Diagnostic Neuroradiology Fellowship Program

 

University of Toronto neuroradiology training is fully approved by the Royal College of Physicians and Surgeons of Canada as a 2-year subspecialty residency for those certified (or eligible for certification) in diagnostic radiology by the Royal College. Those completing the 2-year program are eligible to sit the Royal College neuroradiology certification exam. It is possible to take one year of the program, especially prior to additional training in neuroradiology, such as full-time research in neuroradiology, interventional neuroradiology, pediatric neuroradiology. Such additional neuroradiology activities can qualify as the 2nd year of the Royal College program, with eligibility to take the exam.

Those not under Canadian Royal College designation may still take the same program as fellows. By virtue of program accreditation, trainees with the American Board of Radiology certificate are eligible for the CAQ exam (certificate of added qualification) in neuroradiology.

Positions are available annually. The full 2-year program has rotations in multiple Toronto teaching hospitals: Hospital for Sick Children; Sunnybrook Health Sciences Centre; University Health Network (Toronto General, Toronto Western, and Princess Margaret Hospitals), Mount Sinai Hospital, and St. Michael’s Hospital. From July 2009, 3-month rotations will allow trainees to have training experiences at each site.

The 2-year program includes a variety of clinical neuroradiology experiences. Research activity is expected by each trainee with up to one day per week allotted as protected research time. Weekly city-wide rounds include faculty and trainees presenting interesting cases in a collegial atmosphere, with neuropathology once a month. Interactive, focused tutorials (Professors' Rounds) form the core curriculum, 2-3 times a month after city-wide rounds. Journal club, held a number of times a year as an evening supper meeting, combines presentations by staff and trainees. Time to attend scientific meetings is available for trainees, with support for those presenting research work at a meeting.

The full neuroradiology program is designed for those primarily interested in a dedicated career in neuroradiology.

Sunnybrook Health Sciences Centre
Supervisor: Dr. Chinthaka Heyn

This site offers training and research opportunities of an all-around adult hospital plus perinatology including neurosurgery, neurology, otolaryngology, oncology, neuro-ophthalmology, and neuropathology. Imaging equipment includes three 64-slice CTs, one 4-slice CT, one CT-PET, two 1.5 Tesla MRIs and one 3.0 Tesla MRI. There is a biplane 3D neuroangiography suite. The department is entirely filmless with a versatile PACS system featuring remote web-based access. Full-time attending neuroradiologists, Dr. Sean Symons, Dr. Richard Aviv, Dr. Peter Howard, Dr. Robert Yeung, and Dr. Allan Fox, are responsible for the section activities, including diagnostic neuroradiology and interventional therapy.

Highlight activities for neuroradiology include:

• Largest Canadian trauma centre.
• Regional stroke centre.
• Research centre of cognitive diseases.
• Largest research imaging centre, much in brain.
• Neuro-oncology (dedicated neurologist-neuro-oncologist).
• Neuro-otology (renowned neuro-otologists).
• Regional cancer centre (including brain, spine and head & neck).

Neuroradiology trainees are involved with all activities of neuroimaging. CT and MR studies include attempts to optimize angiography and perfusion protocols. Thorough and fast hyperacute stroke protocols are efficiently acquired and interpreted. Therapeutic neurointerventional procedures include hands-on experience for neuroradiology fellows.

The neuroradiology faculty are involved in numerous collaborative research projects in the areas of stroke, neuro-oncology, head & neck oncology and otology. Fellows are given an academic/elective day per week to perform research at Sunnybrook under the supervision of one of the Sunnybrook neuroradiologists. Each fellow must complete a research project at Sunnybrook as a requirement of the rotation.

Fellows are on-call wtih one of the attending neuroradiologists. Call is from home except for in house read out each weekend morning. Call frequency is 1 in 3. Residents take first call ahead of the fellows.

