About the Fellowship

Overview

The Thoracic and Cardiac Imaging Fellowship accepts five fellows per year for a one-year fellowship in thoracic imaging, thoracic intervention and cardiac imaging. It consists of nine months of fellowship training in diagnostic thoracic imaging and intervention and three months of dedicated fellowship training in cardiac imaging.

Clinical Experience

The 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 imaging training occurs in the Division of Thoracic Imaging under the direction of Jo-Anne Shepard, MD and the dedicated thoracic imagers of the Division of Thoracic Imaging. The cardiac imaging training occurs under the direction of Nina Meyersohn, MD; Brian Ghoshhajra; MD, Udo Hoffman, MD; and the dedicated cardiac imagers of the Division of Cardiovascular Imaging.

Mass General is a 1,057-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 1 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. The Division of Thoracic Imaging performs more than 100,000 imaging examinations per year and provides a concentrated experience in both usual and unusual medical and surgical conditions of the thorax. The Divisions of Thoracic and Cardiovascular Imaging work collaboratively with exceptionally strong medical, surgical and subspecialty services.

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

Curriculum

Imaging Modalities and Clinical Rotations

Training in thoracic and cardiac imaging 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 through the various clinical assignments of the Divisions of Thoracic and Cardiovascular Imaging, 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 Division of Thoracic Imaging perform more than 500 percutaneous needle aspiration biopsies per year in a dedicated interventional CT scanner with on-site cyto-pathology support.

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 and 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 intraprocedural complications
  5. The methods of post-procedure patient recovery, recognition and treatment of biopsy complications (including chest tube placement and management of hemoptysis)
  6. The indications and techniques for fiducial marker placement to localize pulmonary lesions for surgical resection and radiotherapy
  7. Thoracic ablative procedures including microwave and cryo-ablation for both primary lung malignancies and metastatic disease to the chest

Consultative Skills

The team teaches fellows 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 daily teaching, the fellowship also provides didactic teaching.

Thoracic Imaging Clinical Conferences

  • Thoracic Imaging Conference: Weekly conference prepared by the thoracic CT resident of current interesting thoracic CT and thoracic MRI cases. These cases serve as a resource for didactic teaching of residents and fellows.
  • Interstitial Lung Disease Rad-Path Conference: A biweekly 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 with discussions about radiological correlation and patient management of thoracic surgical conditions.
  • Medical Thoracic Oncology Conference: A weekly conference presented by the Thoracic Oncology Conference with discussions about the diagnosis and management of lung, esophageal and other thoracic tumors.
  • Pulmonary Medicine Conference: A weekly conference in which the pulmonary service reviews radiology studies on its inpatients.
  • Pulmonary Grand Rounds: A weekly conference presented by the Department of Pulmonary and Critical Care Medicine, including case presentations and invited lecturers.
  • Infectious Disease Conference: A conference presented jointly by the Department of Radiology and the Infectious Disease Services. Interesting infectious disease cases are presented with radiology correlation.
  • Cytology Conference: A quarterly conference with interesting biopsy case reviews. The indications, technique and cytology results of thoracic biopsy are reviewed with radiology and pathology in attendance. This conference provides an excellent opportunity to see the yield, usefulness of thoracic fine needle aspiration and core biopsy.
  • Lung Screening Conference: A weekly multidisciplinary conference attended by thoracic radiology, thoracic oncology, thoracic surgery, pulmonary medicine and thoracic radiation oncology. Cases are presented, and multidisciplinary management decisions are made regarding pulmonary lesions found on lung cancer screening or non-screening chest CT exams.

Thoracic Imaging Didactic Conferences

  • Thoracic and Cardiac Mini-Courses: A total of two months of noon lectures focused on thoracic and cardiac imaging. This series of lectures is given to the residents, fellows and staff. Several expert grand rounds speakers are invited as visiting professors.
  • Resident Thoracic Case Conference: A Tuesday morning resident case conference in which the staff present teaching cases to the radiology residents. Fellows may participate in the teaching of residents later in the fellowship year.
  • Thoracic Fellow Conference: A series of didactic fellow-level lectures conducted by thoracic imaging staff in the first six months of the fellowship on advanced thoracic imaging and intervention.
  • Post-Graduate Chest Course: The Departments of Radiology at Mass General and Brigham and Women's Hospital jointly present this post-graduate course. The departments hold this course every other year in November during even years. Internationally renowned speakers traditionally visit as guest lecturers.

