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Alex J Auseon
American Heart Journal Volume 7 No.2

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Objectives: To define the practical logistics involved in the training, maintenance of technical proficiency, credentialing, and board certification for academic multimodality cardiovascular imaging specialists. Background: Trends in cardiovascular imaging reflect a new paradigm emphasizing expertise in all four major modalities. In order to become a faculty member responsible for educating fellows-in-training, academic imagers face a daunting process with a shortage of senior mentors. Methods: Detailed information describing fellowship training, the aggregate monthly volume of publications, credentialing, continuing medical education requirements, and board certification were obtained for each subspecialty area of cardiovascular medicine from various online sources. Results: Compared with other subspecialty areas of cardiovascular medicine, multimodality imaging requires more reading (44% more pages of publications), more continuing medical education hours (300-467% more), and additional board certification (three boards instead of one or two).
Conclusions: Achieving competency in multimodality imaging is difficult and expensive in 2009, but still possible. To advance the career development of current academic faculty in this area, future emphasis should be on streamlining training, accreditation, and board certification requirements while focusing on research proving the value of integrated imaging in cardiovascular disease.

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Medical imaging is undergoing exponential growth. A recent report from the US Government Accountability Office noted a doubling of Medicare spending on imaging services from 2000 to 2006.¹ Cardiovascular imaging represents the largest portion of these totals, and there has been universal acknowledgment of the need to increase quality and reduce inappropriate testing in an effort to control costs.² In parallel with this trend, thought leaders within academic cardiology are calling for the training of a new generation of cardiologists with expertise in multimodality imaging (MMI) - namely echocardiography, nuclear cardiology, cardiovascular computed tomography (CCT), and cardiovascular magnetic resonance (CMR) - instead of the traditional one or two.^3-6

The rationale is to provide future cardiovascular imaging subspecialists with a broader base of skills in both mature and evolving technologies, resulting in more efficient, costeffective use with improved diagnostic accuracy and patient outcomes. The release of the American College of Cardiology (ACC) Training Statement on Multimodality Noninvasive Cardiovascular Imaging in 2008 provides a basic structure for fellowship training (see Table 1) that follows this new paradigm, recommending a 'patientcentered' rather than 'technology-centered' approach; consolidating the technical curriculum of each modality into unified, 'parallel' training; assessing imaging competency instead of the traditional 'apprentice model;' and proposing a combined reading room where these integrated imaging practices can occur.⁷

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