NASCI Curriculum – Table of Contents

Objectives:

To provide fellowship directors and fellows with a list of topics that should be covered in a 1-year curriculum in cardiac imaging.
To provide practicing radiologists with a list of the fundamental knowledge and skills necessary to be valuable consultants to cardiologists, cardiothoracic surgeons, and other referring physicians.

Topics:

Physiological aspects of cardiac imaging

A. Normal cardiac cycle
B. Electrocardiography
C. Physiological anatomy of cardiac muscle
D. Mechanics of cardiac contraction
E. Physical basis for blood flow, pressure, and resistance

Anatomy of the heart and great vessels

A. Normal morphology and structure
B. Segmental anatomy of the heart
C. Normal adult heart measurements

Techniques for imaging the heart and great vessels

A. Radiography
B. Computed tomography
C. Magnetic resonance imaging
D. Cardiac scintigraphy (including PET)
E. Other (working understanding)

Congenital heart disease: basic

A. Cyanotic versus acyanotic presentations
B. Most common lesions
C. Post-operative assessment of the following procedures:
D. Most common indications for cardiac MRI in the setting of congenital and acquired pediatric cardiovascular disease
E. Situs anomalies (asplenia and polysplenia)

Unusual congenital heart disease: advanced

A. Double outlet right ventricle
B. Single ventricle
C. Cor triatriatum
D. Hypoplastic left heart syndrome
E. Hypoplastic right heart syndrome
F. Congenital absence of the pericardium
G. Indications for and post-operative assessment of
H. Late or adult presentations of congenital heart disease

Ischemic heart disease

A. Rick factors, primary prevention, and screening
B. Inducible myocardial ischemia
C. Acute MI
D. Chronic MI
E. Post-MI complications
F. Myocardial viability
G. Therapeutic and interventional options

Valvular disease

A. Aortic stenosis
B. Aortic insufficiency
C. Mitral stenosis/mitral insufficiency
D. Tricuspid stenosis/tricuspid regurgitation
E. Miscellaneous
F. Therapeutic and interventional options

Cardiac and pericardial masses

A. Primary lesions
B. Metastasis
C. Therapeutic and interventional options
D. Thrombus vs tumor

Acquired disease of the thoracic aorta

A. Aneurysms
B. Pseudoaneurysms
C. Dissection
D. Aortitis
E. Atherosclerosis
F. Therapeutic and interventional options

Cardiomyopathy

A. Hypertrophic
B. Dilated
C. Restrictive (also infiltrative)
D. Therapeutic and interventional options

Diseases of the pericardium

A. Acute pericarditis
B. Constrictive pericarditis
C. Pericardial effusion
D. Pericardial cyst
E. Pericardial defect
F. Therapeutic and interventional options

Miscellaneous

A. Arrhythmogenic right ventricular dysplasia (ARVD)
B. Coronary artery/sinus of Valsalva aneurysm and fistula
C. Pulmonary arterial hypertension
D. Pulmonary embolism
E. Cardiac transplantation
F. Automatic implantable cardioverter defibrillator (AICD)
G. Pacemakers
H. RF ablation for atrial fibrillation
I. Ventricular assist device

Physics

A. CT physics
B. MRI physics

3-D Imaging and post-processing

A. Multiplanar Reformation (MPR)
B. Maximum Intensity Projection (MIP)
C. Minimum Intensity Projection (MinIP)
D. Volume rendering
E. Surface rendering
F. Ray sum

Radiation

A. Distinguish between exposure, absorbed dose and effective dose
B. Understand the measurements for dose – CTDI, CTDI 100, dose length product
C. Understand the weighting factor for various organs and tissues
D. Be able to read and understand the dose sheets produced by the CT scanner at the end of the examination (I think this should be mandatory)
E. Dose minimization techniques in cardiac and vascular CT
F. Understand the implications in terms of dose of increasing the cranio-caudal field of view by “x” cm (e.g. 5 cm) in retrospectively gated cardiac CT.
G. Understand the dose savings from retrospectively gated to prospectively triggered CT.
H. Understand the dose savings from reducing the kvp from 120 to 100

Evidence-based Cardiovascular Imaging

A. Understand the principles of technology assessment.
B. Be aware of cardiovascular risk factors with an understanding of the Framingham risk score.
C. Understand the imaging risk markers for atheromatous disease, notably coronary calcium score on CT and intimo-medial thickness on carotid ultrasound.
D. Understand how the calcium score affects management above and beyond the Framingham risk score.
E. Appreciate the arguments for and against screening for cardiovascular disease using coronary calcium score.
F. Appreciate the competing modalities for detection of chronic ischemic heart disease including myocardial perfusion scintigraphy, stress echo, stress MRI, cardiac CT, exercise ECG and PET. Be able to enlist advantages and disadvantages of each.
G. Appreciate the competing modalities for detection of acute coronary syndrome.
H. Have an understanding for the clinical contexts in which a high negative predictive value is important for those in which a high positive predictive value is necessary.
I. Be aware of some of the research comparing cardiac CT with myocardial perfusion imaging.
J. Understand the controversies pertaining to cardiac CT particularly with regards to its costs and the costs of treating incidental findings.
K. Appreciate the role of late gadolinium MRI in risk stratifying patients with various forms of cardiomyopathy. Understand the additional prognostic information offered.
L. Understand the seminal study involving survival analysis of patients with hypertrophic cardiomyopathy and scar as detected on late gadolinium MRI.
M. Appreciate how MRI guides the decision to revascularize and how this is superior to PET and myocardial perfusion imaging.
N. Understand how MRI functions as a biomarker for iron involvement of the heart and how this has revolutionized survival of patients with thalassemia.
O. Understand how MRI helps with the decision who should get an ICD and who should receive cardiac resynchronization therapy.