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Thoracic & Cardiac Imaging Fellowship

The Thoracic and Cardiac Imaging Fellowship at Massachusetts General Hospital, Harvard Medical School provides a cutting-edge clinical and research experience in thoracic and cardiac diagnosis and thoracic intervention.

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Training the next generation of specialized radiologists

Training future radiologists is central to the mission of the Mass General Department of Radiology. Chairman Emeritus James H. Thrall, MD, discusses our commitment to education and the key role residents and fellows play within the department. Watch now >

Goal of FellowshipThe Department of Imaging at Massachusetts General Hospital, Harvard Medical School accepts three fellows per year for a one year fellowship in thoracic imaging, thoracic intervention and cardiac imaging. The Thoracic and Cardiac Imaging Fellowship consists of 9 months of fellowship training in diagnostic thoracic imaging and intervention, and 3 months of dedicated fellowship training in cardiac imaging.

Clinical ExperienceThe fellowship offers extensive training in digital inpatient chest radiography, digital outpatient chest radiography, thoracic CT, dual energy CT of the thorax, 3D imaging, thoracic PET/CT, thoracic MRI, thoracic PET/MRI, thoracic intervention (thoracic biopsy and ablation), cardiac CT, cardiac CTA, and cardiac MRI. The Divisions of Thoracic and Cardiac Imaging are supported by a dedicated 3D lab that provides 3D data sets for advanced visualization and diagnosis. The thoracic training occurs in the Division of Thoracic Imaging under the direction of Dr. Jo-Anne Shepard and the dedicated thoracic imagers of the Division of Thoracic Imaging. The cardiac training occurs under the direction of Dr. Brian Ghoshhajra, Dr. Udo Hoffman and the dedicated cardiac imagers of the Division of Cardiac Imaging.

Massachusetts General Hospital is a 1057 bed tertiary care hospital, with multiple intensive care units, including a burn ICU, neuro ICU, medical ICU, surgical ICU, cardiac surgical ICU and cardiac ICU. In addition, Mass General is a level-one trauma center, burn center, and transplant center (including heart and lung transplantation). Mass General is a major oncology referral center with high volume Medical Thoracic Oncology, Pulmonary Interventional and General Thoracic Surgical Services. Through the Pulmonary and Infectious Disease Services we are consulted on a multitude of interesting pulmonary diseases. The Thoracic Division alone performs over 100,000 imaging examinations / year and provides a concentrated experience in both usual and unusual medical and surgical conditions of the thorax. The Thoracic and Cardiac Imaging Divisions work collaboratively with exceptionally strong medical, surgical and subspecialty services.

Three months of dedicated cardiac imaging training in cardiac CT, cardiac CTA and cardiac MRI is incorporated into the fellowship. The Division of Cardiac Imaging performs coronary artery calcium scoring, cardiac CTA for a variety of indications, cardiac CT for morphology and function, and cardiac MRI for a variety of clinical indications. While in the Division of Cardiac Imaging, fellows work closely with and receive teaching from experienced and dedicated cardiac imagers.

Cardiothoracic Imaging Fellowship Curriculum - (Download PDF)1

Imaging Modalities and Clinical Rotations

Training in Thoracic and Cardiac Imaging at MGH incorporates all modalities of thoracic and cardiac imaging including: digital inpatient chest radiography, digital outpatient chest radiography, thoracic CT, dual energy CT of the thorax, 3D imaging, thoracic PET/CT, thoracic MRI, thoracic PET/MRI, thoracic intervention (thoracic biopsy and ablation), cardiac CT, cardiac CTA, and cardiac MRI.

Fellows rotate in the available clinical assignments of the Divisions including: inpatient chest radiography, outpatient chest radiography, thoracic CT, thoracic MRI, thoracic PET/CT, thoracic intervention, cardiac CT and cardiac MRI.

