Cardiology needs radiology’s equipment to train MR fellows

Cardiology fellows may find their cardiovascular MR training inadequate compared with nuclear and vascular imaging, according to a study 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 program directors of all 183 accredited cardiovascular training programs. The 21-question, multiple-response survey collected parallel data for both CMR and vascular imaging. Queries about nuclear cardiology capabilities provided a reference for comparison (JACC 2004; 43[11]: 2108-12).

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," said lead author Dr. Allen J. Taylor, program director of cardiovascular medicine at Walter Reed Army Medical Center in Washington, DC, and colleagues.

They 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, according to the authors.

Nearly 100% of respondents indicated they have dedicated fellow rotations in nuclear imaging, compared with 64% in vascular and 29% in CMR. Nearly half of the CMR programs have no formal curriculum, defined as written, content-based, and periodically recurring. 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 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 having 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.

In April 2002, the core cardiovascular training symposium (COCATS-2) was revised to include, among other changes, a one-month minimum exposure by cardiovascular fellows to CMR. 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 stepping-stones to success," the study said.

For more information from the Diagnostic Imaging archives:

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MR and echocardiography race for cardiac supremacy

Multisequence stress CMR shows promise