Duration: Two year fellowship programme. Degree certificate awarded by Homi Bhabha National Institute.

No. of seats: 1

Eligibility: MD/DNB Radiodiagnosis. Post MD/DNB Senior Resident experience is helpful but not a pre-requisite.

Fellowship application process: MCQs followed by Interview. Standard radiology MCQs (100 questions) are asked which can be prepared from any of the radiology MCQ books. Do read some focused oncoimaging articles and RECIST criteria for the exam; I suggest reading articles written by TMH faculty. Applications are out in April/May every year with the course beginning on 1^st of August. Check the website www.tmc.gov.in for the announcement.

Exams: Appraisal at one year and final exam at end of two years. Theory and practicals at each step.

Thesis: Candidate is required to write a thesis or publish an original research article prior to the final exam.

Working hours and night duties: 0930 to 1730 hours (it can stretch a little longer); 3-4 night duties per month and 1 Sunday every 2 months (as of now)

Hostel accommodation: Provided

Diagnostic and intervention exposure: Lots of hands on exposure for both, as described earlier. Intervention exposure will be more focused on biopsies, with at least one month of vascular IR rotation as well.

Academic activities and multi disciplinary meets: Excellent regular academic schedule focused on the residents; 2-3 weekly talks happen (you can checkout their YouTube Channel here). Fellows and residents are also involved in taking the talks along with the faculty. Over 15 multi disciplinary meets (joint clinics/tumor boards) happen every week; the fellow can attend them during the respective DMG (Disease Management Group) rotations (more on that ahead).

Fees and salary: As of now, the fees is Rs 19,000 for the entire 2-year course. Salary is Central Govt pay scale; currently between 80-90k per month.

Leaves: 30 ELs and 10 CLs

Details about the fellowship

I’m sure all of you have read through the “Beyond the shores’ series of blogs on Café Roentgen. And with this one, I’ll be telling you why all is not lost if you can’t or don’t go beyond the shore! I did my 2-year Cancer Imaging Fellowship from Tata Memorial Centre, Mumbai, after completing my DNB Radiodiagnosis from Delhi and I am going to share my experience with you.

I still remember how overwhelmed I was after entering the hospital and being swarmed in a sea of patients and of the most demanding doctors in scrubs! But that’s the strength of this premier oncology institute which caters to all of India and also its neighbouring countries (you will see many patients from Bangladesh and Nepal, and even from the middle East and Africa over here). This means that you will be exposed to large numbers and a wide variety of cases during the fellowship.

During my fellowship, the fellow was rotated across different modalities including USG, X-ray and special investigations, Mammography, CT, MRI and intervention on a rotation basis every month. Now however, the fellow is rotated DMG wise (more on DMGs ahead). This means that the fellow works and reports only CTs and MRIs of GI cancers one month, head and neck cancers, the next month, brain tumors the third month etc, which I believe is much more conducive to subspecialized learning. I’d like to especially mention about the biopsy rotation in which you get to do multiple USG and CT guided biopsies and FNAs (about 12-15 USG and CT guided biopsies each and 20-25 FNAs happen everyday)! You get rotated in ultrasound, interventional radiology and mammography as well. I would recommend postings in the same even for those who don’t like intervention as they become your USP when you move on to practicing in a different hospital/center. The IR colleagues and consultants are always there in case of difficult cases and complications.

I’ll share some of the salient features about the fellowship and the work experience.

1. TMH has around 10 disease management groups dealing with specific organs or systems such as the GI DMG, Head and neck DMG, and Breast DMG. Each DMG conducts joint clinics (multidisciplinary meetings) for difficult or unusual cases, happening twice or thrice every week. As a fellow you will certainly attend these joint clinics during your DMGwise rotation. You get to experience patient management first hand with the medical, surgical and radiation oncologists and pathologist on the team, and get to understand what they expect from the radiology report (which is something you cannot read and learn from chapters or articles).

2. Since the consultants in the department report DMG-wise, you get to learn the nuances of reporting various cancers. You will get to observe in cases nearly every imaging characteristic that defines the staging in various cancers and more; along with their impact on patient management. All patient data is available on the EMR (electronic medical records) in the hospital giving you an opportunity to corroborate your findings with the patient condition, operative notes, histopathology and lab and other data – in effect you get a follow up on every radiology report, which is the best possible way to learn.

3. There are 17 annual MD candidates in the department whom you work with and tutor; so you learn while teaching and remain in touch with general aspects of radiology as well. Most of your learning for the exam will happen as you read for interesting cases every day, attend seminars and take lectures for junior residents during the departments regular teaching schedule.

4. You will have the authority to finalize and sign off reports. You will be expected to report around 15 scans daily (that’s not as easy as it sounds though, as cases are complex and have multiple priors to compare with). However, the residents will create a prelim report for you, which you have to check, edit, and finalize, and things do get easier as you gain experience. Most cancers have dedicated reporting formats to use, which is a huge advantage. And of course, the faculty is always available for asking doubts and clarifications.

5. You will be assigned a guide who will help you with your thesis as well as decide your curriculum and be the internal examiner for fellowship exams. You can work on on-going research projects as well as your own projects (as part of thesis or even in addition to it) under the guidance of the faculty who are ever encouraging and helpful.

6. You will get a chance to attend many conferences both in house and in other hospitals and with the number and variety of cases available you get to present many posters and oral presentations. You could successfully go for a funded international conference like RSNA or ECR as well if you have something (poster or oral presentation) accepted for the conference.

7. The fellowship curriculum has a provision for going to another cancer centre on observership as well; for instance, I had the opportunity to attend in the department of body imaging at MD Anderson Cancer Centre, USA, America’s top cancer institute. This was a great learning experience and a fruitful interaction in terms of research since I wrote a paper with one of the senior radiologists there. On that note, I’d also like to add the TMH has collaborations with many hospitals and centres abroad and those of you looking to move can certainly benefit from this fellowship in terms of publications and recognition.

Two years in Cancer Imaging may seem like a long time but it certainly adds a lot of value to the rest of your 35-40 year career in radiology; especially with the current trends in oncology both in India and abroad.

Last but not the least, a few cons of the fellowship. The first one being the most obvious; it is an Indian fellowship, and would be slightly less valued in comparison to fellowships from the US or UK. Also, one gets to see routine general radiology cases infrequently; for instance you may feel out of touch once you finish the course with day-to-day musculoskeletal or neuro- radiology or obstetric ultrasound. You may need few months to brush up on the subspecialities of general radiology if you join such a set up. But I would say that someone who can report a complex head and neck cancer, describe an HCC using LIRADS lexicon, report a breast MRI, and differentiate between radiation necrosis and recurrent glioma can certainly report a stroke or appendicitis or pancreatitis! And finally, as I already mentioned earlier, you do find it a bit overwhelming in the beginning, as you have to get used to EMR, PACS, detailed reporting formats, and the concept of DMGs and joint clinics.

If you do decide to go ahead and do this fellowship; I’d like to say that at the end of your fellowship at TMH, you will become a skilled sailor at the sea, with patients, colleagues, seniors and of course books all helping you chart your own course! All the best and feel free to contact me via the Café anytime you need further advice!

– Ashita Rastogi, DNB Radiology , Cancer Imaging Fellow (TMH)

Dr Ashita worked as faculty at Tata Memorial after her fellowship before moving to Delhi State Cancer Hospital, and is now settled in Dubai.