Musculoskeletal Radiology Fellowship Program
The Musculoskeletal Radiology Fellowship Program is currently looking for 2027 candidates.
The fellowship:
The fellowship is education focused with an emphasis on accurate interpretation of diagnostic studies and high level of performance in procedures. In the first 3 months the focus will be on quality of work rather than Quantity. It is expected the fellow will gradually increase speed of reporting over the course of the fellowship. The fellowship has a graduated approach to the fellow acquiring primary responsibility for delivery of care. The fellow will be taught procedures with direct supervision before graduating to remote supervision and eventually independent practice. All studies are reviewed with a staff radiologist with one-on-one teaching.
Clinical Practice:
Musculoskeletal Radiology involves all aspects of musculoskeletal (MSK) imaging and intervention for diagnosis and therapy. Modalities include 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 nuclear medicine as part of the diagnostic work up.
The fellowship is based at the University of Alberta Hospital and involves rotations at Kaye Edmonton Clinic, Royal Alexandra Hospital, Grey Nuns Hospital, Misericordia Hospital and the MIC Gateway Sports Imaging Clinic.
Procedures in MSK imaging may be 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, 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 soft tissue 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 MSK Fellowship director (Dr Suki Dhillon) and subsequently to the Fellowship Program director (Dr Gavin Low) and to the Academic Chair (Prof. D. Emery).
Magnetic Resonance Imaging:
The MSK service performs about 750-1000 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 the cases. In addition to this, the Fellow will be exposed to/have access to cases reported by staff with ample opportunity for discussion of interesting findings. All fellows’ studies are double read with the staff radiologist providing one on one teaching for each case. 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 with a particular emphasis on the diagnosis of spondyloarthropathies. The fellow should achieve 1000 - 1500 MRI cases, read as primary interpreter during the fellowship.
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 achieve 700 - 900 fluoroscopic guided procedures during the fellowship.
Computed Tomography:
The Fellow will read or review 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 achieve 250 - 400 CT cases during the fellowship.
Ultrasound:
Diagnostic Ultrasound:
MSK Ultrasound is currently performed with dedicated booked lists three days per week at the MIC Gateway Sports Imaging clinic. The fellow will be exposed to a full range of diagnostic and therapeutic examinations. The MSK Ultrasound service is extremely busy with high volumes of 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. The first 3 months will be dedicated to MSK US hands-on training with the emphasis on developing expertise in MSK US scanning. This will be under the guidance of MSK sonographers and radiologists. The fellows will be expected to engage in the training process and become fully proficient in hand-on MSK US scanning.
Ultrasound Procedures:
Dedicated US lists for US guided therapies take place at the Gateway Sports Imaging clinic. Once fellows are proficient in MSK US scanning they will transition to training in US guided procedures. 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.
Graduated Responsibility:
Initially the fellow will observe procedure techniques and then progress to performing under direct supervision to remote supervision. The fellows will be expected to learn a variety of techniques from different radiologists. By 3 months, the fellow should be performing common procedures under remote supervision and some under direct supervision. When the fellow is deemed competent the training will transition to the practice phase with the fellow taking responsibility for a whole list under remote supervision. This is commonly at 5-7 months.
In MRI, the first several weeks will require adjustment of the Fellow to our scanning procedures and protocols. By 6 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 (20-25 scans/day). ALL scans and procedures will continue to be 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 be heavily involved in the opinions and interventions generated.
On Call Responsibilities:
The fellow is expected to start taking on-call 6-8 weeks after start of fellowship.
The fellow will take 'on-call' in general CR primarily at the University of Alberta Hospital on weekday evenings and cover MRI spine and MSK referrals. The fellow will be supervised by a staff radiologist. The fellow will work an evening CR reporting shift approximately 32 weekdays over the year.
The fellow will be on-call for a total of 8 weekends during the fellowship. This will include one holiday long weekend. The first two weekends will be CR based call on a day shift with a staff radiologist. The fellow will cover MRI spine and MSK for the day, evening and overnight over the weekend.
The last six weekends will be day shift hybrid call working with a staff radiologist in general Radiology (CT, US, on call procedures) as well as covering MRI spine and MSK. This allows the fellows to maintain their general body skills.
Education/Teaching
Continual Viewer side 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. Weekly MSK case rounds are education focused. Multiple multidisciplinary case rounds have a large educational component. Didactic teaching will be provided to the fellow by members of the Musculoskeletal Radiology Division on an intermittent basis.
MRI Technologist Experience:
During this fellowship, fellows spend 1-2 days with senior MRI technologists learning about scanning protocols and parameters, MR physics and artifacts.
Presentations:
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 this 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. Biweekly Tumor Rounds with the Orthopedic tumor surgeons. 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 six rounds during the year. The fellow is also invited to attend other departmental rounds when available.
Education:
The fellow is expected to assist with the gathering of clinical teaching material and contribute towards educational material and projects.
Quality Improvement (QI)
The fellow will be expected to actively participate in QI and will be expected to present one QI project 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. The fellow will be involved in at least one research project. The current expectation for research for clinical fellows is submission by the fellow of at least 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. This includes:
- Daily logbook kept by fellow of all procedures performed.
- Daily evaluations
- Minutes of all meetings.
- Quarterly evaluation of progress.
- Terminal report to Fellowship Program Director and academic chair.
- Fellowship certificate if successful completion of the program.
Application Prerequisites:
- Applicants should have successfully completed (or be in progression towards) a recognized Radiology postgraduate qualification (FRCPC, FRCR, etc.).
- Due to CPSA licensing requirements, all physicians practising in Alberta need to be able to communicate clearly with their patients in English. Unless exempt, you need to complete an academic version of an English Language Proficiency (ELP) test within 24 months before submitting your CPSA application.
** CPSA needs to be able to verify the test results. Please visit the CPSA website for more information.
https://cpsa.ca/physicians/registration/english-language-proficiency/
Please contact our department for further information regarding the application process.