ADVANCED CARDIOVASCULAR IMAGING. Medical Knowledge. Goals and Objectives PF EF MF LF Aspirational

Transcription

1 Medical Knowledge Goals and Objectives PF EF MF LF Aspirational Know the basic principles of magnetic resonance imaging (MRI) including the role of the magnetic fields and gradient coil systems, generation of the magnetic resonance signal, signal contrast and image formation, and the role of contrast agents Know patient safety protocols relating to MRI including performing cardiac MRI in patients with a cardiac pacemaker or ICD. Know how cardiac MRI may be used to evaluate coronary artery disease including imaging of myocardial infarction, detecting and quantifying myocardial ischemia and assessment of myocardial viability Know the principles of stress perfusion MRI, including protocols involving the use of adenosine and dobutamine as stress agents Know the cardiac MRI features of myocarditis

2 Medical Knowledge Goals and Objectives PF EF MF LF Aspirational Know the cardiac MRI features of various cardiomyopathies including hypertrophic cardiomyopathy, cardiac amyloidosis, cardiac sarcoidosis, arrhythmogenic right ventricular cardiomyopathy and idiopathic dilated cardiomyopathy Know the methodology for cardiac MRI assessment of cardiac chamber volumes and wall thickness Know the methodology for cardiac evaluation of right and left ventricular systolic and diastolic function Know the cardiac MRI features of pericardial disease including pericardial effusion, constrictive pericarditis, pericardial encasement/invasion by tumor and pericardial cysts Know the cardiovascular MRI features of nonoperated adult congenital heart disease including PFO, atrial and ventricular septal defects, anomalous pulmonary venous connections and anomalies of the superior vena cava

3 Medical Knowledge Goals and Objectives PF EF MF LF Aspirational Know cardiovascular MRI features of operated congenital heart disease Know the MRI features of coarctation of the aorta Know the cardiac MRI features of anomalous coronary arteries Know the cardiac features of stenosis and regurgitation of the cardiac valves Know the MRI features of intra-cardiac thrombi and masses Know the cardiovascular MRI features of aortic dissection and aneurysm of the aorta Know the principles of magnetic imaging spectroscopy including potential clinical applications Know the principles of cardiac MRI at 3 Tesla and molecular cardiac MRI

4 Medical Knowledge Goals and Objectives PF EF MF LF Aspirational Know the appropriate use criteria for cardiac MRI in the detection of asymptomatic coronary artery disease, evaluation of chronic chest pain syndromes, evaluation of intracardiac structures, evaluation of acute chest pain, risk assessment using stress MRI, risk assessment in evaluation of patients undergoing non-cardiac surgery, evaluation of coronary artery disease postrevascularization, evaluation of cardiac function, evaluation of extra-cardiac structures and evaluation for scar/viability Know the technical aspects of cardiac computed tomography (CT) including scan modes, preparation of the patient and scan sequence Know the quantity of radiation exposure during cardiac CT and know strategies to limit radiation exposure

5 Medical Knowledge Goals and Objectives PF EF MF LF Aspirational Know the effects of CT radiographic contrast on renal function and the risk of contrast-induced acute kidney injury Know the clinical features of iodinated contrast allergy and recommended methods of medical therapy and prophylaxis Know cardiac CT anatomy including cardiac CT anatomy after computer reconstruction Know the physiologic and pathologic basis for cardiac calcium scanning Know how coronary calcium scores relate to the presence and extent of coronary atherosclerosis/arteriosclerosis in different populations Know the prognostic value of coronary calcium scoring in different populations

6 Medical Knowledge Goals and Objectives PF EF MF LF Aspirational Know the radiographic features of coronary CT angiography, including those of calcified and non-calcified plaque Know the cardiac CT radiographic manifestations of coronary anomalies Know how CT angiography may be used to assess coronary arteries following percutaneous coronary interventions Know the cardiac CT radiographic manifestations of ventricular and valvular morphology and function Know the cardiac CT radiographic manifestations of acute aortic disease, aortic aneurysm and pulmonary embolism

7 Medical Knowledge Goals and Objectives PF EF MF LF Aspirational Know the appropriate use criteria for cardiac CT including in symptomatic patients without heart disease (including those with acute symptoms suspicious for acute coronary syndromes, non-acute symptoms possibly representing an ischemic equivalent and non-acute chest pain suspicious for coronary artery disease), for risk assessment in asymptomatic patients without known heart disease, for detection of coronary artery disease in other situations (new onset heart failure, non-diagnostic stress testing, elevated troponin of uncertain significance, in patients with a positive stress test (symptomatic and asymptomatic), in patients undergoing noncardiac surgery (risk stratification), for risk assessment following myocardial revascularization, for evaluation of adult congenital heart disease, for evaluation of ventricular morphology and function and for evaluation of intra-and extra-cardiac masses

