Radiology and Diagnostic Imaging

Musculoskeletal Radiology Fellowship Program

Please note that the Musculoskeletal Radiology Fellowship Program is currently looking for 2019-2020 candidates.


 
Clinical
Musculoskeletal Radiology involves all aspects of musculoskeletal (MSK) imaging and intervention for diagnosis and therapy.  Modalities are Radiography, Fluoroscopy, Ultrasound, Computed Tomography and Magnetic Resonance Imaging.  The fellowship does not include angiography or nuclear medicine, although nuclear medicine imaging, including PET CT, forms an important part of diagnostic work-up in many cases and there will be an opportunity for some limited exposure to bone scintigraphy. The fellowship is based at the University of Alberta Hospital and also involves the Edmonton Clinic, Royal Alexandra Hospital, the Grey Nuns Hospital and the College Plaza Sports Imaging Clinic.
 
Procedures in MSK imaging maybe guided by fluoroscopy, CT or US.  These include:
Peripheral procedures: Arthrography (MR/CT and fluoroscopic), Joint or Bursa injection, Bone or soft tissue biopsy.
Spinal procedures: Nerve root or Facet joint injection, Discography, Disc or vertebral biopsy and facet joint radiofrequency ablation.
Special procedures: Osteoid Osteoma ablation, Unicameral (simple) bone cyst ablation, Vertebroplasty, Kyphoplasty, Sacroplasty, RF tumor ablation and a wide range of ultrasound guided procedures for tendon and tendon sheath pathology.
Scope of practice at the University of Alberta:
The Radiology & Diagnostic Imaging service in Edmonton is at the forefront of the field in many aspects of Musculoskeletal Radiology. This includes both the scope of the service provided and the specialized techniques that are available. Specifically MRI, osteoid osteoma laser ablation, bone cyst irrigation and vertebroplasty/kyphoplasty/other cementoplasties.

Responsibility:
The Fellow will be primarily responsible to the Mentor(s) for this Fellowship position (Drs. Sean Crowther and Suki Dhillon). Ultimately responsibility is to the Academic Chair (Prof. D. Emery).
 
Magnetic Resonance Imaging:
The MSK service performs about 450-500 MRI extremity scans per week. The fellow will be scheduled in MRI one or two days per week during the year, supervising and personally reporting 10 - 25 cases per day.  In addition to this, the Fellow will be exposed to/have access to an equal number of cases reported by staff with ample opportunity for discussion of interesting findings.  MRI of the knee and shoulder constitute a considerable percentage of the workload however there is substantial experience in MR arthrography and excellent exposure to MRI of all joints with a wide variety of clinical conditions, including arthropathies, trauma, infection and tumor cases. MRI of the spine is included including a particular emphasis on the diagnosis of spondyloarthropathies.  The fellow should achieve a minimum of 1000 - 1500 MRI cases, read as primary interpreter.
 
Interventional Procedures:
Fluoroscopy involves a full range of peripheral and spinal procedures. Arthrography/injection of all peripheral joints including injection of less commonly encountered joints such as temporomandibular, sternoclavicular, subtalar joints and the small joints of the hands and feet.  Spinal fluoroscopy frequently involves injection of facet and sacroiliac joints and nerve roots.  The fellow will also assist with or perform invasive interventional procedures such as arthrodilatation, percutaneous cementoplasties, interstitial laser or radiofrequency photocoagulation of osteoid osteoma and percutaneous alcohol irrigation of bone cyst.  The fellow will undertake spine, other  bone and soft tissue biopsy at the University site under fluoroscopic, CT or US guidance.
The fellow is scheduled weekly in fluoroscopy and is expected to perform 10 - 15 procedures per week in the earlier part of the year.  In the second half of the year there is an opportunity to rotate through a busy outpatient fluoroscopy service performing 25-30 procedures per day.  The fellow should perform a minimum of 500-600 image guided procedures.
 
Computed Tomography:
The Fellow will read musculoskeletal CT scans throughout the week at the University of Alberta Hospital. The majority of these are acute or chronic musculoskeletal trauma. Others are assessment of arthropathy (including dual energy assessment of gout) or focal bone lesion.  The fellow should read a minimum of 300-400 CT cases.
 
Ultrasound:
MSK Ultrasound is currently performed with dedicated booked lists two days per week at the Edmonton Clinic, daily urgent cases for assessment of acute tendon injury at the University Hospital and daily booked lists at a dedicated Sports Imaging clinic. The fellow will be exposed to a full range of diagnostic and therapeutic examinations. Ultrasound guided procedures include routine joint and bursal injections/aspirations, barbotage of calcific tendinopathies, various interventions for refractory tendinopathies including dry needling and paratenon stripping and injection of Morton’s neuromas. The MSK Ultrasound service is extremely busy with current case volumes of approximately 7500-8000 per annum with increasing referrals from orthopedics, rheumatology and sports medicine departments. The fellow will be scheduled in dedicated MSK ultrasound lists one to two times per week throughout the year and will be likely to personally scan and report at least 1000-1500 cases under supervision and guidance from an MSK radiologist with specific training in MSK ultrasound. In addition, the fellow will have the opportunity to discuss a further large volume of cases of interest during the lists.
 