Weekly rounds include neurosurgery, neuroradiology, head/neck cancer, spine, clinical neurosciences, stroke, and brain tumour. Monthly rounds include ENT and morbidity/mortality.

Mount Sinai Hospital
Supervisor: Dr. Eugene Yu

This 6-month rotation is in Medical Imaging at Mount Sinai Hospital, a filmless department with an integrated PACS partnered with University Health Network hospitals of University of Toronto. There are 2 GE MRIs and 2 CTs, including a 4 slice GE and a 16 slice Siemens. A 64 slice Toshiba was installed in 2005. Two general fluoros handle occasional lumbar or cisternal punctures or rare myelography. Dacryocystography, sialography, as well as fluoro- or CT- guided biopsies/aspirations are done when indicated.

The hospital clinical strengths relevant to neuroradiology include: busy emergency room; daily general Otolaryngology Clinic with 2 oncologic surgeons; Ophthalmology service specializing in oculoplastics and orbital mass lesions; extended regional Oral Surgery including mandibular, maxillofacial and TMJ pathologies; as well as neurology, infectious disease, and internal medicine in/out-patient services. This adds to strength with balance of neuroradiology- head & neck radiology case material. There are two onsite neuroradiologists (Drs. E. Kassel and D. Lazinski).

Two weeks of elective time per 6 months of a fellow rotation may be spent (availability dependent) at any of the University affiliated sites, including The Hospital for Sick Children. The purpose may be practical, research or educational, and may be used to complement a Fellow's needs within a wide variety of opportunities. One day/week is allotted for research projects, which may be performed outside the base hospital site.

Princess Margaret Cancer Centre and Toronto General Hospital 
Supervisor: Dr. Eugene Yu

This 3-month rotation is based at the Princess Margaret. But the fellow is responsible for coverage of head and neck imaging cases performed at all sites in the University Health Network and Women's College Hospital. The rotation focus will be Head and Neck Oncology as Princess Margaret has one of the largest Head and Neck Oncology Programs in North America. Clinical rounds are part of the weekly schedule, including Head and Neck Oncology rounds, Endocrine and Skull Base rounds, Tumor Board rounds (in conjunction with the radiation, medical oncology and surgical oncology groups), and Lymphoma rounds.

Medical Imaging is filmless with an integrated PACs system allowing the easy viewing of images at all University Health Network sites. Facilities include digital angiography (TGH), CT fluoroscopy (TGH). PMH site includes 3 CT scanners, 1 PET-CT, 2 MRI scanners. TGH site has 4 CT scanners in the department and 1 in the emergency room, and 2 MRI scanners.

There are three neuroradiologists: Dr. W. Kucharczyk, Dr. E. Bartlett, and Dr. E. Yu. One day per week is allotted as a research/elective day during this rotation. The elective and/or research can be done at any of the University of Toronto Program sites. Elective opportunities are varied and include neuropathology, neurology, neurosurgery and intensive care medicine. The allotted day per week can also be spent in the ENT oncology and radiation oncology clinics, depending upon availability. Similarly, the time can be spent participating in oral radiology film reading sessions with the oral radiologist at PMH -- Dr. Michael Pharoah.

Toronto Western Hospital 
Supervisor: Dr. Robert Willinsky

Exposure, participation and supervision of neuroimaging modalities are customized depending on a candidate’s level of expertise and previous training. Rotations combine cross-sectional imaging with procedural work including diagnostic catheter neuroangiography. Eight full-time neuroradiologists are directly involved at one of the largest neurosciences centres in North America. Neuroradiologists include Drs. K. terBrugge, R. Willinsky, R. Farb, D. Mikulis, R. Agid, R. Smith, and D. Lazinski. The hospital is well equipped with two dedicated neuroradiology biplane digital angiographic suites, 3 clinical MR units including 3T and three 64 slice CTs. State-of-the-art MR does diffusion/perfusion imaging, functional imaging and spectroscopy. Vascular, epilepsy, neurodegenerative, and spine diseases are special areas of interest. The Toronto Western Hospital team leads in some advanced MR techniques including gadolinium-enhanced MRA, spectroscopy and functional imaging. Interventional neuroradiology at the Western is world-renowned providing valuable contributions to knowledge of natural history of a number of cerebrovascular diseases. The interventional program is active in management of aneurysms, arteriovenous malformations, arteriovenous fistulae and stroke. Interventional neuroradiology is active in spine interventions and vertebroplasty.

