Please note that the Musculoskeletal
Radiology Fellowship Program is currently looking for 2019-2020 candidates.
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:
Scope of practice at the University
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
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. R.
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.
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.
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.
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.
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.
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 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:
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.
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
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
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.
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.
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.
The musculoskeletal fellow and staff
of the Musculoskeletal Radiology Division follow the progress of the individual
fellow and the program. This includes:
Please apply via this
hyperlink for a fellowship position:
Please contact Lynda Loiseau at Lynda.Loiseau@ualberta.ca for information on the application process.