FELLOWSHIP TRAINING PROGRAMME

Welcome to NUH - Department of Diagnostic Imaging Fellowship Programme

NUH is a 1200 bed tertiary academic hospital and major referral centre for a comprehensive range of medical and surgical specialties in SE Asia. NUH is at the forefront of cutting edge medicine, delivering services such as organ transplantation, paediatric cardiac surgery, oncology, various cardiovascular and neurological therapies (surgical, medical and neurointerventional).

It also harbors sub specialized paediatric and obstetrics-gynaecology departments under the same roof. It is one of the three comprehensive stroke centers in Singapore with one of the leading acute ischemic stroke thrombolysis and thrombectomy programmes in this part of the world.

Sited within the National University of Singapore (NUS) campus, it is the primary teaching hospital for the NUS school of Medicine. NUS has consistently been among the top universities in the world. For the last 3 years, NUS has consistently been the number 1 university in Asia as per Times Higher Education University Rankings. The QS World University Rankings has also ranked NUS as number 2 in Asia for 2018 (15th rank in the whole world).

The Department of Diagnostic Imaging (DDI) provides high quality imaging and therapeutic (interventional and nuclear medicine) services to the comprehensive range of clinical specialties at NUHS. On an average, each year we perform around 360,000 studies which includes > 5500 interventional radiological procedures (including around 200 therapeutic neurointerventions); 2500 PET CT studies; over 7000 other nuclear imaging studies (including cardiac studies); more than 25000 MRI and over 45000 CT studies; >28000 ultrasound examinations and >10000 mammograms.

Our faculty includes 45 full time radiologists in pursuit of clinical, research and educational excellence. Our team also constitutes internationally acclaimed radiologists such as Prof Joseph Lee, Prof Vincent Chong and Dr David Townsend (Nobel Laureate).

Our Department is equipped with a vast array of advanced machinery viz, 3 angiography suites ( 1 biplane DSA machine, 1 hybrid CT-Angio suite, 1 single plane DSA unit); 7 MRI scanners ( 2 of them are 3T and 5 of them 1.5 T), one PET-CT, one SPECT –CT, two gamma-cameras, five CT machines (two Dual energy CT, two 256 slice machines and one 64 slice scanner), 3 mammography units (one machine is tomosynthesis and two are contrast enhanced mammography enabled) and several ultrasound machines. We also have PET-MRI machine for research purposes placed within university campus.

NUH-DDI offers fellowship programmes in following areas:

1. Body Imaging
2. Breast Imaging
3. General Radiology
4. Interventional Radiology
5. Advanced Interventional Radiology in Neurointervention
6. Musculoskeletal Imaging
7. Neuroradiology
8. Nuclear Medicine
9. Paediatric Radiology

All Radiology fellowships involve 6/12 months of rigorous training with multimodality exposure to your subspecialty area of interest. Beyond clinical duties, fellows are involved in resident and medical student teaching, multidisciplinary rounds and research projects. Fellowships are designed to prepare individuals for an academic career or practice within a subspecialised private group.

Fellows are expected to read various imaging studies, protocol and supervise or perform procedures under supervision. There is an expectation that weekend work may occur. In this case, the fellow will be compensated with off in lieu time during the week. On call work may also be required, depending on the subspeciality fellowship programme one chooses.

Our department attracts enthusiastic collegial trainees interested in expanding their subspecialty knowledge through evidence-based medicine. The Fellowship training program intake will take place twice a year, January and July. Please submit your application 6-12 months early before your preferred attachment date.

 

Eligibility

To be eligible, applicants must:

1. Have a post-graduate medical degree from a recognised institution in their country of study.
2. Have a full radiology qualification (local equivalent of FRCR, FRANZCR, FRCPC or American Board of Radiology), from the appropriate accreditation body in their country.
3. Have at least 5 years of experience working in a radiology department.
4. Be proficient in English. English proficiency exams like TOEFL and IEPLT are a pre-requisite for registration with the Singapore Medical Council if the applicant’s medical education was not conducted in English (please refer to the Singapore Medical Council website http://www.healthprofessionals.gov.sg/smc for further details).
5. For more information on the eligibility of the fellowship, please click here.

 

Body Imaging Fellowship

Body Imaging Fellowship offers in-depth training in cardiac, chest, abdominal and pelvic radiology. One of the fortes of our body imaging fellowship programmes is the scope of learning transplant related imaging (for eg for liver donor liver transplantation) as well as advanced cardiac imaging (including cardiac MRI) that is performed is good numbers at our institution. We also perform several other advanced body imaging studies such as multiphasic MRI for the liver and prostate, MRI and CT enteroclysis, CT colonography, CT for chronic and acute pulmonary thromboembolic disease

 

Breast Imaging Fellowship

Apart from training in the interpretation of imaging studies and interventional procedures, the Breast Imaging Fellowship also places emphasis on the development of multidisciplinary breast practice and a good understanding of the current status of breast diagnosis and management. This includes comprehensive breast imaging, breast cancer genetics, breast cancer surgery, breast pathology and breast cancer oncology. Our fellows can expect to achieve proficiency in advanced breast imaging such as MRI breast, breast tomosynthesis and contrast enhanced mammography at the completion of their fellowship.