An integrated PACS serves the University Health Network, Women's College and Mount Sinai Hospital. This allows fellows easy access to imaging data to create an encyclopedia of teaching cases for future use. Images can be easily transferred onto a flash drive or "burned" onto CDs.

Participation in ongoing clinical research in MRI, CT and interventional neuroradiology is available to fellows, as well as access to MRI research. Participation in weekly city-wide neuroradiology rounds held at the Toronto Western Hospital is encouraged, as well as attendance at weekly neuroscience, stroke, interventional cerebrovascular, and neurosurgical rounds.

The Hospital for Sick Children
Supervisor: Dr. Helen Branson

As a major referral base for Canada and abroad the experience and exposure at HSC is unmatched.

Fellows work closely with seven fellowship trained pediatric neuroradiologists: Dr. Charles Raybaud, Dr. Derek Armstrong, Dr. Susan Blaser, Dr. Helen Branson, Dr. Suzanne Laughlin, Dr. Manohar Shroff and Dr. Elysa Widjaja.

Four on-site MRs, one MR-3T and three MRs 1.5 T allow time for clinical activities while one on-site state of the art MR 3T is utilized for research. Also on-site is one CT and one PET/CT. Myelography and both diagnostic and interventional angiography are performed at the Hospital for Sick Children.

Fellows actively participate in all clinical rounds, cover both CT and MR with staff support by reviewing all CTs and MRs throughout the day, and spend time performing diagnostic angiography and myelography. Opportunities for research are vast due to the high volume of interesting case material as well as 20% protected research time.

St. Michael's Hospital
Supervisor: Dr. Dipanka Sarma

The diagnostic neuroradiology trainee at St. Michael's Hospital will participate in all cross-sectional imaging examinations of Brain, Head & Neck and Spine; whereas the neurointerventional trainee will participate in all diagnostic angiographic procedures and endovascular interventions.

The site has three 1.5 Tesla MRIs, three multi slice CTs and a bi-plane angiographic unit with 3-D capability. The rotation at St. Michael's Hospital is under the supervision of 4 neuroradiologists: Dr. Bruce Gray, Dr. Tom Marotta, Dr. Walter Montanera and Dr. Lyne Noël de Tilly. Dr. Marotta and Dr. Montanera are interventional radiologists. Dr. Gray has dual certification in radiology and nuclear medicine.

There are 7 neurosurgeons at St. Michael's Hospital, including a skull base surgeon, a spine surgeon, and two vascular neurosurgeons. One of them, Dr. Spears, is actively participating in the neurointerventional service. Eight neurologists work at St. Michael's Hospital.

The neuroradiology experience at St. Michael's Hospital is quite broad with this hospital being a trauma centre and the largest MS clinic in Canada. A large number of brain tumours are being treated including a wide variety of skull-base lesions. The cardiovascular program is very strong at St. Michael's Hospital.

Rounds and teaching: There are weekly Neuroscience Rounds where neurologists, neurosurgeons, neuropathologists and neuroradiologists are scheduled to present a topic of their choice in a relatively collegial atmosphere. The neuroradiology trainee is expected to participate in these rounds. Neuroradiology rounds are also given to the radiology residents every Wednesday. They are given by the neuroradiology attendees and the diagnostic fellow is more than welcome to participate.

Applying for a Fellowship

Dr. Pejman Maralani

Neuroradiology Fellowship Progam Director