Training In Nuclear Cardiology Research Articles

Visual assessment of left ventricular perfusion and function with electrocardiography-gated SPECT has high intraobserver and interobserver reproducibility among experienced nuclear cardiologists and cardiology trainees

Background. Stress electrocardiography (ECG)-gated single photon emission computed tomography (SPECT) for assessment of left ventricular perfusion and function improves the confidence of interpretation and enhances specificity for detection of coronary artery disease. The reproducibility of visual interpretation of ECG-gated SPECT images and the significance of training and experience have not been reported previously in a large series of consecutive patients. We evaluated both intraobserver and interobserver agreement of interpretation of ECG-gated SPECT images among 3 cardiology trainees and 3 experienced nuclear cardiologists from 3 institutions. Methods and Results. Three nuclear cardiologists and 3 cardiology trainees who had fulfilled American College of Cardiology/American Society of Nuclear Cardiology Core Cardiology Training Symposium (ACC/ASNC COCATS) guidelines for level II training in nuclear cardiology independently evaluated 106 consecutive technetium 99m sestamibi SPECT images with ECG gating of either the stress or rest images. All cases were interpreted blindly, twice in random sequence, without clinical data. We assessed intraobserver and interobserver agreement for myocardial perfusion, left ventricular regional and global systolic function, and overall clinical impression, by means of percent agreement and Cohen's κ statistic. Intraobserver agreement was good (82%–92%, κ = 0.54–0.84) for assessment of myocardial perfusion, systolic function, and overall impression. Interobserver agreement was also good, ranging from 65% to 90% (κ = 0.32–0.76), with better agreement found for assessment of function (77%–85%, κ = 0.52–0.7) than for perfusion (65%–80%, κ = 0.32–0.6). For all measures, there were no significant differences in reproducibility between nuclear cardiologists and cardiology trainees. Conclusions. Interpretation of ECG-gated SPECT images has high reproducibility and agreement among both nuclear cardiologists and cardiology trainees. (J Nucl Cardiol 2002;9:263-70.)

American college of cardiology policy statement on nuclear cardiology services

Nuclear cardiology is a cardiovascular subspecialty with a definable body of knowledge and skills critical for its optimal performance. Recognizing the special training and experience needed to deliver nuclear cardiology services, the American College of Cardiology (ACC), the American Society of Nuclear Cardiology (ASNC), and the American Heart Association (AHA) have developed and published guidelines for appropriate professional training and the clinical use of radiographic devices and cardiac radionuclide imaging. TM The 1995 ACC/ASNC Training Guidelines, 1 for example, require training or experience equivalent to Level II training in nuclear cardiology, including 4 to 6 months of formal training. Based on those guidelines, a certification examination has been developed by the Certification Council of Nuclear Cardiology* that outlines the body of knowledge and the clinical training recommended to perform nuclear cardiology procedures.

Who is interpreting nuclear cardiology studies in the United States, and what are the requirements for privileges? A national survey of institutional policies from 80 major medical centers

Background. This survey was conducted to determine the guidelines used by major medical centers in the United States for obtaining hospital privileges to interpret nuclear cardiology studies. The American College of Cardiology (ACC) and the American Society of Nuclear Cardiology (ASNC) have established guidelines to help maintain an adequate level of proficiency in the practice of nuclear cardiology. These guidelines were published only recently, and many hospitals have adopted different processes to obtain these privileges. It is likely that a marked difference among institutions exists. Methods and Results. The survey was conducted predominantly by mailings with additional telephone communications if more information was needed. Chiefs of cardiovascular medicine sections were contacted to provide information concerning the policy of granting nuclear cardiology privileges at his or her institution. The responses were tabulated in four categories and the responders were asked to comment on whether they agreed or disagreed with their own university's policy. Of 80 responses (68%) from 121 institutions, cardiologists were involved in reading these studies in 62 (78%) and radiologists were the sole interpreters in 18 (22%). ACC or ASNC guidelines were strictly followed at 48 sites (60%). Eight (10%) and 6 (8%) of these institutions mandated a minimum requirement of, respectively, 12 and 6 months of additional training in nuclear cardiology. Ten (13 %) of the cardiologists surveyed disagreed with their own institution's policies, primarily noting that the ACC and ASNC guidelines were more appropriate. Conclusion. The recently established ACC/ASNC guidelines clearly have had an impact on the practice of attaining privileges in nuclear cardiology and are the most commonly quoted criteria used by institutions in the United States to assess competence in nuclear cardiology.

