The Chest fellowship provides experience in all aspects of thoracic radiology including interpretation of plain films, cross-sectional imaging including all thoracic CT and MRI. Experience in PET CT imaging will also be acquired. All thoracic interventional procedures are also performed by the thoracic division including pleural, mediastinal, lung and chest wall biopsies as well as diagnostic pleural taps. The fellow will also be given two months of elective in cardiovascular imaging. The division works closely with both pulmonary medicine and thoracic surgery in planning patient care. To this end, fellows are expected to present the cases for our three interdisciplinary conferences, two of which are weekly and one of which is monthly. All fellows are expected to participate in research and are given one academic day per week starting two months after the start of the fellowship. Fellows are also expected to participate in education of residents and medical students and to participate in Resident lectures.
Brigham and Women's Hospital (BWH, "The Brigham") is the second largest teaching affiliate of Harvard Medical School and is the largest hospital in the Longwood Medical and Academic Area in Boston, Massachusetts, US. With Massachusetts General Hospital, it is one of the two founding members of Partners HealthCare, the largest healthcare provider in Massachusetts. Brigham and Women's Hospital conducts the second largest hospital-based research program in the world, with an annual research budget of more than $630 million. In 2013 the BWH Biomedical Research Institute (BRI) received $630 million in research support from all sources. For over a decade, it has been one of the two hospitals receiving the most National Institutes of Health (NIH) funding among independent hospitals in the United States. It employs over 3,300 researchers. Pioneering milestones include the world's first successful heart valve operation and the world's first solid organ transplant.
The Thoracic Imaging fellowship provides extensive training and experience in all aspects of thoracic radiology, including interpretation of plain radiographs, cross-sectional imaging including CT and non-vascular Thoracic MRI, 3D imaging and thoracic intervention. The department of Thoracic Imaging accepts three fellows per year for a one-year fellowship. The fellowship also includes 2 months of dedicated experience in Cardiac imaging. However, fellows can choose to spend these two months in a rotation of their choice (e.g. abdominal intervention).
We are a high-volume division, interpreting close to 30,000 chest CTs and 250 MRIs per year. The Brigham and Women’s Hospital is a referral center for a number of thoracic diseases, and so we provide care for patients with a wide variety of conditions. In particular, BWH has a dedicated center for lymphangioleiomyomatosis; a large heart and lung transplant program (over 75 lung and 22 heart transplants were performed in the last year); a large oncology referral base from the Dana-Farber Cancer Institute, including more than 275 allogeneic stem cell transplants performed per year. Our Thoracic Surgery program is one of the largest in the country and performs a wide variety of surgical procedures for lung cancer and esophageal cancer per year. In addition, the group is a referral center for mesothelioma, and performs many pleurectomies and pneumonectomies.
Fellows gain rich clinical experience in a wide spectrum of thoracic diseases by reading cases as well as by participating in weekly multidisciplinary conferences. These include weekly Thoracic Surgery Morbidity and Mortality conferences, lung and esophageal cancer tumor boards, and Multidisciplinary Interstitial Lung Disease conference. Interesting thoracic interventional cases are presented once every month during the thoracic radiology cytopathology conference.
Our division performs between 425 and 450 thoracic biopsies per year. These include lung, mediastinal, and chest wall biopsies. The majority of interventional procedures are done with CT-fluoroscopic guidance, and some procedures are done with US guidance. Fellows will gain periprocedural skills, including learning the indications for lung biopsy, patient selection and contraindications, and management of anticoagulants. Fellows are pushed early on to gain supervised independence in planning a biopsy approach and performing the procedure. Fellows will also learn to place chest tubes should the need arise, as well as how to manage other procedural complications.
In addition to lung biopsies, our group performs CT-guided micro-coil localizations of lung lesions for preoperative planning. We also provide intraoperative support to our thoracic surgery colleagues by marking small, non-palpable lung nodules with fiducials by utilizing the Siemens ARTIS pheno robotic C-arm in either our state-of-the-art hybrid operating room or our Advanced Multimodality Image Guided Operating (AMIGO) suite. (The AMIGO suite is a medical and surgical research environment that houses a complete array of advanced imaging equipment and interventional surgical systems that allows multidisciplinary teams of specialists use this equipment array and the unique design of the suite to efficiently and precisely guide treatment.)
The Brigham Health Lung Cancer Screening Program is under the direction of the Division of Thoracic Radiology within the Lung Center, providing close multispecialty collaboration for the diagnosis and treatment of lung cancer. All images are read by dedicated subspecialty trained thoracic radiologists who specialize in the detection and management of lung nodules. Brigham and Women’s Hospital developed patient centered low dose screening program prior to participation in the National Lung Screening Trial (NLST) and provided a clinical lung cancer screening program continuously since the termination of NLST in 2011.
Fellows are given 2 months of elective time, during which time they may do rotations in other subspecialties in the Department of Radiology. We encourage fellows without prior dedicated experience in cardiac imaging to use their elective months in that division. The division of cardiac imaging performs a high volume of cardiac CT and MR examinations, with ample opportunity to learn the interpretation of coronary CTAs, cardiac MRIs done for infiltrative and ischemic cardiomyopathy, pre-procedural planning CTAs for transcatheter aortic valves (TAVR), as well as many other studies and indications. If a fellow has prior experience in cardiac imaging, they can choose to instead use their elective time to hone their procedural skills in the department of Abdominal Imaging and Intervention division, which performs numerous CT-guided biopsies and drainages.
Fellows are allocated 3 weeks of vacation time plus approximately one week of time off during either Christmas or New Years and 5 days of conference time. [ A fund is provided to help defray meeting costs.]
The department of Thoracic Imaging at Brigham and Women’s Hospital provides ample opportunities for research and scholarly activities. Faculty members are members of and participate in national and international meetings such as RSNA, STR, ARRS, and the Fleischner Society. All fellows are expected to work on an original research project under the guidance of one of our faculty members. Fellows are afforded one academic day per week for this purpose and are encouraged to submit educational exhibits and research abstracts for national radiology meetings such as RSNA, STR and ARRS. In past years, our fellows have been quite productive, producing multiple abstracts at major national meetings as well as publications in peer-reviewed journals.
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