Southampton

Multimodality Cardiac Imaging Fellowship – Wessex Cardiothoracic Centre, Southampton General Hospital

Supervisors: Dr Dhrubo Rakhit (Dhrubo.Rakhit@uhs.nhs.uk) & Dr Benoy Shah (Benoy.Shah@uhs.nhs.uk)

Current Fellow: Dr James Stirrup (james.stirrup@uhs.nhs.uk)

overview

Wessex CTC is a large surgical centre covering a population of approximately 2.8 million in South England and is a tertiary referral centre for heart failure, EP, interventional cardiology, cardiac imaging, paediatric cardiology and adult congenital heart disease. There is one clinical fellowship in multi-modality cardiac imaging, which commences in January of each year. The fellow works under the supervision of Dr Dhrubo Rakhit and Dr Benoy Shah, the sub-specialist consultants in echocardiography.

Fellows will obtain expertise in all aspects of adult echocardiography including 3-D imaging, stress echocardiography (exercise and dobutamine stress) and trans-oesophageal echocardiography. There is an excellent case mix and procedural numbers – a fellow can expect to perform in excess of 250 stress studies and 250 TOEs during the year. In addition, the Imaging Fellow is a member of the TAVI team, attending the weekly TAVI MDT meeting and assisting with peri-procedural TOE. There is also a weekly stress CMR list (dedicated slot for the Imaging Fellow) with 1-on1 training provided by the cardiothoracic radiologists. The Fellow can expect to report at least 100 CMR studies during the year. Attendance at cardiac CT lists can also be negotiated, pending training requirements.

The post does include some commitment to the general Cardiology SpR on-call rota, but there is no requirement for general medical on call and only a minimal clinic requirement.

Further Details

How to get it

The Fellowship in Southampton is obtained after an open interview with the position being advertised on a national level (NHS Jobs website) in the second half of each year. Informal contact with the supervising consultants prior to interview and for further information is both welcomes and encouraged.

Weekly timetable

There are two stress echo lists and two TOE lists a week that the Fellow usually performs, sometimes this may be three lists. There is also a weekly CMR list, as well as the weekly lunchtime echo meeting and weekly Cardiovascular Grand Round. Non-timetabled sessions are frequently filled by urgent or impromptu in-patient referrals (TOE / stress echo) providing further experience for the Fellow.

Case mix

TOE – Plenty of experience in advanced assessment of valve disease, including 3D acquisitions and post-processing of the mitral valve and aortic valve in potential TAVI candidates. A lot of exposure to all other reasons for TOE imaging, ranging from atrial appendage assessment through to evaluation of cardio-embolic stroke.

SE – Exercise is the preferred stress modality and the Fellow will be trained in both exercise and dobutamine stress techniques, including stress echo for aortic and mitral valve assessments.

CMR –Plenty of exposure to stress CMR for viability and ischaemia assessment, as well as structural assessment (e.g. cardiomyopathies) and others (e.g. cardiac masses, aortic assessment, congenital cases).

On-call commitment

The post comes with a general cardiology on-call commitment. The Fellow contributes to the Cardiology SpR general on-call rota on roughly a 1:12 basis. The level of commitment may change slightly on a yearly basis dependent on the number of cardiology SpRs and fellows.

Past Fellows

2014 – Dr Benoy Shah – now Consultant Cardiologist, University Hospital Southampton
2013 – Dr Kris Lyons – now Consultant Cardiologist, Northern Ireland
2012 – Dr Lindsay Smith – now Locum ACHD Consultant, University Hospital Southampton
2011 – Dr Michaela Scheurmann-Freestone – now Consultant Cardiologist, Basingstoke

Testimonials

Dr Benoy Shah (2014)

“This is a superb year for those looking to undertake comprehensive training in advanced echocardiography coupled with very useful and superbly taught cardiac MRI. I performed over 250 TOEs and nearly 300 stress echos in one year, as well as assisting in the regular TAVI procedures. The echo department, which the Fellow helps to support, is very friendly and has very high-spec machines. There is also a Heartworks simulator for TTE and TOE learning. There are precious few Imaging Fellowships in the UK with a predominant focus on advanced echocardiography, so this Fellowship offers a unique and valuable opportunity for Imaging trainees. Very highly recommended!”

Dr Kris Lyons (2013)

“The cardiac imaging fellowship at Southampton runs annually from Jan 1st and is usually advertised around September, with the fellow being appointed following interview. This is an excellent multimodality imaging fellowship with fixed weekly responsibilities including stress echo lists and TOE lists. Patient mix is varied with dobutamine/exercise echo for assessment of ischaemic heart disease as well as valvular heart disease. There is ample opportunity to develop skills in advanced techniques such as 3D echo and intraoperative TOE.  Initially supervision is provided at an appropriate level for the fellow, however eventually lists will be performed unsupervised. There is a large, dynamic echo department with 4 rooms running full time and the fellow will be expected to provide opinions and give advice to the team of physiologists. The lead clinical physiologists are extremely supportive and it is worth while taking time to get to know them.

Southampton has a very large Cardiac MRI service with a full time Siemens 1.5T scanner within the cardiology department.  There are 4 cardiac radiologists who supervise the structural and stress CMR lists.

There is also a huge congenital heart disease service with options to attend additional dedicated CMR lists and TTE lists. Cardiac CT is available, again supervised by the cardiac radiologists.  There is a TAVI programme with opportunity to perform intra-procedural TOE and attend the weekly TAVI MDT where cases are discussed in detail by subspecialty experts.

There are some clinical responsibilities with the post.  Two fellows share a single slot on the cardiology registrar rota. The rota is full shift with a week of nights and a week covering CCU.  This is a busy job with excellent clinical experience and a wealth of opportunity to develop skills in advanced echo, cardiac MRI and cardiac CT. Previous experience in these areas would certainly be an advantage and proficiency in echo would be a prerequisite. Dr Rakhit is an excellent supervisor and is always available for clinical and non-clinical advice. He is very supportive with regard to flexibility in the weekly schedule.  I was able to obtain BSE accreditation in TOE, as well as SCMR accreditation in CMR and BSCI accreditation in cardiac CT during my time there.”

Dr Michaela Scheurmann-Freestone (2011)

I can highly recommend the fellowship particularly for multimodality cardiac imaging – rather than just go for one modality, there is the opportunity to improve in several – I did stress echo, 3D TOE, cardiac MRI and cardiac CT – which was excellent! The post also prepares you for your duties as an imaging consultant – there is ample opportunity to stand in if the consultants are not around – provided of course that your training is advanced enough.”