Effectiveness of nuclear cardiology training guidelines: A comparison of trainees with experienced readers

Background. To evaluate the effectiveness of published nuclear cardiology training guidelines, the diagnostic accuracy of image interpretation by nuclear cardiology trainees was compared with that of experienced nuclear cardiologists. Methods and Results. The accuracy of three experienced nuclear cardiologists and three trainees with level II experience following Society of Nuclear Medicine/American College of Cardiology/American Society of Nuclear Cardiology guidelines in the interpretation of 114 exercise 99mTc-labeled sestamibi single-photon emission computed tomographic imaging studies was evaluated. Studies were selected randomly and included patients with less than 5% likelihood of coronary artery disease, as well as patients with angiographically demonstrated single and multivessel disease. Studies were interpreted by each reader without knowledge of clinical or exercise data. Each reader classified perfusion as normal or abnormal. Accuracy was assessed according to sensitivity, normalcy rate, and predictive accuracy. In addition, the ability of experienced readers and trainees to identify abnormal perfusion in patients with multivessel disease was compared. Trainees had high accuracy, comparable to experienced readers for sensitivity, normalcy rate, and predictive accuracy, as well as the ability to identify abnormal perfusion in patients with multivessel disease. In all categories, experienced interpretors demonstrated a trend toward greater accuracy with less observer variability than did trainees. Conclusion. Structured training in nuclear cardiology following Society of Nuclear Medicine/American College of Cardiology/American Society of Nuclear Cardiology guidelines during clinical cardiology fellowship is effective, and trainees possess the skills to interpret myocardial perfusion images accurately. Interpretive skills can be expected to improve further with experience.

Guidelines for training in adult cardiovascular medicine. Core Cardiology Training Symposium (COCATS) task force 5: Training in nuclear cardiology

Guidelines for training in adult cardiovascular medicine. Core Cardiology Training Symposium (COCATS) task force 5: Training in nuclear cardiology

Guidelines for training in adult cardiovascular medicine. Core cardiology training symposium (COCATS) task force 5: Training in nuclear cardiology

Guidelines for training in adult cardiovascular medicine. Core cardiology training symposium (COCATS) task force 5: Training in nuclear cardiology

901-101 Evaluating the Effectiveness of a Nuclear Cardiology Training Program: Comparison of Trainees with Faculty

To evaluate the effectiveness of structured nuclear cardiology training. the reproducibility and accuracy of image interpretation by nuclear cardiology faculty and senior cardiology fellows were compared. The reproducibility and accuracy of 3 faculty and 3 trainees with 6 months training following Nuclear Regulatory Commission/American College of Cardiology guidelines were assessed using 138 exercise Tc-99 m Sestamibi SPECT studies. Studies were randomly selected and included patients with < 5% likelihood of CAD as well as patients with angiographically demonstrated single and multivessel disease. Studies were interpreted twice by each reader without knowledge of clinical or exercise data. Each reader classified perfusion as normal (N) or abnormal (AB). AB perfusion was further classified as fixed (F) or ischemic (I). Reproducibility was compared with respect to first order (N vs AB) and second order (N vs F vs I) intra and inter observer agreement and assessed using percent agreement (%) and Cohen's kappa. Accuracy was assessed using sensitivity and normalcy rate and compared using percent agreement and Cohen's kappa. Trainees Faculty % kappa % kappa Reproducibility First order Intra: 89 0.78 92 0.82 inter: 80 0.59 86 0.71 * Second order intra: 81 0.66 87 0.74 * inter: 69 0.46 82 0.64 * Accuracy Sensitivity 82 87 Normalcy Rate 85 89 % agreement/kappa 83 063 87 0.73 * * p < 0.05 compared with trainees Trainees had high reproducibility and accuracy. comparing favorably with faculty in all categories. Faculty had significantly higher results in several categories. Structured training in nuclear cardiology following Nuclear Regulatory Commission/American College of Cardiology guidelines during clinical cardiology fellowship is very effective. resulting in high reproducibility and accuracy. Interpretive skills can be expected to further improve with experience.

Task force 5: Training in nuclear cardiology

Task force 5: Training in nuclear cardiology

Task force V: Training in nuclear cardiology and nuclear magnetic resonance

A. General training (2 months) for all cardiology fellows is designed to make the fellow conversant with the field of nuclear cardiology (level 1). B. Specialized training (4 months) for individuals who wish to have special expertise in clinical nuclear cardiology and responsibility for all clinical nuclear cardiologic activity (level 2). C. Advanced training (1 year) for trainees who wish to pursue an academic direction in nuclear cardiology including patient care, teaching and research (level 3).