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 be exposed to a broad range of upper and lower limb pathologies including trauma, infection, arthritis, degenerative diseases, dysplasias, and neoplasms. There is collaborative exposure to orthopedic surgeons, rheumatologists, physiatrists, and physiotherapists. The fellowship provides a particularly comprehensive exposure to MSK interventions. Exposure to pediatric MSK radiology and sarcoma surgery is relatively light and candidates requiring extensive exposure to these areas should explore other fellowships.

The fellowship is based at St. Joseph’s Health Care London. Fellows may request spending a portion of their time at London Health Sciences especially if they require intensive exposure to lower extremity orthopedic surgery.

Signature MSK programs by site include:

St. Joseph’s Health Care (SJHC)

  • Roth-McFarlane Hand and Upper Limb Centre
  • SJHC Rheumatology Centre
  • Parkwood Hospital (a large rehabilitation centre)

University Hospital (Optional)

  • Fowler-Kennedy Sports Medicine Clinics
  • Lower Extremity Orthopedic Surgery

 Victoria Hospital (Optional)

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

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.


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

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 MSK pathologies. Learn how to rapidly build expertise in rare MSK pathologies as required.

5. Interventions:

Develop expert knowledge of the indications, protocols, and recent developments in MSK radiology interventions. Understand how imaging guided procedures fit into treatment plans. Know when not to proceed with an MSK intervention. 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 (usually dry needling or dextrose injection) 
vi. Biopsy: Bone and soft tissue neoplasms/lymph nodes/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 (optional).

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.