Nuclear Cardiology Core Curriculum


This on demand activity is based on the live Fellows in Training course offered March 9th, 2018 in Orlando, FL.  The goal is to provide a better understanding of the role of nuclear cardiology in evaluating patients with a variety of cardiac conditions to ensure appropriate use. Although it does not offer extensive training or certification in the field, it offers an important background of information from which healthcare professionals can pursue a more in-depth understanding of nuclear cardiology.

This activity does not qualify for continuing education (CME), continuing nurse education (CNE) or continuing education (CE) credit.

Members: Free

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PROGRAM DIRECTOR

Mouaz Al-Mallah, MD, MSc, FASNC (Director)
King Saud bin AbdulAziz Univ for Health Sciences
King AbdulAziz Cardiac Center
Riyadh, Saudia Arabia

FACULTY

Mouaz Al-Mallah, MD, MSc, FASNC
King Saud bin AbdulAziz Univ for Health Sciences
Riyadh, Saudia Arabia

Ahmed Aljizeeri, MBBS
King Saud bin Abdulaziz University for Health Sciences
Riyadh, Saudi Arabia.

Jamieson Bourque, MD, FASNC
University of Virginia Heart and Vascular Center
Charlottesville, VA

Marcelo DiCarli, MD
Brigham and Women’s Hospital
Boston, MA

Rami Doukky, MD, FASNC
Rush University Medical Center
Chicago, IL

Emilio Fentanes, MD
Tripler Army Medical Center,
Honolulu, HI

April Mann, MBA, CNMT, RT(N), NCT, MASNC
Hartford Hospital
Hartford, CT

Prashant Nagpal, MD
University of Iowa
Iowa City, IA

Khurram Nasir, MD, MPH
Yale School of Medicine
New Haven, CT

Overview

This on demand activity is based on the live Fellows in Training course offered March 9th, 2018 in Orlando, FL.  The goal is to provide a better understanding of the role of nuclear cardiology in evaluating patients with a variety of cardiac conditions to ensure appropriate use. Although it does not offer extensive training or certification in the field, it offers an important background of information from which healthcare professionals can pursue a more in-depth understanding of nuclear cardiology.

Statement of Need

Today more than 5000 laboratories in the United States are performing 9 million nuclear cardiology procedures evidence to the important role it plays in the diagnosis and management of patients with cardiac disease. [Slomka 2012]  Over the past several decades the strength of nuclear cardiology procedures have gained acceptance and are part of many clinical management guidelines.  Despite this acceptance there are still issues that require updating to ensure that the procedures are used appropriately and safely.  In the minds of many, the procedures are too long, radiation exposure too high and the incidence of false positive studies affects the confidence in the procedure.  Health professionals performing nuclear cardiology imaging need to understand appropriate use so that they can request tests appropriately and evaluate the results in combination with other testing and clinical findings in their patients.  Recent advancements in instrumentation and software and protocols to optimize efficiency and reduce radiation exposure are critical to successful utilization. This initiative will provide the opportunity to learn the latest updates in nuclear cardiology as well as develop a foundation of information that will allow proper utilization of this imaging modality most effectively.

Course Objectives

After participating in this program, participants should:

  • Recognize the proper application of the ACC/ASNC Appropriate Use Criteria across a variety of patients         
  • Employ optimal methodology to acquire, process, interpret, and report nuclear cardiology studies
  • Describe approaches to minimize radiation exposure to patients
  • Evaluate the benefits and risks of new protocols and imaging technologies and how to incorporate these into clinical practice
  • Review and improve interpretation skills in standard and emerging technologies in nuclear cardiology
  • Recognize how to utilize clinical practice guidelines to enhance performance, document compliance, and improve clinical management
  • Analyze and update the basic physiological approach to stress testing and perfusion imaging
  • Review the role of radionuclide myocardial perfusion imaging in the diagnosis and prognosis of coronary artery disease
  • Evaluate the role of complementary myocardial imaging techniques including cardiovascular computed tomography

Disclosures

As an accredited provider of the Accreditation Council for Continuing Medical Education (ACCME), the American Society of Nuclear Cardiology (ASNC) adhere to the ACCME’s Standards for Commercial Support. In compliance with the standards, it is ASNC’s policy to ensure balance, independence, objectivity, and scientific merit in all of its educational activities through disclosure of relevant financial relationships with commercial companies and resolution of any conflicts of interest. The financial interest or relationships requiring disclosure are outlined in ASNC’s CME Conflict of Interest Policy. All planners and presenters involved with this activity were required to disclose any relevant financial relationships. The ASNC has reviewed this activity’s faculty disclosures and resolved or managed all conflicts of interest through a peer review process.

