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Program Curriculum

The curriculum is designed to allow the Advanced Cardiovascular Imaging fellow to become experienced in all aspects of workflow, from collaboration with referring providers and patient preparation to image acquisition and interpretation using the techniques of practical application of state-of-the-art cardiovascular imaging. In particular, the trainee will gain knowledge of CT and MR physics, scanning principles related to cardiovascular imaging protocols, familiarity with contrast agents used for safe and optimal imaging, interpretative skills for reading clinical cardiovascular imaging studies including data post-processing tools for analysis, an in-depth knowledge of normal and pathologic cardiovascular anatomy, and the physiology of acquired and congenital heart disease, cardiothoracic diseases and vascular diseases of the aorta.

Fellows have hands-on supervised clinical training, one-on-one teaching sessions with imaging attendings, and participation in research and educational activities. Additionally, administrative aspects of laboratory operations, quality improvement, accreditation, and maintenance and development involving multimodality imaging technologies and equipment will be learned. The high volume of clinical studies and well-rounded opportunities provide fellows an excellent teaching environment.

The clinical and didactic training has focus on the integration of modality imaging in the care of complex cardiac diseases. Close involvement with multidisciplinary teams will be expected, including surgical, interventional, structural, heart failure, electrophysiology, nursing, industry and quality assurance.

Multimodality Imaging Training

  • Cardiac CT, calcium score, CTA, CT FFR, 4D CT, TAVR, coronary, congenital and structural evaluation.
  • Acquisition, analysis and interpretation of cardiac CT studies.
  • CT physics and artifacts, acquisition of sequences and methodology.
  • MRI/MRA, mapping, congenital, structural and valvular evaluation.
  • MRI physics and artifacts, acquisition of sequences and methodology.
  • CMR studies performed for evaluation of ischemic heart disease, cardiomyopathies, pericardial disease, valvular disease, vascular disease, mass evaluation and congenital heart disease.
  • Acquisition, analysis, and interpretation of CMR and stress CMR studies.
  • Structural interventional TEE (TAVR, MitraClip, Tri-Clip, WATCHMAN, Amulet, TMVR, paravalvular leak occlusion, VSD/ASD closure).
  • Advanced echocardiography (TTE/TEE, advanced valvular quantitation, 3D imaging, strain).
  • Additional opportunities for PET, SPECT, PYP scan, vascular US, 3D printing and research.

Learning Goals

Cardiac MRI

Basic MR physics

 

Basic pulse sequences for MR imaging

 

MRI safety

 

CMR and devices – patient preparation, safety and artifacts

 

CMR stress perfusion imaging

 

CMR for flow quantification

 

Optimize CMR image quality and troubleshooting during acquisition

 

Recognize and minimizing common CMR artifacts

 

Ischemic and nonischemic heart disease

 

CMR for T1 and T2 mapping

 

CMR for assessing acute coronary syndromes

 

Acute myocarditis and the Lake Louise Criteria

 

Pericardial disease

 

CMR for cardiac involvement in systemic diseases and infections

 

CMR for assessing cardiac masses and tumors

 

CMR for assessing HCM

 

CMR for assessing DCM and ARVC

 

CMR for infiltrative and storage heart disease

 

CMR for assessing non-compaction cardiomyopathy

 

CMR for iron overload

 

CMR for differentiating athlete's heart from cardiomyopathies

 

CMR for valvular heart disease

 

Common congenital heart disease

 

Complex congenital heart disease

 

Understanding shunts

 

Vascular disease

 

CMR for assessment of aortic diseases

 

CMR for assessment of pulmonary arteries and veins

 

CMR for assessment of coronary arteries

 

CMR for assessment of peripheral vascular disease

 

Extracardiac and extravascular findings

Cardiac CT

Perform pre‐exam tasks

Review prior focused medical history and clinical information

  • Evaluate clinical indications considering appropriate use criteria
  • Educate referring physician and other healthcare providers
  • Perform or direct pre‐test counseling for patient
  • Screen for contraindications
  • Perform or direct pre‐test patient preparation and test Instructions

Supervise patient (pre‐test, intra‐scan, post‐test) treatment optimization

  • Manage heart rate and recognize arrhythmias
  • Select scanning protocol and troubleshoot scanning acquisition problems
  • Perform scan quality assessment
  • Practice radiation safety principle
Interpreting and Managing CT Findings

Identify artifacts

 

Assess coronary anatomy

 

Quantify coronary artery stenosis

 

Assess coronary stents

 

Assess coronary artery bypass grafts

 

Assess chronic total occlusions

 

Perform plaque characterizations (e.g., identify high risk plaque)

 

Assess coronary anomalies

 

Assess pulmonary veins

 

Assess cardiac veins

 

Assess cardiac chambers

 

Assess cardiac function

 

Assess pericardium

 

Assess native/artificial valves

 

Assess myocardium

 

Assess appendage

 

Assess septum (atrial/ventricular)

 

Assess percutaneous valvuloplasty procedures (e.g., feasibility AVR, etc.)

 

Assess congenital heart disease

 

Assess aorta

 

Assess pulmonary artery

 

Assess vascular anomalies

 

Assess common lung disease, pulmonary nodules/tumors and pleural effusions

 

Assess mediastinal and hilar pathology

 

Assess other non‐vascular structures (e.g., bones, soft tissue)

 

Assess calcium scoring

 

Supervise reconstruction protocols

 

Actively perform post‐processing (i.e., manipulation and reformatting at workstation)

 

Evaluate and treat adverse contrast reactions and extravasations

 

Evaluate and manage contrast‐induced nephropathy

Program Highlights

  • Joint Advanced Cardiac Imaging conference with the University of South Florida
  • ECHO/imaging conferences weekly
  • CT/MRI – collaboration with referring providers, patient preparation and imaging protocol selection, active image acquisition, interpretation and reporting with attending physician
  • Structural interventional TEE imaging for transcatheter aortic valve replacement (TAVR), transcatheter mitral edge-to-edge repair (TEER), transcatheter tricuspid edge-to-edge repair (T-TEER), left atrial appendage occluder device (WATCHMAN) and other structural interventional procedures
  • Coverage of stress tests/imaging – one weekend each month

Research Related to Residency/Fellowship

A wide range of clinical research opportunities are available that can be performed with the collaboration of interventional, structural, electrophysiology, heart failure or surgical teams.