The project aims to assess the impact of utilization of inpatient CT angiographic imaging in patients with subarachnoid hemorrhage (SAH), and will be performed as a retrospective cohort study using Ontario registry and health administrative data. CT angiographic imaging is frequently used in the inpatient setting in monitoring of SAH patients for the development of delayed cerebral ischemia (DCI), however, there is considerable uncertainty regarding the effectiveness of current imaging practices with regard to influencing patient outcomes. This project is intended to provide evidence on the value of imaging monitoring in patients with SAH at risk for development of DCI, which is of critical importance in establishing evidence-based guidelines for management and imaging appropriateness in these patients.
Congratulations, Dr. Rawal
With a generous donation from alumnus Dr. Jim Mergelas, the Department created the Mergelas Family Graduate Scholarship Award. The award supports a resident in the Clinical Investigator Program (CIP), working toward either a Masters or PhD.
Last September at the annual Alumni Reception Dr. Mergelas presented the award to
Dr. Cheung's research project is to study the use of Gadofosvest trisodium (Gdfos), a blood MR contrast agent in the detection and characterization of liver lesions.
Congratulations, Dr. Cheung.
(PGY 3) for being the recipient of the Mergelas Family Graduate Scholarship Award which was created after a very generous donation by Dr. Jim Mergelas.
On October 5th 2014 at the annual Alumni Luncheon. Departmental Chair, Dr. Alan Moody presented the award to Dr. Singh (pictured right) on behalf of Dr. Mergelas who was unable to attend on this occasion.
Dr. Singh's research is entitled
Congratulations, Dr. Singh!
Save The Date
5th Medical Imaging Alumni & Education Day
Our 5th Medical Imaging Alumni and Education Day will be held on January 17th 2015 at the Li Ka Shing Knowledge Institute please click here
to view the event poster. More information will be sent out in the coming weeks.
In August 2014, Gary Cronin
joined the Department of Medical Imaging. One of his roles within the department is to assist Tony Hanbidge with Alumni affairs. This includes Alumni engagement and communications. The Department is proud of our Alumni and would love to hear from previous residents, fellows and faculty about awards, accomplishments and much much more.
Social Media Presence
We are delighted to announce the Medical Imaging Alumni now have a Twitter and Linkedin accounts. Please click on the icons below to join and be part of our social media presence.
Department Awards and Achievements
Outstanding Teachers as selected by the Residents, in alphabetical order:
Outstanding Teachers as selected by the Fellows, in alphabetical order:
- Dr. Robert Bleakney, JDMI
- Dr. TaeBong Chung, JDMI
- Dr. Errol Colak, SMH
- Dr. Andrew Crean, JDMI
- Dr. Djeven Deva, SMH
- Dr. Nasir Jaffer, JDMI
- Dr. Walter Mak, SMH
- Dr. Pejman Maralani, SHSC
- Dr. Ravi Mohan, JDMI
- Dr. Antony Raikhlin, SMH
- Dr. Sapna Rawal, JDMI
- Dr. Paraskevi (Laurie) Vlachou, SMH
Outstanding teachers in the Residency and Fellowship Programs, in alphabetical order, as selected by the residents AND fellows:
- Dr. Mostafa Atri, JDMI
- Dr. Helen Branson, HSC
- Dr. Govind Chavhan, HSC
- Dr. Alan Daneman, HSC
- Dr. Richard Farb, JDMI
- Dr. Korosh Khalili, JDMI
- Dr. Anish Kirpalani, SMH
- Dr. Laurent Milot, SHSC
- Dr. Walter Montanera, SMH
- Dr. Lyne Noel de Tilly, SMH
- Dr. Martin O’Malley, JDMI
- Dr. Charles Raybaud, HSC
- Dr. Manohar (Manu) Shroff, HSC
- Dr. Elysa Widjaja, HSC
The Edward L. Lansdown Award for Outstanding Teacher in the Residency Training Program:
- Dr. Anthony Hanbidge, JDMI
- Dr. Timo Krings, JDMI
- Dr. Caitlin McGregor, SHSC
- Dr. Oscar Navarro, HSC
Gordon Potts Award for Outstanding Resident:
Resident Teacher-Mentor Award:
Chief Resident Award:
The RSNA Roentgen Resident/Fellow Research Award:
- Dr. Pejman Maralani, SHSC
Night Call Through the Decades
Our feature item for this current alumni newsletter addresses "Night Call" and how it has changed through the eyes of residents through the years. Thanks to contributions from Drs. Zelovitzky, Herman, Christakis, Kirpalani and Diamond we are able to give you an insight in how experiences and procedures have changed through the decades. Enjoy !