The following individuals reported no financial relationships:
Jamieson Bourque, MD
Marcelo Di Carli, MD
Linda Giering, PhD, ASNC Staff
April Mann, MBA, CNMT, RT(N), NCT
Prashant Nagpal, MD
Khurram Nasir, MD, MPH

The following individuals reported relevant financial relationships

Mouaz Al-Mallah, MD, FASNC: Consulting Fees: Pfizer, Novartis
Rami Doukky, MD, FASNC: Research
Grant: Astellas Pharma, ASCEND HiT; Advisory Board: Astellas Pharma; Honoraria:
Astellas Pharma

Clinical Guidelines and Quality Standards Documents

ASNC is committed to documenting and providing evidence-based standards for the field of nuclear cardiology and cardiovascular CT. ASNC served as the author or co-author on each of the clinical guidelines and position statements listed below. The date shown with each guideline or statement reflects the most recent date of approval or endorsement. Clinical guidelines that pertain to our Educational activities can also be found in the list. For clinical documents related to nuclear cardiology training (such as COCATS).

To access these documents, go to https://www.asnc.org/guidelinesandstandards.

Imaging Guidelines for Nuclear Cardiology Procedures
Relevant protocols developed through evidence- or consensus-based standards for the field of Nuclear Cardiology

  • ASNC imaging guidelines for nuclear cardiology procedures - 2017
  • Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease— state-of-the-evidence and clinical recommendations - 2017
  • ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures - 2016
  • SPECT: Stress, Protocols, and Tracers - 2016
  • SPECT: Stress, Protocols, and Tracers -2016 - Chinese Edition (Translated in 2017) - NEW
  • First-Pass Radionuclide Angiography (FPRNA) - 2009 - Extended through 2015
  • Equilibrium Radionuclide Angiocardiography (ERNA) - 2009- Extended through 2015
  • Single Photon Emission Computed Tomography - 2010
  • SIngle Photon Emission Computed Tomography - 2010- Chinese Edition (Translated in 2016)
  • Single Photon Emission Computed Tomography - 2010 - Spanish Edition (Translated in 2014)
  • Myocardial Perfusion Planar Imaging - 2009
  • PET Myocardial Perfusion and Glucose Metabolism Imaging - 2009
  • Standardized Reporting of Radionuclide Myocardial Perfusion and Function - 2009

Appropriate Use Criteria
Statements that denote when it is appropriate to perform a medical service or procedure, with the expectation that the benefits of such a service or procedure significantly outweigh the potential risks

  • ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease - Oct 2017
  • ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease - June 2017
  • ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease – February 2014
  • Appropriate Use for Diagnostic Catheterization - May 2012
  • Appropriate Use Criteria for Coronary Revascularization: Focused update - 2012
  • Appropriate Use Criteria for Echocardiography - 2010
  • Evaluating Appropriateness for Cardiac Computed Tomography - 2011 (Summary)
  • Appropriate Use Criteria for Cardiac Computed Tomography - 2010
  • Appropriate Use Criteria for Cardiac Radionuclide Imaging - 2009
    Appendix: Appropriate Use Criteria for Cardiac Radionuclide Imaging Data Supplement - 2009
  • Appropriate Use Criteria for Stress Echocardiography - 2008
  • Appropriate Use Criteria for Transthoracic and Transesophageal Echocardiography - 2007
  • Appropriate Use Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging - 2006

Preferred Practice Statements
A set of predominantly forward-looking statements focusing on the goals of Nuclear Cardiology Imaging

  • Patient-Centered Imaging - 2012

Information Statements
Educational tools comprised of systematic reviews of clinical concepts and scientific evidence that serve as a resource to advise clinicians

  • Status of cardiovascular PET radiation exposure and strategies for reduction: An Information Statement from the Cardiovascular PET Task Force- May 2017
  • The Role of Clinical Effectiveness of Multimodality Imaging in the Management of Cardiac Complications of Cancer and Cancer Therapy - 2016
  • ASNC Model Coverage Policy: Cardiac Positron Emission Tomographic Imaging - 2014
  • Strategies for Defining an Optimal Risk-Benefit Ratio for Stress Myocardial Perfusion SPECT - 2011
  • The Role of Radionuclide Myocardial Perfusion Imaging for Asymptomatic Individuals - 2011
  • Recommendations for Reducing Exposure in Myocardial Perfusion Imaging - 2010
  • Variability in Radiation Dose Estimates from Nuclear and Computed Tomography Diagnostic Imaging - 2009
  • DICOM and Interconnectivity Update - 2009
  • ASNC Review of the ACCF/ASNC Appropriateness Criteria for SPECT MPI - 2007
  • Cost-Effectiveness of Myocardial Perfusion Imaging - 2005

Position Statements
A set of statements that serve as an expression of ASNC’s stance on specific practice, policy, or professional issues

  • American Society of Nuclear Cardiology and Society of Nuclear Medicine and Molecular Imaging Joint Position Statement on the Clinical Indications for Myocardial Perfusion PET-2016
  • The Role of Radiology Benefits Managers and Private Insurers in the Physician-Patient Relationship: A Statement in Opposition of Test Substitution - 2011

