STAT and high-priority performed. Fellows must be on-site Saturday and Sunday for reporting as specified in the Departmental policy.  They should report 35 plain films in the morning and 35 plain films in the afternoon and send it to the staff covering plain films morning and the staff covering plain films in the evening. Time and assigned duties may be discussed in advance with the staff on call.

Education by Cardiothoracic Imaging Staff

Teaching is a vital part of the fellowship. Teaching includes daily review and discussion of cases and procedures with the assigned staff. For each rotation the fellow will be working with a chest or cardiac radiologist who will be on-site and available for discussion and teaching at any time.

The fellows will have dedicated formal teaching Tuesdays at noon for Cardiac Radiology (interesting cases rounds) and Mondays at 4:00 PM for Thoracic Radiology, including lectures, review of articles, review of teaching files and case-based rounds, given by one of the radiologists or fellows (in Cardiac), invited chest pathologists or respirologists or cardiac surgerons. Fellows are encouraged to attend resident noon rounds and multidisciplinary rounds and lectures in cardiac and chest imaging.

Rounds

Rounds are a vital part of the department and the learning experience afforded to trainees at academic centers.  Fellows are expected to participate in these events.  Rounds include:

Chest Radiology-Pathology Rounds (“Pizza Rounds”) – alternate Fridays at noon. Presentation of 3 to 4 cases by the fellow in Thoracic Imaging, with discussion of pathological findings by a thoracic pathologist and thoracic surgeon.

Respirology-Radiology Rounds (“R&R Rounds) – once a month Tuesdays at noon. Rounds presented in conjunction with a Respirology staff who presents the clinical history followed by presentation of radiological findings by the fellow in Thoracic Imaging.

Multidisciplinary Thoracic Oncology Conference and Thoracic Clinical Trials Research Conference - every Friday morning, from 8:00 to 9:00 am. Presented by a staff chest radiologist for discussion and management decision with medical and radiation oncologists, thoracic pathologists and thoracic surgeons.

ILD Rounds – presented by Dr. Souza and the multidisciplinary ILD team for discussion of cases from the Respirology ward on Wednesdays.

Grand Rounds – are held every month and feature presentations by third year residents, interdivisional fellows and staff or visiting professors.  All fellows are expected to present one Grand Rounds lecture in the second half of the fellowship year.  The topic of the rounds is open to areas of personal consideration, under the guidance of a self chosen staff preceptor in the Cardiothoracic imaging.

Pathology Rounds (M&M Rounds) – presented once a month by one of the radiology residents, including errors and misdiagnosis in cases seen in the daily practice.

Thoracic Pathology Meeting – presented at noon by a Thoracic Radiologist and Dr. Marcio Gomes, Thoracic Pathologist in the Pathology Department, each time a specific topic is discussed with clinical-radiological-pathological correlation, with emphasis on pathological findings.

Congenital Cardiac Rounds – these are multidisciplinary rounds held on Mondays once a month from 5:00 until 6:30 PM. Cases are presented by a staff Cardiothoracic radiologist and management is discussed with cardiologists and cardiac surgeons. Fellows are expected to attend.

Cardiac Imaging Rounds – held every Wednesday at noon at the Heart Institute.  Fellows will be expected to present a topic once or twice a year.  Fellows will be expected to attend the week they rotate in Cardiac Radiology

Cardiac Imaging and MR interesting cases rounds-Held every Tuesday at noon at the HI. Fellows will be expected to present a topic several times a year.

TAVI rounds: Every Thursday at 7,30 am. Fellows are expected to attend these multidisciplinary rounds while on their cardiac rotation.

CME Course  

The Ottawa Hospital Department of Radiology has initiated an intense CME program that is well-known throughout North America.

Fellows can attend these events.  Many events are held regionally but outside of the city and require travel arrangements at the fellows own expense.  Time for participation is deducted from the allotted conference leave noted above. Most of the events occur on weekends so limited allotted time would be required.

For further information on CME opportunities please visit http://www.ottawaradcme.com

ACLS Course

This is highly recommended in order to deal with complications resulting from thoracic interventional procedures and adverse events resulting from premedication used for cardiac CT  and cardiac MR as well as contrast reactions.

Academic Time and Research

One day a week will be provided to each fellow for academic and research activities.  This is a large block of time on an annual basis during which time the fellow will have to develop research experience. This time is protected for fellows to have the opportunity to maximize the advantage of working at an academic institution to develop research skills and experience by participating in a project.  At the beginning of the year fellows will be introduced to projects being developed in the department for review or consideration.  Academic time will not be provided for fellows not involved in a research project.

Ideally projects chosen will be able to be completed within the year as a fellow, and provide the opportunity to fellows to present information at a conference or lead to a publication. All fellows are expected to present their work at the Annual Radiology Department Research Day held in June of each year.

In weeks where an evening shift is assigned, fellows assigned to the evening shift will receive their academic day on the same day.

Holidays

4 weeks

Conference Leave

One week ($1500.00 contributed to travel and accommodation if candidate is presenting at the meeting)* (please check most updated policy with Ms. Avril D’Silva as the money and time to attend conferences may change)

Application Deadline:

Academic Year 2022-23: deadline to apply is September 30, 2020

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