Fellowship Experience – Perth, Australia

Dr Lucy Childs is a UK radiology trainee who has been out in Perth, Australia doing her neuroradiology fellowship. She has very kindly shared her experiences and advice on the fellowship with us below:

NIISWA is the Neurological Imaging and Intervention Service of Western Australia.

There is a link here to information about the fellowship: http://niiswa.com/index.php/fellowships.html

There are 3 diagnostic fellows and 1 neuro intervention fellow each year. The fellowship is typically one year long, but can be extended to 2 years, particularly for the interventional fellows.

It’s a tertiary Neuroimaging specialist centre with advanced neuroimaging techniques including CT and MR perfusion, spectroscopy, functional MR imaging etc. NIISWA runs a 24 hour mechanical thrombectomy service for acute strokes, as well as the usual gamut of neurointervention (aneurysms/ AVM management/ stents etc.)

As a fellow you work across two hospital sites: Sir Charles Gairdner Hospital (SCGH) and the Royal Perth Hospital (RPH). These are both public hospitals (like NHS). SCGH is the regional neuro-oncology centre with a large neurosurgical department. The state trauma unit is sited at RPH.

There are two MRI scanners at SCGH one 1.5 and one 3T, (same at RPH). The MRI scanners work almost exclusively performing neuroimaging. The MRI and CT radiographers are excellent, very experienced and tailor scans to the specific clinical requirements, working closely with the neuroradiology team. The MRI scanners work from 0800-1700 for inpatient scanning and 0615-2200 for outpatient scanning with additional out-of-hours oncall service.

The job is busy, there is a large exposure to pathology with a high volume of abnormal scans. Very few ‘normal’ scans are performed by NIISWA. At SCGH CT imaging is reported by general radiologists with referral to NIISWA only when specialist input is required. At this site imaging is predominantly MRI based. All modalities are reported by NIISWA at RPH.

As a diagnostic fellow you are expected to perform fluoroscopically guided lumbar punctures, fluoroscopic and CT guided facet joint injections, fluoroscopically-guided nerve root sleeve injections, fluoroscopically-guided epidural injections and spinal markings prior to surgery. If you are not interested in or not comfortable with performing procedures most days of the week (usually at least 1-2/day) then this fellowship might not be the one for you, as this is entirely expected.

There is the opportunity to do head and neck reporting. H&N reporting is nearly all cross-sectional, with almost no ultrasound imaging as this is performed by sonographers at NIISWA, although you are still part of the FNA service.

As a fellow you actively participate in journal club meetings, CME lectures and MDT presentations. Teaching is generally case based and there is excellent senior consultant supervision at all times.

The pay is excellent. Typically equates to £125,000/ year ($200,000 AUD) when on call payments are included (these are variable). The on call is 1 week in every 4 and you are essentially on call from home 5pm-8am and working your normal hours the rest of the week. Annual leave is unfortunately very low in your first year at only 20 days/year. There are no zero days before or after on calls either.

Western Australia is an enormous geographical area with its own unique challenges. It’s not uncommon for ‘flying doctors’ to bring patients from many hundreds of kilometres away from small remote Australian communities. In combination with socio-economic problems, this leads to cases more often seen in developing countries – indeed it is the only place where I have encountered cases of leprosy.

Overall, this is a very educational fellowship with an excellent supportive neuroimaging team. The downsides would include the lack of time off (to explore the area). Perth also feels like a very ‘new’ city which is currently short on culture and multiculturalism, but is making progressive attempts to improve this. There are also incredible beaches which do go some way in offsetting the lack of art establishments!

Our thanks to Lucy for sharing such detailed information about the fellowship – if you are currently undertaking a neuroradiology fellowship in the UK or abroad, please do get in touch and tell us what you think about it!