 

General Radiology Fellowship

The General Radiology Fellowship provides and overall exposure to various aspects of radiology. It includes training in the interpretation & reporting of plain films in both routine & emergency settings, IVU, fluoroscopy, general ultrasound, CT and MRI. A reasonably good exposure to cross sectional imaging will be available to the trainees undergoing this programme.

 

Interventional Radiology

The comprehensive interventional radiology services at NUH is a perfect training ground for anyone with passion of obtaining proficiency in this exciting field of therapeutic radiology. We have a very strong hepatobiliary interventional service that includes Y90 radio-embolisation therapy for liver tumors, TIPS, Transjugular liver biopsy and liver transplant related interventions. We provide a 24/7 endovascular treatment in acute ischaemic stroke service and over100 stroke thrombectomies a year. A variety of other complex neurointerventional treatments such as flow diversion, AVM and AVM embolization, intra-arterial chemosurgery for retinoblastomas are performed regularly at our department.

We organise workshops on stroke and aneurysm treatment from time to time and fellows are encouraged to attend the same. In the field of interventional oncology, besides biopsy of most regions in the body we also perform thermal ablation therapies for different organ system. We work in close collaboration with our vascular surgeons for aortic interventions. Besides the aforesaid niche areas we are high volume centre for routine IR procedures such and embolization for bleeders and tumors, biliary drainage and stenting, nephrostomy insertion and ureteric stenting, dialysis access related interventions, peripheral vascular interventions, biopsies and drainages.

 

Advanced Interventional Radiology in Neurointervention

National University Hospital as a world-renowned academic healthcare center of excellence also harbors a world -class Neurointerventional service. We perform around 400 therapeutic Neurointerventions each year, besides several more diagnostic neurointerventional procedures. The general scope of services includes treatment of cerebral aneurysms (coiling, flow diversion, intrasaccular flow disruption), cerebral and spinal AVM and AVF embolisations (including reconstructive therapies for DAVF), acute stroke thrombectomy, endovascular management of intra and extracranial atherosclerotic disease, IAC for pediatric retinoblastomas, pre-operative embolisation for head and neck as well as spinal tumors, embolisation for head and neck bleeders and percutaneous treatments for vascular malformation as well as spinal pain therapies. Neurointervention in NUH is helmed by a highly experienced team of three senior consultants viz A/Prof (Adj) Anil Gopinathan, Dr Yang Cunli and Dr Leonard Yeo. Besides the high volume of clinical work, we are also active in clinical research and international clinical trials. In the last five years, more than 100 research papers have come from our team besides a large number of invited lectures and scientific papery presented by our faculty members.

 

Objective of the programme

Primary goal is to provide the trainee with a broad knowledge base, procedural skills and clinical judgement required to function as a safe and effective neurointerventionist.

 

Entry Requirement

(i) Completed one year of interventional radiology fellowship or equivalent (as deemed adequate by the selection committee to ascertain the applicant’s basic angiographic skills) OR 
(ii) For primary applicants for the advanced fellowship: They should produce evidence of residency training (or equivalent) in radiology, neurology or neurosurgery. They should demonstrate understanding of the principles of management of ischemic stroke, intracranial aneurysms and vascular malformation, reasonably capable of interpreting cerebral angiography and neuroimaging and should have performed at least 50 diagnostic cerebral angiographies under supervision. 

 

Components of Training (Clinical and/or non-clinical) Programme (E.g. ward rounds, outpatient clinics, research, etc) & its frequency

1. Hands on training under direct supervision of a credentialed neurointerventionist.
2. Daily Case discussions
3. Participation in on-call neurointerventional cases.
4. Interventional Neuroradiology outpatient clinics
5. Multidisciplinary rounds that the Fellow will be exposed to will include, but not limited to:

1. Vascular –Radiology multidisciplinary meeting (Monday 8 to 9am)
2. Vascular malformation round (7.30 to 9am; last Tuesday of every month)
3. Neurology and Neurostroke round (Every Wednesday 1 to 2 pm)
4. Neurosurgery Round (Every Thursday 7.30 to 11 am)
5. ENT –Radiology multidisciplinary meeting (Wed 8 to 9am)
6. Nationwide neurointerventional educational seminars and meetings. 

