Body and Breast Imaging Fellowship
Introduction
These fellowships offer exposure to high-end breast and abdominal imaging via a variety of modalities and disease processes.
In order to allow adequate exposure, starting in the academic year of 2023-2024 we will be separating the breast Imaging fellowship and Abdominal Imaging fellowship to a full year each. Combined fellowship may be offered in special circumstances and based on availability.
Body Imaging
The body imaging fellowship is a 1 year post residency training program which aims to provide comprehensive exposure to a broad range of abdominal and pelvic imaging modalities and procedures. The fellow will develop skills that will enable them to handle complex cases and transition to a consultant role in both academic and community practice settings.
The fellowship program is city wide and the fellows rotate through the following hospital sites-
Saint Joseph's healthcare (SJHC)- An urgent care center with large gastroenterology and genitourinary presence.
London health sciences-
- University Hospital (multiorgan transplant facility and hepatobiliary/pancreas center)
- Victoria hospital (trauma, pediatric and OB center)
All the participating departments perform multimodality clinical abdominal and pelvic imaging examinations in CT, MRI and ultrasound. Research studies using PET MRI are also performed. Rotations through Obstetrical US can be arranged if desired. All studies are interpreted using a city-wide PACS system. Equipment at all sites is state-of-the-art and includes-
- 7 CT units, all with dual energy capability–
3 at VH (2 Canon Genesis and 1 Canon Prime)
2 at UH (2 Canon Prism)
2 at SJHC (Siemens)
- 6 MR units – Siemens
2 at UH – Siemens 1.5T Sola and 3T Vida
2 at VH – Siemens 1.5T Sola and 3T Vida
2 at SJHC-Siemens 1.5 tesla
- One 3 T hybrid PET MRI unit at SJHC primarily used for research imaging.
A significant component of the fellowship will focus on oncology imaging, predominantly CT and MRI. Fellows are exposed to complex cases, including GI and hepatobiliary malignancies (large volume colorectal carcinoma, pancreatic cancer, HCC) and gynecological malignancies. There is ample exposure to imaging and staging guidelines currently used by the National Comprehensive Cancer Network (NCCN) with emphasis on synoptic reporting for MRI of rectal cancer, pancreatic cancer, HCC and prostate cancer. In general, use of standardized reporting is encouraged.
There is large volume of CT colonography and CT/MR enterography cases, with excellent exposure to inflammatory bowel disorders. SJHC is also one of the only 3 centers in Canada performing MR elastography of the liver for fibrosis estimation.
Fellows are expected to participate fully in a variety of weekly multidisciplinary case conferences, where clinicians from various disciplines discuss complex cases. This is an opportunity for fellows to gain experience presenting cases to an interdisciplinary audience, while simultaneously learning the fine details that clinicians expect from radiology reports.
Fellows are given graded responsibility with respect to MR protocoling, reporting and case discussion. All cases are interpreted under the supervision of fellowship-trained faculty radiologists in the Body Imaging division.
Interventional procedures using ultrasound and CT guidance form another important part of this program. These consist mainly of ultrasound and CT-guided biopsies.
Research
There are extensive academic opportunities for Fellows. Involvement in research is an expectation of the Fellowship program, and one day of protected academic time is provided for proven research projects. Several projects are done in collaboration with Lawson and Robarts Research institute in London. Some of the ongoing research projects include:
- Primovist MRI – Educational Endeavour
- A prospective study evaluating diagnostic accuracy, outcome, and economic impact of abbreviated Primovist-enhanced MRI of the liver in patients with metastatic colorectal carcinoma.
- Radiomics in pancreatic and prostate cancer.
In summary, the program will provide the education and mentoring needed to function as a well-rounded body radiologist at a subspecialist level.
Breast Imaging
Our team is part of the Breast Care Program of St. Joseph’s Health Care London, which is a dynamic interdisciplinary breast care team of radiologists, surgeons, advanced practice nurses and others in a setting that nurtures innovative care for patients and collaboration among care providers focused on the best in care, teaching and research.
Our center is an affiliate site of the Ontario Breast Screening Program (OBSP), including the high-risk program.
As a result of our large practice and state of the art technology, we are able to offer our fellows comprehensive training and exposure to all aspects of breast imaging, including screening, diagnostic, interventional breast imaging as well as research and teaching.
Our equipment includes 5 digital mammography machines with Tomosynthesis capability (GE Pristina mammography system), 2 contrast enhanced mammography (CEM) units and 2 stereotactic core biopsy units, state of the art ultrasound machines (Toshiba) and two 1.5 T Siemens MRI magnets.
We perform an average of 25,000 screening and diagnostic mammograms including 1000 contrast enhanced mammograms, 10000 breast ultrasounds, 3000 breast MRI, 2500 ultrasound guided biopsies, 800 stereotaxic biopsies, 300 MRI guided biopsies and 600 preoperative localizations per year.
Fellows have exposure to a high volume of digital screening mammograms, digital diagnostic mammograms and tomosynthesis, contrast-enhanced digital mammography, diagnostic ultrasounds, breast MRI and interventional procedures. Interventional procedures include: stereotactic core and vacuum assisted biopsies, ultrasound guided interventions, MRI guided vacuum assisted biopsy and MRI guided preoperative localization, preoperative wire and radioactive seed localizations and galactography.
There are several Breast Imaging rounds occurring monthly with review of current cases, presentations of new techniques and advances in the field of Breast Imaging.
Fellows are expected to participate fully in weekly Multidisciplinary Tumor Boards, where clinicians from various disciplines discuss complex oncology cases. This is an opportunity for fellows to gain experience presenting cases to an interdisciplinary audience, while at the same time learning the fine details that clinicians expect from radiology reports.
Fellows are given graded responsibility with respect to supervising cases and consulting.
Research
We offer on-site clinical research facilities with dedicated research scientists from Robarts and Lawson's Research Institute.
Our center was the first to perform CEM guided biopsy in North America as part of world-wide study and will join the upcoming Contrast Enhanced Mammography Imaging Screening Trial (CMIST). Currently, our center also participates in the Tomosynthesis Mammographic Imaging Screening Trial (TMIST), the largest North American prospective screening trial.
There are research opportunities involving MRI an 3T PET MRI in collaboration with Lawson and Robarts research institutes in London. Research opportunities are also available in collaboration with the Surgical breast center and the London Regional Cancer Program (LRCP).
The fellow will have one day protected academic time for proven research projects.