The 70's - Dr. Leon Zelovitzky
(JDMI - Cardiac Imaging)
Radiology during the decade of the 1970’s was little different from the late 1960’s.
Refinements such as double contrast barium examinations of the GI tract, the Seldinger technique for angiography and introduction of television monitors in various examining rooms improved the capability of the radiologist. Textbooks were generally not easily available and teaching was far less frequent than the many rounds residents enjoy today. CT, MR and ultrasound were in their infancy and hardly played a role in clinical radiology.
Early CT was hampered by an inordinately long examination with poor contrast and resolution not infrequently leading to embarrassing misinterpretations. Teaching was largely at the bedside during routine reporting. Routine radiology comprised of barium studies, lymphangiograms and sialograms with the odd mammogram thrown in.
The introduction of the double contrast technique resulted in a better quality barium examination and enabled the radiologist to see small intraluminal lesions not apparent on the earlier, single barium, contrast studies.
Plain radiographs of the chest, abdomen, MSK, skull and sinuses were read routinely throughout the day. Rotational radiology involved myelograms, pneumoencephelograms, IVP’s, and micturating cystourethorgrams. The angiography rotation gave the resident an opportunity to learn the Seldinger technique, broadening the scope of the angiographer.
Emergency Radiology - Most hospitals required the in-loco presence of the resident from 5:00 pm to 8:00 am in the morning of the following day. The bulk of emergency reporting were mostly interpretation of chest radiographs, MSK and three views of the abdomen. KUB’s were performed for renal calculi often followed by an IVP. Emergency barium studies were most often done for mechanical bowel obstruction and suspected volvulus; although later in the 70’s fell into disfavour due to the danger of barium perforation.
For mesenteric infarction, angiodysplasia of the colon, a mesenteric angiogram was performed if the patient’s metabolic state allowed.
In cases of suspected pulmonary thromboembolism, the routine was first a VQ scan, almost always indeterminate, followed by the gold standard at the time: the pulmonary angiogram.
It was mandatory in the 70’s for an anaesthetist to be present during the pulmonary angiogram should resuscitation be required. This often produced a logistic nightmare as very frequently the anaesthetist was in the operating room and it was hours before he was available for the procedure, initiated during emergency hours, often flowing over into the next day.
During the Neuroradiology rotation, myelograms were done in the afternoons, most often for suspected disc lesions. Cerebrovascular angiography was considerably more common than it is today for diagnostic purposes.
Pneumoencephelograms (air studies) were performed for direct and indirect indicators of intracerebral lesions. The procedure was poorly tolerated by the patient and often required 2-3 days hospitalization for a severe headache and vomiting. Lymphangiogramps were performed for staging of lymphoma, metastases and intrinsic lymphastic disease.
Sialograms were performed largely for salivary calculi and less frequently for tumours, mostly of the paratoid gland.Lung biopies were first performed in the United States in 1981 and were not performed in the 70’s.
In summary, the decade of the 70’s for the radiology resident was extensive plain film experience and a great deal of barium and IVP studies, a few lymphangiograms, sialograms and myelograms in the mix.
The 80's - Dr. Steve Herman
(JDMI - Thoracic Imaging)
Call in the 80's was very different than it is today. First, from what I hear it’s like now, it was quite a bit easier back then. And secondly, the work we did was not at all similar.
While most of us stayed onsite throughout the night, if you lived close you could actually sleep at home. And while you were occasionally awakened during the night, on a typical night you could sleep from around midnight to 6 a.m. And even when you were awakened, more often than not you could deal with the issue on the phone.
Being the very early 80’s for me, CT and US were still fairly new and were done by staff. So for the residents, the usual reason for calls was to do an IVP (with vomiting/urticaria not unusual at all) or a Barium study or to help interpret plain films. Sometimes the latter made you wonder how some of the other residents ever got accepted into Med School. E.g. being awakened at 3 a.m. to come to ER and help with an L-spine and on arriving being asked, “Where’s the scotty dog again?” Another time being told they’re having trouble interpreting a CXR and on arriving needing to take the film down from the viewbox and pull apart the PA and lateral which were stuck on top of each other.
So while call is not one’s favourite activity, at least you get a few good stories out of it (and maybe some education?!)