Graduated Responsibility:
Initially the fellow will observe procedures and scans performed and interpreted by staff.  Within a few weeks, the fellow will perform and report these studies under direct supervision.  By 3 months, the fellow should be performing common procedures under remote supervision.  In MRI, the first several weeks will require adjustment of the Fellow to our scanning procedures and protocols.  By 3 months, the Fellow should supervise and report 10 - 15 MRI scans per day with minimal staff supervision and by the 4th quarter of the year should be capable of supervising the MRI service at staff level (25-30 scans/day). ALL scans and procedures are double read by a member of staff which provides an excellent opportunity for teaching and feedback.
As a regional tertiary referral centre, the University of Alberta Hospital MSK imaging group receives many requests for opinions and interventions on a wide variety of neoplastic, infective, arthropathic and traumatic cases. The fellow will be expected to actively participate in review of these cases and to heavily involved in the opinions and interventions generated.
 
On Call responsibilities:
The fellow will take ‘on-call’ at a staff level in general radiology primarily at the University of Alberta Hospital at weekends during the day.  Most of this is radiography and involves reporting intensive care and inpatient plain film radiography in support of the on call general radiologist. The fellow will also work an evening plain film reporting shift approximately once per month. The fellow is expected to start taking on-call two months after arrival and will be on-call for a total of 8 weekends in the remaining 10-month period. This will include one holiday weekend.
 
Education/Teaching

Continual Viewerside Education:
All scans or procedures are double read by a member of staff which provides extensive one-on-one teaching.  A significant part of the day is occupied in reviewing the fellow’s cases.
 
MRI Technologist Experience:
During this fellowship, fellows spend 1 week with senior MRI technologists learning about scanning protocols and parameters, MR physics and artifacts.
 
Didactic:
Didactic teaching will be provided to the fellow by members of the Musculoskeletal Radiology Division on an intermittent basis.  The fellow is expected to be involved in seminars/lectures to be given to the Musculoskeletal Radiology Division, residents and medical students. Over the course of the year will include:
Two 30-minute presentations to the Musculoskeletal Radiology Division.
1 or 2 lectures to the residents through the course of the year.
One lecture to medical students.
Two presentations of Grand Rounds to the department, at least one of which is expected to be research.
Meetings of MSK Division:
The Musculoskeletal Radiology Division meets on a weekly basis from September through May. Meetings last approximately 1 hour. The meeting is devoted to review of  interesting case material with an established diagnosis or unusual or problem cases including clinical follow-up, operative findings or laboratory reports.  The Department of Radiology has a Journal Club and the Musculoskeletal Division is responsible for this once a year.
 
Clinical Meetings:
Members of the division meet on a regular basis with specialists in the field - once a month meetings with Rheumatologists and intermittent attendance at weekly clinical meetings with the Division of Orthopedic Surgery. Quarterly MSK Tumor Rounds meet with the Orthopedic tumor surgeons and bone pathologists. There is also an annual meeting with the medical and physical training team of a local professional sports franchise to review the players injuries and imaging from the previous season.
 
Radiology rounds:
Musculoskeletal Radiology Rounds (teaching/tutorials) for the Residency Program are every Wednesday morning at 0730. The fellow is expected to attend these rounds which are conducted/chaired by a staff radiologist. The fellow will also chair these rounds later in the year. The fellow is also invited to attend other departmental rounds when available.
 
Teaching file:
The fellow is expected to assist with the gathering of clinical teaching material and will submit one case to the Department of Radiology Teaching File per week.
 
Clinical audit:
The fellow will be expected to actively participate in clinical audit and will be expected to present 2 audit projects to either the MSK subgroup or the whole imaging department during the course of the year.
 
Research:
The Musculoskeletal Radiology Division is a very active research group.  Prof. Lambert has tended to spearhead the majority of the projects and is now complimented by Dr.s Dhillon and Jaremko.  The fellow will be involved in at least two research projects. Typically this involves one clinical review and one laboratory investigation.  The current expectation for research for clinical fellows is submission by the fellow of at least one first authored scientific presentation and one first authored scientific publication. The fellow is encouraged to bring forward ideas for research projects before commencing the post or upon arrival.
 
Progress:
The musculoskeletal fellow and staff of the Musculoskeletal Radiology Division follow the progress of the individual fellow and the program.  This includes:
Daily logbook kept by fellow of all procedures performed.
Logbook kept by fellow of interesting cases.
Minutes of all meetings.
Quarterly reports submitted to Fellowship Program Director.
Terminal report to Fellowship Program Director and academic chair.
Certificate of successful completion.
 
Please contact Lynda Loiseau at lynda.loiseau@ualberta.ca for further information regarding the application process.