Cardiothoracic Imaging Fellowship at Toronto Radiology/St. Michael’s Hospital

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 [largest implanter in downtown Toronto, fourth largest in Ontario] and cutting edge Mitral and Tricuspid programs – visit us on YouTube https://www.youtube.com/@KCnTO) and its subspecialty Respirology services including Cystic Fibrosis, Hereditary Hemorrhagic Telangiectasia, Primary Ciliary Dyskinesia, 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.

We perform approximately 1700 cardiovascular CTs per year, the majority of which are for coronary imaging, approximately 600 of which are structural heart CTs (for transcatheter aortic, mitral and tricuspid valve replacement, and minimally invasive mitral valve surgery), and almost 200 of which are for pulmonary vein ablation.

The cardiovascular MR experience encompasses cardiac MR and thoracic MRA, with additional caseload in abdominal and peripheral MRA. We perform approximately a thousand cardiovascular MRI cases per year (12% 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 for a decade.

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 two 512-slice dual-energy GE Revolution Apex volumetric CT scanners and two 64-detector GE CT scanners. We have 2 cardiac capable clinical 1.5T Philips Achieva dStream Broadband MR scanners with SmartSpeed (both with complete cardiac tissue mapping packages [T1, T2 and T2*]) and 2 cardiac capable 3T Siemens Vida scanners (both with a full 3T cardiac tissue mapping packages [T1 and T2]). Postprocessing in CT is performed on TeraRecon, Circle CVI, and GE Advantage Workstation thin client, installed on multiple workstations, and MRI post-processing is performed on Circle CVI, (which has tissue mapping, perfusion, strain, and 4D flow 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 fellows 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 7 full-time supervisory faculty members in cardiothoracic imaging.