Author + information
- Scott D. Flamm, MD⁎ ()
- ↵⁎Department of Radiology, MC 2-270, St. Luke’s Episcopal Hospital, 6720 Bertner Avenue, Houston, TX 77030
In a recent issue of JACC, Taylor et al. (1) described the current difficulties in training cardiovascular fellows in cardiovascular magnetic resonance imaging (CMR). Reichek (2) followed with an editorial comment on the results of the Taylor et al. (1) survey and described some of the history of CMR imaging and the educational impediments. There is little to argue with in either report, save for one remarkable omission common to both. Both Taylor et al. (1) and Reichek (2) discuss the necessity for collaborative arrangements between cardiologists and radiologists, and the importance of open cooperation among the various professional societies—in specific, the American College of Cardiology (ACC) and the Society for Cardiovascular Magnetic Resonance (SCMR). Curiously, however, both reports mislaid any mention of the American College of Radiology (ACR). If collaborative efforts between cardiologists and radiologists are “the ideal,” as noted by Reichek (2), it is a striking comment that any mention of a relationship, collaborative or otherwise, between the ACC and the ACR has been sidestepped.
What could be the reason for this? As Taylor et al. (1) noted, almost two-thirds of all clinical work and more than half of all training are found in centers where radiology controls CMR activities. It is clearly in the best interest of patient care for physician imagers to have top-flight training. For CMR this certainly is best served with skills that are a hybrid of training found in cardiology and radiology. An in-depth knowledge of cardiovascular physiology and pathophysiology is an integral requirement; so too are detailed understandings of the structures contiguous with and adjacent to the cardiovascular system that intimately affect its functioning, as well as a superior understanding of the magnetic resonance imaging physics relative to imaging the cardiovascular system. This constellation of skills is not found in the training of any general cardiologist or radiologist. A considerable advance in training for each is paramount, and, in my opinion, is unlikely to be found at the vast majority of centers without a cooperative and collaborative approach (to make the point, one can only imagine the glee of a personal-injury attorney upon hearing the cardiologist, who has missed the obvious lung tumor on a CMR study, explaining that “it wasn’t part of my training”).
If we wish to quickly elevate CMR to one of, if not the premier noninvasive tool for CV diagnosis, a new paradigm of training is needed that encompasses the unique skill set required. Let those groups best equipped to do so—ACC, SCMR, and the ACR—work together in a truly collaborative manner to define and refine the requirements for, training of, and certification necessary for practitioners desirous of providing excellent patient care through the advantages CMR brings.
Please note: Dr. Flamm is a member of the Board of Trustees of the Society for Cardiovascular Magnetic Resonance, and a Board Member of the North American Society of Cardiac Imaging.
- American College of Cardiology Foundation
- Taylor A.J.,
- Udelson J.E.,
- Fuster V.,
- American College of Cardiology Foundation’s Cardiovascular Imaging Committee and the Cardiovascular Training Directors Committee
- Reichek N.