 

Methods of training delivery

Although the primary focus would on endovascular training, the fellow will also be allowed exposure to modalities like fluoroscopy, ultrasound, CT & MRI and neurosonography.  Trainees will participate in a broad spectrum of neurointerventional therapies as listed below (but not limited to) 

1. Management of intracranial aneurysms 
2. Endovascular treatment for Acute Ischemic stroke 
3. Carotid angioplasty and stenting 
4. IR management for intracranial and spine AVMs and AVFs 
5. Angioplasty and stenting for intracranial atherosclerotic disease 
6. Pre-operative embolization for head and neck, spinal and intracranial tumours 
7. Percutaneous nerve blocks and neurolysis/ ablation 
8. Endovascular treatment for chronic subdural hematomas 
9. Intra-arterial chemosurgery for retinoblastoma 
10. Percutaneous sclerotherapy and embolization for head and neck vascular malformations 

 

Musculoskeletal Imaging Fellowship

The MSK Imaging Fellowship includes training in interpretation of CT and MRI, as well as performing arthrography and certain minor interventional procedures. There is significant exposure to MSK ultrasound.Close cooperation exists between the MSK Section, the Department of Orthopaedic Surgery and the Department of Hand & Reconstructive Microsurgery. Sports medicine and joint imaging constitutes a substantial volume of our musculoskeletal imaging work. The Department of Orthopaedic Surgery also conducts a comprehensive clinical course with a strong radiological component. Fellows are welcome to participate in such teaching sessions.

 

Neuroradiology Fellowship

Neuroradiology Fellowship includes clinical experience and instruction in MRI (including functional imaging), CT and CT/MR angiography and perfusion studies as they are applied to brain, head & neck and specialized spine imaging.Close cooperation exists between the Neuroradiology Section and departments of Neurology, Neurosurgery, ENT surgery and Ophthalmology. Each of these departments holds a regular conference with the Neuroradiology section.

 

Nuclear Medicine Fellowship

The Nuclear Medicine fellowship at the Department of Diagnostic Imaging NUHS is between 6 to 12 months. The Nuclear Medicine Division provides a broad spectrum of exposure i.e. general nuclear medicine, nuclear cardiology, therapeutic nuclear medicine and PET/CT metabolic imaging to the fellow. These four subspecialties allow for a wide variety of cases, as well as close interaction with clinicians to discuss management and treatment plans.

At the end of the nuclear medicine rotation, the fellow will develop skills in the safe administration of unsealed radioactive substances to the patients, practical supervision of patient scanning procedures, data manipulation and image processing. The Nuclear Medicine Division contributes to the National Physics curriculum and the postgraduate training of Diagnostic Radiology and Nuclear Medicine residents.

 

Paediatric Radiology

The fellow will spend most of his or her time in one of the Diagnostic Imaging sections. The remaining time is to be used for reading, self-study and project work. Apart from training in the interpretation of Imaging studies (X-rays, Ultrasound, CT, MRI and Nuclear Medicine), Interventional and Fluoroscopic procedures, the Diagnostic Imaging Fellowship also places emphasis on the development of multidisciplinary Imaging practice and a good understanding of the current status of diagnosis and management. The training shall include and not limited to Diagnostic Imaging subspecialities such as Body Imaging, Neuro Imaging, Intervention, Musculoskeletal, Cardiac, Pediatric, Breast and Nuclear Medicine. The Fellow may spend more time in one of these subspecialities, depending on his interest, training and department requirements.

Close cooperation exists between the Diagnostic Imaging department and, but not limited to, the Departments of Surgery, Medicine, Cardiology, Oncology, Neurology, Pediatrics and Orthopedics. Fellows are expected to attend the various multidisciplinary and clinico-radiological meetings.

 

Educational Objectives

At the end of the training the fellows should be able to:

1. Practise independently and safely
2. Develop appropriate protocols and techniques for their practice
3. Advise medical colleagues on the appropriate use of imaging studies or procedures
4. Train medical students, residents and clinicians
5. Interact appropriately with referring clinicians, patients and family

 

Responsibilities of Fellows

During their training, fellows are expected to:

1. Report examinations or perform procedures carried out in their section
2. Attend relevant radiological and clinical conferences and rounds
3. Contribute to research projects conducted in his/her section
4. Contribute to organization of teaching materials
5. To participate in all training activities of the department. In addition to daily rostered work, you could be called upon to perform after hours or weekend on call duty. You would be compensated with off in lieu time during the weekdays.

 

Sponsorship

There will be no financial commitment by the hospital or the department. Fellows must be sponsored by either the government, regional health authority or an appropriate institution in their home country to undergo the fellowship training in Singapore. This requirement for formal sponsorship can be found in Singapore Medical Council's website.

 

More Information and Guidelines

Please click here to go to Singapore Medical Council's website.

Application

Please download the fellowship application form here.

 

Application and information:

Please submit all your CV with your recent photo, application form and related supported documents 6 - 12 months before your preferred attachment date.

 

Contact Information

Email: ddifellows@nuhs.edu.sg

Updated by NUHS Department of Diagnostic Imaging postgraduate training committee (2021).