JACC Vol. 51, No. 3, 2008 January 22, 2008:409–14
Budoff et al. ACCF COCATS 3 Training Statement: Task Force 13
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Task Force 13: Training in Advanced Cardiovascular Imaging (Computed Tomography)
Endorsed by the American Society of Nuclear Cardiology, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, and Society of Cardiovascular Computed Tomography
Matthew J. Budoff, MD, FACC, Chair Stephan Achenbach, MD (Society of Cardiovascular Computed Tomography Representative), Daniel S. Berman, MD, FACC, Zahi A. Fayad, PHD, FACC (Society of Atherosclerosis Imaging and Prevention Representative), Michael Poon, MD, FACC, Allen J. Taylor, MD, FACC, Barry F. Uretsky, MD, FACC (Society for Cardiovascular Angiography and Interventions Representative), Kim Allan Williams, MD, FACC (American Society of Nuclear Cardiology Representative)
Computed tomography (CT) is one of the most rapidly evolving techniques for assessing cardiovascular anatomy. The complex nature of the imaging devices and anatomy and the rapidly advancing uses of these modalities require the trainee to be introduced to this modality. Clinical application of CT encompasses noncontrast (coronary calcium evaluation), contrast (CT angiography and function), and hybrid studies (combining nuclear cardiac scanning with CT). Computed tomography, like invasive catheterization, provides information concerning cardiovascular anatomy and function (i.e., ejection fraction). Hybrid devices are rapidly evolving to incorporate state-of-the-art, high-speed multi-detector computed tomography (MDCT) technology, along with the latest positron emission tomography (PET) and single-photon emission computed tomography (SPECT) detector systems. Current hybrid systems (MDCT plus nuclear) provide attenuation correction for SPECT and PET thereby further improving the diagnostic accuracy of more traditional radionuclide techniques. It should be noted that the guidelines for fellows-in-training outlined here and those for physicians in practice previously published have slightly different targets for time and experience (1). The fellows-in-training are expected to get exposure to CT throughout their training, incorporating the results with echocardiography, nuclear cardiology, cardiovascular magnetic resonance (CMR), and cardiac catheterization when appropriate. Physicians in practice who are rst being exposed to cardiovascular computed tomography (CCT) will most likely not have this comprehensive approach. Guidelines for practicing physicians are published by the American College of Cardiology/American Heart Association Task Force on Clinical Competence in Computed Tomography and Magnetic Resonance (2). Fellowship training in CT should include instruction in the basic aspects, but only those fellows who go beyond the basic level are trained sufciently for independent interpretation of CT studies. Every trainee should be educated in the use of CT and in cardiovascular anatomy, physiology, and pathophysiology, as well as physics of CT and radiation generation and exposure. As many CCT studies are done before and after intravenous administration of iodinated contrast, a thorough understanding of contrast injection methods, adverse events and their treatments, and contrast kinetics in patients will be required. In particular, knowledge is needed in the methods of contrast-enhanced imaging of the pericardium, right ventricle, right atrium, and superior and inferior vena cavae as well as imaging of the left heart, surrounding great vessels, and the central circulation. By the end of the fellowship, trainees should have been exposed to CCT studies, both in interpretation and performance. It is currently recognized that many programs might not have availability of CCT, and options should be made available to obtain training at a different facility if the primary program cannot accommodate. The trainee should master the relation between the results of the CT examination and ndings of other cardiovascular tests, such as catheterization, nuclear cardiology, magnetic resonance, and echocardiography. Every cardiology fellow should be exposed to and be familiar with the technical performance, interpretation, strengths, and limitations of CT and its multiple clinical applications. It is recognized that CT is an evolving technology in a rapid phase of development and improvement, with an expanding list of clinical indications. For appropriate use of this technology, it is possible to dene 3 levels of expertise (Table 1). All cardiology fellows must attain at least the rst level of expertise. This entails under-

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