Cardiology fellows may find their cardiovascular MR training inadequate compared with nuclear and vascular imaging, according to a study conducted by the American College of Cardiology Foundation. The lack of CMR equipment and/or curricula concerns the ACCF because recently revised training guidelines require a minimum exposure to the modality.
A survey developed by the cardiovascular imaging committee of the ACCF was sent to the program directors of all 183 accredited cardiovascular training programs. The 21-question, multiple-response survey collected parallel data for both CMR and vascular imaging. Nuclear cardiology capabilities were also queried to provide a reference for comparison (JACC 2004; 43[11]: 2108-2112).
Conducted between November 2002 and January 2003, the survey garnered a 52% response rate. It revealed that only 12 respondents out of 96 owned CMR hardware, compared with 46 for nuclear and 42 for vascular.
"Ownership of CMR hardware is a major infrastructural hurdle for training programs," wrote lead author Dr. Allen J. Taylor, program director of cardiovascular medicine at Walter Reed Army Medical Center in Washington, DC.
Taylor and his colleagues encouraged programs to take full advantage of local and regional centers to broaden the training opportunities. Collaborative relationships between clinical departments such as radiology and cardiology will be crucial to the success of these efforts, they wrote.
Nearly 100% of respondents indicated that they have dedicated fellow rotations in nuclear imaging, compared with 64% in vascular and 29% in CMR. Nearly half the CMR programs have no formal curriculum, defined as written, content-based, and periodically recurring. Additionally, the breadth of training opportunities in centers with CMR is typically very limited.
Overall, the program directors rated the importance of incorporating new technologies within their programs as high, but nuclear and vascular imaging were rated significantly higher (5.7 and 5.2, respectively) than CMR (4.9) on a scale of 1 (not important at all) to 7 (extremely important).
Faculty with expertise and dedicated training time for CMR came from cardiology at only 18% of programs and from radiology at a mere 6%. At 19% of programs, both disciplines supplied dedicated CMR faculty.
The core cardiovascular training symposium (COCATS-2) was revised in April 2002 to include, among other changes, a one-month minimum exposure to CMR by cardiovascular fellows. The guidelines recommend that fellows actively participate in CMR study interpretation and didactic courses.
"Maturation of CMR methodologies and greater penetrance and acceptance of the techniques into clinical practice are essential steppingstones to success," according to the study.
For more information from the Diagnostic Imaging archives:
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