Musculoskeletal Fellowship

The Musculoskeletal Imaging Fellowship is a one year post-residency training program which aims to provide comprehensive exposure to a broad range of musculoskeletal imaging modalities and procedures. Fellows will develop skills that will enable them to handle complex musculoskeletal cases and transition to a consultant role in both academic and community practice settings.

Fellows will rotate citywide at three campuses – London Health Sciences Centre (University Hospital and Victoria Hospital) and St. Joseph’s Health Care. This facilitates exposure to the full complement of MSK procedures and imaging modalities including adult and pediatric cases and inpatients and outpatients. Fellows will be exposed to a broad range of upper and lower limb pathologies including trauma, infection, arthritis, degenerative diseases, and neoplasms. There is a collaborative approach with orthopedic surgeons, rheumatologists, oncologists, physiatrists, and physiotherapists.

Signature MSK programs by site include:

University Hospital

o Fowler-Kennedy Sports Medicine Clinics
o Arthroplasty

St. Joseph’s Health Care

o Roth-McFarlane Hand and Upper Limb Centre
o Rheumatology Centre

Victoria Hospital

o London Regional Cancer Centre
o Level 1 Trauma Centre
o Children’s Hospital

The following are detailed goals and objectives:

Primary Goal:

This program will provide the education and mentoring needed to function as a well-rounded musculoskeletal (MSK) radiologist at a subspecialist level.

Note: Spinal imaging is reported by both MSK and neuroradiologists at St. Joseph’s Health Care and may be considered an optional component of the objectives.

Objectives:

1. General

Facilitate an appreciation for:

i. Teamwork, camaraderie
ii. Collaborative relationships with patients and referring clinicians
iii. Comprehensive service
iv. Excellent patient care
v. Timely, accurate, and quality radiology reports
vi. Ongoing learning

2. Anatomy and Physiology

a. Know the anatomy and physiology of the pelvis, upper limb, and lower limb in detail.

3. Modalities

Develop an expert knowledge of indications, imaging protocols, interpretation, reporting, and new developments with regard to the MSK system in the following modalities:

i. Plain radiographs
ii. Digital tomography
iii. Ultrasound (including scanning and limited associated physical examination)
iv. CT
v. MR (including supervising complex MSK studies on site)
vi. BMD (optional)

4. Pathology

Acquire subspecialty-level knowledge of the common and rare MSK pathologies.

5. Interventions

a. Develop expert knowledge of the indications, protocols, and recent developments in MSK radiology interventions. Understand how imaging guided procedures fit into treatment plans. Learn to perform and teach each of the following procedures:

i. Aspiration and injection of all articulations
ii. Nerve blocks
iii. Bursal aspiration/ injection
iv. Tendon sheath aspiration/ injection
v. Tendon, ligament, and capsule prolotherapy (dry needling, dextrose injection, and potentially platelet rich plasma)
vi. Biopsy: Bone and soft tissue neoplasms/synovium
vii. Spine procedures: nerve root and facet joint injection
viii. Miscellaneous additional MSK injections: pyriformis muscle, thoracic outlet (middle, anterior scalene, and levator scapulae/ pectoralis minor), Alcock’s canal, etc

6. Teaching

Organize and lead MSK teaching rounds. Teach at least one of each type of MSK rounds done at each institution, preferably more, including:

● Citywide MSK resident rounds
● Hand and Upper limb rounds at St. Joe’s
● Rheumatology rounds at St. Joe’s
● Participate in multidisciplinary rounds, including: Multidisciplinary Sarcoma Tumor Boards at Victoria Hospital

7. Research

Develop familiarity with MSK radiology research by taking at least one project from conception to submission for publication. Fellows have 1 protected academic day per week while working on their project.

Interested candidates may apply with a letter of intent, CV and three references. Applications are to be sent to the Fellowship Coordinator Ms. Rachael Patrick. Please submit by August 1, 2022.