Interventional Experience

The members of the Thoracic Division perform >300 percutaneous needle aspiration biopsies/year in a dedicated interventional CT scanner, with on-site cyto-pathology.  Fellows will learn:

  1. The indications for thoracic procedures, procedural risks, benefits and alternatives to the procedure.
  2. Patient selection, appropriate use of pertinent pre-procedural tests, and the contraindications of the procedure.
  3. How to effectively obtain informed consent and adhere to institutional universal “time out” procedural protocols.
  4. How to monitor sedation/analgesia, plan an appropriate biopsy approach, recognize pertinent anatomic landmarks, appropriately execute the biopsy, appropriately obtain samples (cytology, core biopsy and microbiology specimens), and recognize intra procedural complications.
  5. The methods of post-procedure patient recovery, recognition and treatment of biopsy complications (including chest tube placement and management of hemoptysis). 

Fellows may also participate in radiofrequency ablation (RFA) for both primary lung malignancies and metastatic disease to the chest.

Consultative Skills

Fellows are taught to consult with primary care physicians and subspecialists with increasing independence throughout the fellowship year. By the end of the year, fellows learn to be expert consultants in cardiac and thoracic imaging through a variety of conferences and through daily clinical experience.

Teaching

In addition to the clinical experience and teaching that occurs daily, didactic teaching is also provided:

  • Thoracic and Cardiac Mini-Courses
    A two month series of noon lectures focused on Thoracic and Cardiac Imaging. This series of lectures is given to the residents, fellows and staff of Mass General.  Several expert grand rounds speakers are invited as visiting professors.
  • Resident Thoracic Case Conference
    Every Tuesday morning, there is a resident case conference in which the staff present teaching cases to the Mass General Radiology residents.
  • Thoracic Fellow Conference
    A monthly Thoracic Fellow Conference is also provided to teach more advanced topics at the level of Thoracic Imaging Fellows and Thoracic Imagers.
  • Post-Graduate Chest Course (Download PDF)
    This post-graduate course is presented jointly by the Departments of Radiology at Massachusetts General Hospital and Brigham and Women's Hospital. This course is held every other year in November in even years. Internationally renowned speakers traditionally visit as guest lecturers.

Fellows are given opportunities to develop their own clinical educator skills during fellowship. Fellows are given the opportunity to present a lecture at the thoracic mini-course, give resident case conferences, and present research material at national meetings.

Educational Resources

The Division of Thoracic Radiology maintains a current library of the major imaging and clinical textbooks in Thoracic and Cardiac Imaging. Fellows are encouraged to borrow and read the library books. The Division also owns DVDs which are useful in preparation for the cardiac board exam. The Division also maintains a large teaching file of exceptional cases from the last 10 years of clinical practice. This material is invaluable for teaching file material and lectures. Almost all major journals are available electronically on line. The hospital library and Harvard Medical School library are also available resources if needed.

Conferences

A wealth of clinical conferences occurs at the Massachusetts General Hospital in which the Divisions of Thoracic and Cardiac Imaging serve a vital multidisciplinary role:

