European CMR Certification: LIST OF PROCEDURES FORM

Transcription

1 European CMR Certification: LIST OF PROCEDURES FORM Application for: Level 2 Level 3 Candidate is requested to submit a list of 150 (Level 2) or 300 (Level 3) studies reported by her/him as detailed in the certification guidance. This list must be signed by the candidate s supervisor. Supervisor s first and last name: Signature: Please note the Certification Assessment Committee may request copies of some of these reports. Thus candidates for CMR certification have to keep this information available until certification is granted. In the attached logbook, please summarise the primary (main) diagnosis assigned to each case. Only one primary (main) diagnosis can be assigned to each study. Please Note: follow the target guidelines for case mix.

2 Level 2 Requirements Primary (Main) Diagnosis Required Number Actual Number Detection of myocardial infarction and assessment of viability >25 Stress testing with either vasodilator or staged inotropic stress >25 Left and right ventricular function assessment >5 Aortic, mitral, tricuspid, and pulmonary valve pathology >5 Aortic pathology including dilatation and dissection >5 Common basic CHD and ACHD (such as coarctation of the aorta, post-operative Tetralogy of Fallot, intracardiac shunts, coronary anomalies) >25 Assessment of causation of heart failure >5 Assessment of cardiomyopathy phenotype including hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy >25 Pericardial abnormality >5 Cardiac mass/tumour;angiography of major arteries including aorta, pulmonary, carotid, and renal. >5 Total Cases

3 Level 3 Requirements Primary (Main) Diagnosis Required Number Detection of myocardial infarction and assessment of viability >50 Actual Number Stress testing with either vasodilator or staged inotropic stress >50 Left and right ventricular function assessment >10 Aortic, mitral, tricuspid, and pulmonary valve pathology >10 Aortic pathology including dilatation and dissection >10 Common basic CHD and ACHD (such as coarctation of the aorta, post-operative Tetralogy of Fallot, intracardiac shunts, coronary anomalies) >50 Assessment of causation of heart failure >10 Assessment of cardiomyopathy phenotype including hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy >50 Pericardial abnormality >10 Cardiac mass/tumour;angiography of major arteries including aorta, pulmonary, carotid, and renal. >10 Total Cases

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