The 90's - Dr. Monique Christakis
(Sunnybrook Health Sciences Centre - Musculoskeletal Imaging)
Call has always been the thorn in the resident’s side. Times have changed with respect to the practice of medicine and therefore call has evolved over time. In 1991-1995 at U of T radiology, call was in house only at Sick Kids and Sunnybrook while the other hospitals were home call. While on call, the focus was more to review the radiographs from emergency and the occasional CT. The CT’s performed were predominantly heads for trauma or stroke. There was no CT technologist in house and one would have to be called in from home to perform a CT requested by the ER. We had no MRI on call. If a patient came in to the emergency with cauda equina or cord compression, we would perform a myelogram CT. To rule out pulmonary embolism required ventilation perfusion study.
Call was variably busy and it was not unheard of (although highly uncommon) to sleep through the night without disturbance. Some residents always seemed luckier than others. In the morning we reported out all the radiographs and CT’s from the emergency from the night before and then continued on service to the end of the day. If we were up all night with call, which could certainly happen at Sunnybrook or SickKids, we would still work the entire next day. We began our call when we started the residency and took call until the end. Exams were no excuse not to take call!
The 00's - Dr. Anish Kirpalani
(St. Michael's - Body Imaging)
I was a radiology resident at U of T from 2001 to 2005. During that time, we were on the tail end of the transition from after-hours radiology being mostly procedurally driven with relatively few cases to a high-volume inpatient and ER on-call diagnostic scan service. By 2001, the JDMI (before it was called that) had two resident call pools: TGH/MSH, which was in-house, and TWH, which was home call in the evenings. While it was possible to get hammered with on-call cases all night, you usually were able to catch some sleep or get some studying time in at those centres. In those days, we had DDx lists loaded on our PalmPilots (not iPhones), not all suspected appendicitis cases were imaged from the ER, MRIs on-call were a rare event except for occasional stroke cases, and we were just completing the transition from IVP to renal colic protocol CT scans for suspected obstructed renal stones. At St. Michael's and Sunnybrook, in-house call was busy, full of trauma studies, and it was rare that you got much sleep. The only exception to this was during the few months of SARS craze in Toronto in 2003, when the call volumes were memorably lighter. At St. Michael's in particular, we had to respond to all traumas by going to the ER to review plain films (yes, films on viewboxes) and do “FAST” ultrasound exams. At all sites, there were no in-house staff radiologists to back us up or read studies. As PGY-2 residents in the early 2000s, we got a few intro months of shadowing senior residents in July and August, and then you were on-call on your own after Labour Day and had to learn on the job! No buddy call in those days, and no after-hours shifts. While things have undoubtedly gotten busier on-call, we were already pretty busy on-call with similar things during that time period.
Current Day - Dr. Ivan Diamond -
PGY 5 Chief Resident
In March 2014 the residency program transitioned, on a pilot basis, to a shift-based model for after-hours coverage. Each day at the 5 core after-hours sites (Sunnybrook, St Michael’s Hospital, The Hospital for Sick Children, Toronto General/Mount Sinai, Toronto Western/Princess Margaret Hospital/Women’s College Hospital) there are 3 residents who provide “in-house” coverage. Residents typically cover the after-hours periods in blocks of 3 or 4 consecutive overnight shifts (8pm-8am), 3 or 4 consecutive evening shifts (5pm – 8:30 pm) or 2 consecutive weekend day shifts. After-hours schedules are made twice a year (May and October) each for a 6-7 month period. Residents are able to cover any site that they have previously rotated at and therefore after-hours responsibilities can be fairly shared between all the residents within a given PGY year and not dependent on the number of residents assigned to a particular site. At all sites, the radiology resident is the most paged person in the hospital after-hours. Case volumes after-hours are very high (I know of a resident who dealt with over 100 cases during a 24 hour weekend shift prior to our transition to the shift based model) and there is increasing, pressure from the clinical services for rapid turn around. At many of the sites, there are fellows and/or staff who are also reporting during the after-hours periods, especially during the evening hours and on weekends. Despite the presence of fellows and staff, residents are still expected to provide, as much as possible, focused preliminary reports on studies performed on patients in the emergency department and inpatients during the after-hours periods.
Opportunity - Alumni Social Media Committee
If you are an Alumna or Alumnus with an interest in social media, please consider joining the Alumni Social Media Committee. There is still one unfilled position. You will be involved in discussing and developing new concepts of Alumni engagement through social media. We would specifically like to recruit a member of our Alumni who has been in practice for more than 5 years, preferably in a Community based hospital. For more information please contact Gary Cronin.
We look forward to hearing from you.