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

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

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

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.