Abdominal 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.
Abdominal Imaging
Our department performs multimodality, state-of-the art clinical Abdominal Imaging examinations in CT, MRI, and Ultrasound. Research studies using PET-MRI are also performed.
Two 1.5 T Siemens MRI units and one 3T hybrid PET-MR unit are used for clinical and research imaging. There are two CT Scanners with dual energy capability, one used primarily for research.
A significant component of the fellowship will focus on oncologic imaging, predominantly CT and MRI. Fellows are exposed to complex cases, including GI malignancies (large volume colorectal carcinoma), gynecologic malignancies, and hepatic tumors. There is ample exposure to imaging and staging guidelines currently used by the National Comprehensive Cancer Network (NCCN). There is an emphasis on synoptic reporting for MRI of rectal carcinoma, HCC, and prostate carcinoma.
Fellows are expected to participate fully in weekly Multidisciplinary Case Conferences, 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 MR protocols, reporting, and case discussion.
As a number of referrals come from gastroenterologists, we also see a large volume of CT Colonography and Enterography cases, with excellent exposure to inflammatory bowel disorders. Approximately 350 CT Colonography cases are performed annually. We are also one of only 3 centres in Canada performing MR Elastography of the liver for fibrosis estimation.
The practice has a large genitourinary presence, receiving referrals for imaging of complex genetic disorders. There is also opportunity to become proficient in US-guided prostate biopsy.
Research
There is a large scope of research opportunities available. Ongoing projects include: (1) MR Elastography for fibrosis quantification in patients with chronic liver disease; (2) Hybrid imaging (PET-MRI) for prostate and rectal carcinoma; (3) Radiomics in pancreatic and prostate carcinoma. Several projects are done in collaboration with Lawson and Robarts research institutes in London.
The fellow will have one half day of protected academic time for proven research projects.
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.