  • Thoracic Imaging Conference
    Weekly conference prepared by the Thoracic CT resident of current interesting thoracic CT and thoracic MRI cases. The outstanding case material serves as an excellent resource for didactic teaching of residents and fellows.
  • Interstitial Lung Disease Rad-Path Conference
    A bi-weekly conference presented jointly by the Pulmonary Medicine, Thoracic Radiology and Pulmonary Pathology Services. Interesting Interstitial Lung Disease cases are presented with clinical, radiology and pathology correlation.
  • ICU Rounds
    Daily ICU rounds with Thoracic Radiologists and ICU staff in Medical, Surgical and Cardiac Intensive Care Units.
  • PET-CT Conference
    A monthly conference presented to discuss chest and abdominal PET-CT cases.
  • Thoracic Surgical Conference
    A weekly conference presented by the Thoracic Surgical Service at which radiological correlation and patient management of thoracic surgical conditions are discussed.
  • Medical Thoracic Oncology Conference
    A weekly conference presented by the Thoracic Oncology Conference at which the diagnosis and management of lung, esophageal and other thoracic tumors are discussed.
  • Pulmonary Medicine Conference
    A weekly conference in which the Pulmonary service reviews radiology studies on their inpatients.
  • Pulmonary Grand Rounds
    A weekly conference presented by the Department of Pulmonary and Critical Care Medicine, including case presentation and invited lecturers.
  • Infectious Disease Conference
    A conference presented jointly by Radiology and the Infectious Disease Services. Interesting Infectious Disease cases are presented with radiology correlation.
  • Cardiac Conferences
    Dedicated Cardiac conferences include weekly Cardiovascular Imaging Seminar, Cardiac Catheterization Conference, Cardiac MR/CT Conference, Congenital Heart Disease Conference and Cardiac ECHO/MRI Conference.

Vacation and Conference Time

Fellows receive 20 vacation days per year. For attendance at national meetings, 5 days may be granted at the approval of the division head.

Evaulation

Fellows receive faculty feedback and mentoring throughout the fellowship year. Fellows are formally evaluated every 3 months and provided feedback on their progress.  Fellows also formally evaluate the faculty, the program and the degree to which educational objectives are being met twice a year. Every 4 months, formal meetings with the Program Director and assistant program director are conducted to mentor fellows, ensure educational goals are being met and adjust the program to career objectives (when appropriate).

1.  Society of Thoracic Radiology Core Curriculum in Thoracic and Cardiothoracic Imaging, 2012.



 

 

The Thoracic and Cardiac Divisions have active clinical research programs. The faculty participates in RSNA, ARRS, STR, NASCI and Fleischner Societies. At the Massachusetts General Hospital, abundant opportunities exist for scholarly activity including: educational exhibits, review articles, book chapters and original research. Fellows are expected to participate in clinical research projects in conjunction with the staff.

The department provides secretarial assistance and the support of the Radiology Educational Media Service (REMS) in preparation of exhibits, presentations, and manuscripts. Assistance with statistical analysis is available through the Massachusetts General Hospital Institute for Technology Assessment. Departmental support is provided to fellows for presentation of research at major medical meetings. Dedicated academic time is assigned to fellows who demonstrate a research commitment (1day/wk).

Research interests in the Divisions of Thoracic and Cardiac Imaging are extensive and include:

  • Computer Aided Diagnosis
  • CT Dose Reduction: extensive research including iterative reconstruction techniques, MBIR, kV modulation, etc.
  • Pilot study for sub milli-sievert imaging
  • Virtual Autopsy: novel use of imaging to assist autopsy, advance dose reduction and rad-path correlation
  • Dual Energy CT
  • Thoracic Radiofrequency Ablation
  • Thoracic Biopsy
  • Imaging Biomarkers
  • Imaging of lung cancer: staging and imaging of novel mutation tumors
  • Imaging the post operative chest: techniques and complications
  • HRCT: imaging of ground glass lesions, pulmonary hemorrhage
  • Critical care imaging
  • Coronary Artery Calcium Scoring
  • Combined cardiac, pulmonary and aortic CTA (triple rule out

Faculty Textbooks:

