Chest (Thoracic) Radiology Fellowship Program
The Chest fellowship provides experience in all aspects of thoracic radiology including interpretation of plain films, and 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 eight weeks of elective time 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.
Overview of Brigham and Women’s Hospital
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 Mass General Brigham, 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 three 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.
Overview of Fellowship
The Division of Thoracic Imaging accepts four fellows per year for the Thoracic Imaging track and two fellows per year for the Cardiothoracic Imaging track in conjunction with the Division of Cardiovascular Imaging. The Thoracic Imaging track includes training in thoracic imaging for 10 months and cardiovascular imaging for 2 months, while the Cardiothoracic Imaging Track includes training in thoracic imaging for 6 months and cardiovascular imaging for 6 months; this is a one-year fellowship. The Thoracic Imaging fellowship provides extensive training and experience in all aspects of thoracic radiology, including interpretation of digital chest radiographs, cross-sectional imaging including CT and non-vascular thoracic MRI, 3D imaging and thoracic intervention. All thoracic interventional procedures are performed by the thoracic division including pleural, mediastinal, lung and chest wall biopsies as well as diagnostic pleural taps.
As mentioned, the fellowship incorporates dedicated experience in Cardiac Imaging where the fellow would work within the Division of Cardiovascular Imaging at BWH and gain expertise in cardiac CT, cardiac CTA, and cardiac MR.
The division works closely with the Divisions of Pulmonary Medicine, Thoracic Surgery, and Medical and Radiation Oncology in planning patient care. To this end, fellows work closely with the staff to present at various multi-disciplinary clinical conferences.
Clinical Experience & Fellowship Curriculum
The Brigham and Women’s Hospital is a referral center for a number of thoracic diseases, and we work closely with the Divisions of Pulmonary Medicine and Critical Care, Thoracic Surgery, and Medical and Radiation Oncology in planning and providing patient care. BWH is also a referral center for cystic lung diseases and has a large heart and lung transplant program (over 75 lung and 22 heart transplants were performed in the last year). The BWH Department of Radiology has recently merged with the DFCI Radiology Department further expanding our oncological case mix. Our Thoracic Surgery program is one of the largest in the country, performing a wide variety of surgical procedures for malignancies in the thorax. We are a referral center for mesothelioma, having one of the largest mesothelioma programs in the world.
The Thoracic Imaging Division is a high-volume division and fellows would be exposed to a rich daily case mix. Usual daily volumes include 190-230 CTs, 10-12 lung cancer screening CT studies, approximately 300 chest radiographs, 3-6 non-vascular thoracic MRIs, and 2-4 lung biopsies. Fellows gain rich clinical experience in a wide spectrum of thoracic diseases by reading cases as well as by participating in weekly multidisciplinary conferences.
Fellows are allocated eight weeks of time for training in Cardiac Imaging. Fellows without prior dedicated experience in cardiac imaging are encouraged to use the eight weeks for gaining further expertise in cardiac imaging, particularly nuclear cardiology and MRI. The Division of Cardiac Imaging performs a high volume of cardiac CT and MR examinations, including coronary CTA, cardiac MRI pre-procedural planning CTA studies.
Thoracic Imaging Multi-Disciplinary Clinical Conferences
- Interstitial Lung Disease Rad-Path Conference: A weekly conference presented jointly by the Divisions of Pulmonary Medicine and Critical Care, Rheumatology, Thoracic Radiology and Pulmonary Pathology Services. Interesting interstitial lung disease cases are presented with clinical, radiologic and pathologic correlation.
- Thoracic Surgery Morbidity and Mortality Conference: A weekly conference presented jointly with the Thoracic Surgery Division highlighting the imaging findings and management of post-operative complications following thoracic surgery.
- Lung Cancer Tumor Board: A weekly multi-disciplinary conference presented jointly with the Divisions of Thoracic Surgery, Thoracic Oncology, Radiation Oncology and Pulmonary Pathology with discussions about the diagnosis and management of lung tumors.
- Esophageal Tumor Board: A weekly multi-disciplinary conference presented jointly with the Divisions of Thoracic Surgery, Thoracic and Gastrointestinal Oncology, Radiation Oncology and Pulmonary Pathology with discussions about the diagnosis and management of esophageal and gastric tumors.
- Cytopathology Conference: A monthly 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 and usefulness of thoracic fine needle aspiration and core biopsy.
- Lung Screening Conference: A monthly conference in which challenging screening cases are presented, and management decisions are made regarding nodules and other findings found on lung cancer screening chest CT exams.
- Thoracic Interesting Case Conference: Weekly conference prepared by the thoracic imaging fellow showcasing interesting thoracic CT and MRI cases seen during the week. These cases serve as a resource for didactic teaching of residents and fellows as well as peer review.
- Thoracic Fellow Conference: A series of didactic fellow-level lectures given by thoracic imaging staff on advanced topics in thoracic imaging and intervention.
- Thoracic Journal Club: A hot topic or other article of interest is presented monthly by a thoracic Imaging fellow or senior resident.
- Thoracic and Cardiac Mini-Courses for Residents: Morning and noon didactic lectures focused on thoracic and cardiac imaging. Several expert Grand Rounds speakers are invited as visiting professors. Fellows may join in the conference and also participate in the teaching of residents later in the fellowship year.
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 performed with CT-fluoroscopic guidance, and some procedures 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 to utilize this equipment array and the unique design of the suite to guide treatment efficiently and precisely.
Lung Cancer Screening
The Brigham Health Lung Cancer Screening Program is under the direction of the Division of Thoracic Imaging 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 a 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.
Academic, Vacation, and Conference Time
Fellows are allocated 15 days of vacation time plus approximately one week recess during either Christmas or New Years and 5 days of CME conference time. A fund is provided to help defray meeting costs. All fellows are expected to participate in research and are given one half academic day per week beginning in September 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.
The Division 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 half 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.
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 for mentorship to ensure that educational goals are being met and to adjust the program based on career objectives when appropriate.
Mark Hammer, MD
Rachna Madan, MD
Andetta Hunsaker, MD
How to Apply
Interested candidates can submit an electronic application here.
Applications require the following to be uploaded as pdfs:
- Personal Statement
- Recent Photo (jpeg)
- Three (3) contacts for faculty letters of reference (one letter must be from the Residency Program Director or current supervisor)
- Exam Transcripts
- If applicable, ECFMG Certificate