8 Patient Care Goals and Objective PF EF MF LF Aspirational Be able to: Describe and implement MRI protocols for assessment of coronary artery disease (including stress protocols), cardiomyopathies, assessment of cardiac structure and function, assessment of valvular heart disease, evaluation of pericardial disease, evaluation of adult congenital heart disease, evaluation of aortic disease and coronary angiography Describe and implement patient safety protocols for cardiovascular MRI Employ contrast agents in the diagnosis of cardiovascular disease using cardiovascular MRI Accurately interpret cardiac MRI images of acute and remote myocardial infarction Perform stress MRI and accurately interpret stress MRI images Employ Bayesian analysis in risk stratification using stress cardiac MRI

9 Patient Care Goals and Objectives PF EF MF LF Aspirational Recognize cardiac MRI images obtained in the assessment of myocardial viability and differentiate between viable and nonviable myocardium Recognize cardiac MRI images of patients with selected cardiomyopathies Recognize cardiac MRI images of patients with myocarditis Measure/quantify left ventricular and right ventricular systolic and diastolic function using cardiac MRI Recognize cardiac MRI images of pericardial disease Recognize cardiovascular MRI images of non-operated common adult congenital heart diseases

10 Patient Care Goals and Objectives PF EF MF LF Aspirational Recognize cardiovascular MRI images of disease of the aorta and pulmonary artery Recognize cardiovascular MRI images of disease of the aorta and pulmonary artery Distinguish appropriate from inappropriate use of cardiovascular MRI for diagnosis and risk stratification using current guidelines Utilize cardiovascular CT protocols that limit radiation exposure Effectively manage patients with allergy to iodinated radiographic contrast (prophylaxis and treatment) Employ appropriate therapy to minimize the risk of contrast-induced acute kidney injury in patients undergoing cardiovascular CT

11 Patient Care Goals and Objectives PF EF MF LF Aspirational Employ cardiac calcium scanning and coronary calcium scoring to identify the presence and extent of coronary atherosclerosis/arteriosclerosis in various populations Recognize normal coronary anatomy imaged using cardiac CT angiography Recognize and quantify coronary artery stenoses in native coronary arteries, following PCI and following coronary artery bypass grafting using cardiac CT angiography Recognize coronary anomalies in patients undergoing CT coronary angiography Recognize scan artifacts in CT coronary angiograms Utilize cardiac CT to assess valvular heart Disease

12 Patient Care Goals and Objectives PF EF MF LF Aspirational Recognize CT angiographic abnormalities associated with acute aortic syndromes, aortic aneurysms and acute pulmonary embolism Differentiate appropriate from inappropriate use of cardiovascular CT based on current guidelines

13 Systems-based Practice Goals and Objectives PF EF MF LF Aspirational Be able to: Utilize cardiovascular MRI and CT in association with other diagnostic modalities (eg, stress testing; cardiovascular history and physical examination) to make therapeutic decisions and provide risk stratification in patients with cardiovascular disease Know the costs/charges for cardiovascular MRI and CT relative to other diagnostic techniques for similar indications Be prepared to justify use of cardiovascular MRI and CT to third party payers based on appropriate use criteria

14 Practice-based Learning and Improvement Goals and Objectives PF EF MF LF Aspirational Be able to: Utilize the results of the in-training examination and board review modules to assess selfknowledge and practice competency in advanced cardiac imaging Obtain level I training in cardiovascular MRI and CT Obtain supplemental training to qualify for level II training in cardiovascular MRI and/or CT

15 Interpersonal Communication Skills Goals and Objectives PF EF MF LF Aspirational Educate patients and their families about the reasons you have chosen to perform cardiovascular MRI or CT Educate patients and their families about the risks associated with cardiovascular MRI and CT and provide them with an understandable description of the chosen procedure; use educational brochures as an adjunct. Educate referring physicians as to the potential clinical benefits of cardiovascular MRI and CT

16 Professionalism Goals and Objectives PF EF MF LF Aspirational Provide the interpreting physician with appropriate clinical information including the clinical question(s) to be answered Work with the physician(s) performing cardiovascular MRI or CT to select the appropriate the appropriate protocol to answer the clinical question posed