Other ASNC Documents

  • Conference Proceedings from the 9th Nuclear Cardiology Invitational Conference - 2008
  • Verification of Experience in Cardiovascular Computed Tomography (CCT) - 2007
  • A Report of the ASNC Task Force on Women and Heart Disease - 2003
  • A Suspected Acute Ischemic Syndromes in the Emergency Department or Chest Pain Center - 2002

Other Clinical Guidelines

  • 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy - ACCF/AHA Guideline - 2011
  • Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Hypertropic Cardiomyopathy - ASE Guidelines - 2011
  • Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2011 Update - AHA Guideline - 2011
  • 2010 ACCF/AHA Guidelines for Assessment of Cardiovascular Risk in Asymptomatic Adults - 2010
    (Click here for the Executive Summary)
  • Outcomes Research in Cardiovascular Imaging: Report of a Workshop Sponsored by the National Heart, Lung and Blood Institute - 2009
  • ASNC Imaging Guidelines on New Technology for Clinical Use - 2009
  • 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Joint Society Statements
Public statements on issues within the field of Cardiology that are supported by multiple professional societies and experts

  • Clinical quantification of myocardial blood flow using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC
  • A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology
  • Joint SNMMI-ASNC expert consensus document on the role of 18F-FDG PET/CT in cardiac sarcoid detection and therapy monitoring
  • 2016 ACC/ASE/ASNC/HRS/SCAI Health Policy Statement on Integrating the Healthcare Enterprise-2016
  • ASNC/SNMMI Model Coverage Policy: Myocardial sympathetic innervation imaging: Iodine~123 meta-iodobenzylguanidine (123I~mIBG)
  • TF 7 Cardiovascular Computed Tomographic Imaging - 2015
  • TF 6 Nuclear Cardiology - 2015
  • Approaches to Enhancing Radiation Safety in Cardiovascular Imaging: A Scientific Statement From the American Heart Association - 2014
  • 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery - 2014
  • SNMMI/ASNC/SCCT Guideline for Cardiac SPECT/CT and PET/CT 1.0* - 2013
  • Developing an Action Plan for Patient Radiation Safety in Adult Cardiovascular Medicine - 2012
  • ACCF/AHA Focused Update on Perioperative Beta Blockade - 2009
  • 2008 Key Data Elements and Definitions for Cardiac Imaging - 2008
  • 2008 Health Policy Statement on Structured Reporting in Cardiovascular Imaging - 2008
  • Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance - 2005

Sessions Included:

Stress Testing, Tracers and Protocols (Mar 09, 2018 11:25 AM)

Risk Stratification & Prognosis (Mar 09, 2018 11:50 AM)

Coronary Artery Calcium Scoring (Mar 09, 2018 12:30 PM)

Clinical Applications of Coronary CT Angiography (Mar 09, 2018 12:55 PM)

Non-Coronary Cardiac CT (Mar 09, 2018 01:20 PM)

Appropriate Use Criteria (Mar 09, 2018 02:00 PM)

Cardiac PET (Mar 09, 2018 02:25 PM)

Radiation Exposure in Cardiac Imaging (Mar 09, 2018 03:25 PM)

Patient Centered Imaging: Modality Imaging Selection for Different Indications (Mar 09, 2018 03:50 PM)

SPECT Acquisition, Processing & Artifacts (Mar 09, 2018 10:55 AM)

Members: Free

Sessions

SPECT Acquisition, Processing & Artifacts


Identification: 001

Credits: None available.

Speaker(s):
  • April Mann, MBA, CNMT, RT(N), NCT, FASNC, Hartford Hospital

Stress Testing, Tracers and Protocols


Identification: 002

Credits: None available.

Speaker(s):

Risk Stratification & Prognosis


Identification: 003

Credits: None available.

Speaker(s):

Coronary Artery Calcium Scoring


Identification: 004

Credits: None available.

Speaker(s):

Clinical Applications of Coronary CT Angiography


Identification: 005

Credits: None available.

Speaker(s):

Non-Coronary Cardiac CTNon-Coronary Cardiac CT

Preview Available

Non-Coronary Cardiac CT


Identification: 006

Credits: None available.

Speaker(s):

Appropriate Use Criteria Appropriate Use Criteria

Preview Available

Appropriate Use Criteria


Identification: 007

Credits: None available.

Speaker(s):
  • Rami Doukky, MD, Cook County Health and Hospitals System

Cardiac PETCardiac PET

Preview Available

Cardiac PET


Identification: 008

Credits: None available.

Speaker(s):

Radiation Exposure in Cardiac Imaging


Identification: 010

Credits: None available.

Speaker(s):

Patient Centered Imaging: Modality Imaging Selection for Different Indications


Identification: 011

Credits: None available.

Speaker(s):