Cardiac Imaging Conferences

  • Dedicated cardiac conferences include weekly a Cardiovascular Imaging Seminar, Cardiac Catheterization Conference, Cardiac MR/CT Conference, Congenital Heart Disease Conference and Cardiac ECHO/MRI Conference.

Fellows receive opportunities to develop their own clinical educator skills during fellowship. Fellows can 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 Imaging maintains a current library of the major imaging and clinical textbooks in thoracic and cardiac imaging. Fellows can borrow and use these resources. The division also has useful materials for the cardiac board exam. The division maintains a large teaching file of exceptional cases from the last 10 years of clinical practice. Almost all major journals are available online. The hospital library and Harvard Medical School library are also available as additional resources.

Vacation and Conference Time

Fellows receive 20 vacation days per year, some of which may be used for presentation of research, abstracts or educational exhibits at national meetings.

Evaluation

Fellows receive faculty feedback and mentoring throughout the fellowship year. Fellows have formal evaluations every three months and receive 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 four months, fellows have formal meetings with the program director and assistant program director for mentorship, to ensure educational goals are being met and to adjust the program based on career objectives when appropriate.

Research Experience

The Thoracic and Cardiac Divisions have active clinical research programs. The faculty participates in the RSNA, ARRS, STR, NASCI and Fleischner Society. At Mass General, 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 staff.

The department provides secretarial assistance and support in exhibit preparation, presentations and manuscripts. The Mass General Institute for Technology Assessment assists with statistical analysis. Fellows also have departmental support for presentation of research at major medical meetings. Dedicated academic time may be assigned to fellows who demonstrate a research commitment. Academic time is at least 12 days per year and may be as high as one day per week.

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

  • Computer Aided Diagnosis
  • Artificial intelligence and machine learning in thoracic imaging
  • CT technology and dose reduction: extensive research including iterative reconstruction techniques, MBIR, kV modulation and new imaging technologies
  • Sub millisievert imaging
  • Dual energy CT
  • Thoracic MRI
  • Thoracic microwave ablation
  • Thoracic cryoablation
  • Thoracic biopsy
  • Thoracic fiducial marker placement
  • Imaging biomarkers
  • Imaging of lung cancer: staging, imaging, imaging of novel mutation tumors, imaging of drug and treatment related toxicities
  • Lung cancer screening
  • Imaging the post-operative chest: techniques and complications
  • Critical care imaging
  • Thoracic imaging in underserved populations
  • Coronary artery CTA: calcium scoring, stenosis imaging, myocardial infarction, congenital anomalies
  • Coronary CT angiography in the ED
  • Imaging of atherosclerotic plaque and coronary risk stratification
  • Aortic aneurysm and endovascular aortic repair

How to Apply

The Thoracic and Cardiac Imaging Fellowship is currently full for the 2019-2020 and 2020-2021 academic years.

For the 2021-2022 academic year, the Massachusetts General Hospital Department of Radiology has joined 90 radiology departments across the United States in pledging to follow the October 2018 guidelines for fellowship interviews and acceptances established by SCARD (Society of Chairs of Academic Radiology Departments). Applications for the 2021-2022 academic year may be submitted electronically by email or in the form of hard copy by US mail. Authors of reference letters may send their letters by email, however we ask that the original signed hard copies of the reference letters be sent by US mail to follow (address listed below). Interviews for the 2021-2022 academic year will be conducted after December 1, 2019 in accordance with the current SCARD guidelines.

To apply, please complete and send the following:

  1. Current Curriculum Vitae
  2. Fellowship application [Word Doc]
  3. Personal statement or letter of intent
  4. Three current letters of recommendation addressed to Jo-Anne Shepard, MD. One letter must be from the residency program director or a current supervisor.
  5. Copies of USMLE scores (if taken)

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