  • McLoud TC, Boiselle P. Thoracic Radiology: The Requisites. 2nd Ed. Elsevier Health Sciences, 2010.
  • Stephen W. Miller MD, Suhny Abbara MD, Lawrence Boxt. Cardiac Imaging: The Requisites. 3rd Ed. Mosby, 2009.
  • Abbara S, Walker TG. Diagnostic Imaging - CardioVascular. Amirsys Inc., 2008.
  • Parker MS, Rosado-de-Christenson ML, Abbott GF. Chest Imaging Case Atlas. 2nd Ed. Thieme, 2012.
  • McLoud TC, Boiselle PM, Abbott GF. Thoracic Imaging: Case Review Series. 2nd Ed. Mosby, 2010.
  • Gurney JW, Abbott GF, Winer-Muram HT, Rosado-de-Christenson ML, Mohammed TH. Specialty Imaging: HRCT of the Lung: Anatomic Basis, Imaging Features, Differential Diagnosis. Lippincott Williams & Wilkins, 2009.
  • Michael P. Federle, Melissa L. Rosado-de-Christenson, Paula J. Woodward, Gerald F. Abbott, Akram M. Shaaban. Diagnostic and Surgical Imaging Anatomy: Chest, Abdomen, Pelvis. Amirsys, 2006.
  • Melissa L. Rosado-de-Christenson, Gerald F. Abbott. Healey T, Chung JH, Wu CC, Carter B, Lichtenberger J, Winer Muram H, Kanne J, Franquet T, Ternes, Strollo D. Diagnostic Imaging: Chest. Lippincott Williams & Wilkins, 2012.
  • Chung JH, Ghoshhajra BB, Rojas CA, Dave BR, Abbara S. CT Angiography of the Thoracic Aorta. Radiol Clin North Am. 2010 Mar;48(2):249-264

Scientific publications involving thoracic fellows in the last 3 years

  • Kligerman S, Abbott GF. Radiologic review of the new TNM classification for lung cancer. American Roentgen Ray Society, Boston 2009. (Awarded Silver Medal)
  • Abbott GF, Chung JH, McLoud TC. The Incomplete Border Sign Revisited. LL-CHE2123. Educational Exhibit at the RSNA 96th Scientific Assembly and Annual Meeting. Chicago, IL. 2010.
  • Healey TT, Abbott GF. Centrilobular Nodules: A Bulls Eye Diagnosis? LL-CHE2144. Educational Exhibit at the RSNA 96th Scientific Assembly and Annual Meeting. Chicago, IL. 2010.
  • Lin CH, Goyal N, Abbott GF, Shah RD, Chusid J, Salvatore MM. Imaging Features of Pulmonary Aspiration. LL-CHE-TU6B. Educational Exhibit at the RSNA 96th Scientific Assembly and Annual Meeting. Chicago, IL. 2010.
  • Download full list of Publication - PDF

 

 

 

To apply for the combined Thoracic & Cardiac Imaging Fellowship

The MGH Thoracic and Cardiac Imaging Fellowship is currently full for the 2014-2015 and 2015-2016 academic years. We will be accepting applications for the 2016-2017 academic year after June 1, 2014. To apply please complete the following:

  1. Current Curriculum Vitae
  2. Fellowship application (PDF)
  3. Personal statement
  4. Three current letters of recommendation addressed to Dr. Jo-Anne Shepard (see below). One letter must be from the Residency Program Director
  5. Copies of USMLE scores (steps 1-3)

 

Fellow applicants are encouraged to be meet criteria to take the ABR exam, to be able to obtain a full Massachusetts medical license and federal DEA number prior to start of fellowship. Steps 1-3 of the USMLE must be completed 6 months prior to the start of the fellowship.  Bonafide candidates will be invited for an interview and tour.

To apply or for questions regarding the fellowship, please contact Matthew D. Gilman, MD, Associate Fellowship Director.

 

Contact Information

Director: Jo-Anne Shepard, MD
Phone: 617-724-4256
Fax: 617-724-0046
Email: jshepard@partners.org

Associate Director: Matthew D. Gilman, MD
Phone:617-724-4254
Fax: 617-724-0046
Email: mgilman@partners.org

Administrative Assistant: Ana L. Forim
Email: aforim@partners.org

U.S. Mailing Address:
Jo-Anne Shepard, MD
Massachusetts General Hospital
Division of Thoracic Imaging
Department of Radiology
55 Fruit Street, Founders 202
Boston, MA 02114

Phone: 617-724-4254
Fax: 617-724-0046