Fellows: getting nuclear training from a radiologist?

[BrianFantana]

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I have a question for the fellows out there. At the program I am going to for cards, I heard that nucs are read by radiology and that the opportunity exists to get trained if you want. Is this usual? Is it possible to get solid Nuc training from a radiologist? This is an honest question, for all I know, radiologists may be better than cardiologists at reading them. I am just a little anxious about learning something "cards" from a non-cardiologist (and yes, I know it was originally a radiology thing). At the program I did residency, cards read the nucs as well as the cardiac MR - I just thought this was the norm.

 

[gutonc]

I have a question for the fellows out there. At the program I am going to for cards, I heard that nucs are read by radiology and that the opportunity exists to get trained if you want. Is this usual? Is it possible to get solid Nuc training from a radiologist? This is an honest question, for all I know, radiologists may be better than cardiologists at reading them. I am just a little anxious about learning something "cards" from a non-cardiologist (and yes, I know it was originally a radiology thing). At the program I did residency, cards read the nucs as well as the cardiac MR - I just thought this was the norm.

At our program (note, I'm not a cards fellow but I know the answer to this about the program here), MUGAs are read by rads. In order to smooth things over w/ rads (insert the "My Machines" scene from scrubs here) cardiac CTs are officially ready by rads (although if ordered by one of the cardiac imaging guys, they'll read it themselves, just not bill for it) and cardiac MRs are read by cards.

 

[dragonfly99]

Brian,
I share your concerns.
The nucs were read by the cardiologists (except for the ones done on ER patients) at the hospital where I did residency. At the fellowship program I'm going to, I've heard that nucs are "controlled by radiology", which doesn't sound good ):

 

[cardsfellow2007]

I have a question for the fellows out there. At the program I am going to for cards, I heard that nucs are read by radiology and that the opportunity exists to get trained if you want. Is this usual? Is it possible to get solid Nuc training from a radiologist? This is an honest question, for all I know, radiologists may be better than cardiologists at reading them. I am just a little anxious about learning something "cards" from a non-cardiologist (and yes, I know it was originally a radiology thing). At the program I did residency, cards read the nucs as well as the cardiac MR - I just thought this was the norm.

Get trained if you can. If you are being trained by a radiologist then well…”it is what it is.” At the program that I am at the cardiology fellow reads all Nucs. All of the outpatients are over-read with a cardiologist and the inpatients are over-read alternate weeks with a radiologist or cardiologist. The radiology reads are very different as they focus on the pictures (what’s physically there) whereas the cardiology reads focus on the patient and clinical picture. The radiologists focus also on the physics when teaching which is very important for passing the board test.

Being trained in nucs is very important if you go into private practice or academics as its the highest reimbursing diagnostic test (greater than MRI, DSE, CT, or a diagnostic cath)...In academics you may have an easier time fulfilling your clinical responsibility and in private practice more jobs will be open to you. Training usually means getting the necessary hours of didactics (80 or 200 hours depending on your state), 300 studies (we do 20+ a day so this isn't a problem - don't know if that is universal), a radiation safety course, and passing the ASNC board exam. If you train in Nucs after fellowship if will cost a TON of money so if you have the chance to check that box in fellowship do it!

 

[gluon999]

Hey cardsfellow,

I know this is quite far ahead for me (I am only a lowly MS3 🙁) but cardiology is something I am looking forward to doing. I've heard that one can get level II certification in reading cardiac imaging studies in their 3 years of fellowship (that is 6 months of imaging training, right?). Does that include echos, TEEs, cardiac CT/MRI and nucs? Or is that something just limited to echos?

Lets say you want to be level II certified in nucs and CT/MRI, do you have to do an additional year after fellowship? Thanks

 

[BrianFantana]

Get trained if you can. If you are being trained by a radiologist then well…”it is what it is.” At the program that I am at the cardiology fellow reads all Nucs. All of the outpatients are over-read with a cardiologist and the inpatients are over-read alternate weeks with a radiologist or cardiologist. The radiology reads are very different as they focus on the pictures (what’s physically there) whereas the cardiology reads focus on the patient and clinical picture. The radiologists focus also on the physics when teaching which is very important for passing the board test.

Being trained in nucs is very important if you go into private practice or academics as its the highest reimbursing diagnostic test (greater than MRI, DSE, CT, or a diagnostic cath)...In academics you may have an easier time fulfilling your clinical responsibility and in private practice more jobs will be open to you. Training usually means getting the necessary hours of didactics (80 or 200 hours depending on your state), 300 studies (we do 20+ a day so this isn't a problem - don't know if that is universal), a radiation safety course, and passing the ASNC board exam. If you train in Nucs after fellowship if will cost a TON of money so if you have the chance to check that box in fellowship do it!

What do you mean "over-read"?

I will definitely get trained, I just wanted to know if learning under a cardiologist is important enough that its worth doing an away rotation or two to get the additional training.

 

[cardsfellow2007]

What do you mean "over-read"?

I will definitely get trained, I just wanted to know if learning under a cardiologist is important enough that its worth doing an away rotation or two to get the additional training.

After reading the studies on own we go "over" them with the attending.

It really depends on the radiologist reading with you. If they are like the ones I work with - then definitely do an away rotation for a more comprehensive clinical approach.

 

[cardsfellow2007]

Hey cardsfellow,

I know this is quite far ahead for me (I am only a lowly MS3 🙁) but cardiology is something I am looking forward to doing. I've heard that one can get level II certification in reading cardiac imaging studies in their 3 years of fellowship (that is 6 months of imaging training, right?). Does that include echos, TEEs, cardiac CT/MRI and nucs? Or is that something just limited to echos?

Lets say you want to be level II certified in nucs and CT/MRI, do you have to do an additional year after fellowship? Thanks

There are four areas of non-invaisive imaging according to the ACC: TTE/TEE, Cardiac CT, Cardiac MRI, Nucs.

You can get level II in all of these areas in many, but not all, fellowship programs. You can get level III in TTE/TEE, but need an extra year for the others.

There is a COCATS training document on the ACC website which details all the requirements.

 

[gluon999]

There are four areas of non-invaisive imaging according to the ACC: TTE/TEE, Cardiac CT, Cardiac MRI, Nucs.

You can get level II in all of these areas in many, but not all, fellowship programs. You can get level III in TTE/TEE, but need an extra year for the others.

There is a COCATS training document on the ACC website which details all the requirements.

So lets say you get level II in all imaging modalities in your 3 years of fellowship, can you, as an attending, read these studies legitimately? If yes, then why the need for level III certification?

 

[cardsfellow2007]

So lets say you get level II in all imaging modalities in your 3 years of fellowship, can you, as an attending, read these studies legitimately? If yes, then why the need for level III certification?

So that you can "run" your own lab. I already have the numbers in all modalities to be level III, but need an administrative/academic project if I want to proceed as level III. From a legalistic perspective, I could already read them on my own (as a second year fellow this prospect is a little scary).

 

[wrx04silver]

From a realistic perspective, to suggest that you are level III trained in all of these modalities is downright laughable. In other words, you are full of ****.

 

[ucladukes]

From a realistic perspective, to suggest that you are level III trained in all of these modalities is downright laughable. In other words, you are full of ****.

I don't necessarily agree. I know at the program at my institution, the fellows definitely get the numbers for level III Echo certification and I am pretty sure they get the numbers for level III Nuc. CT and MRI, on the other hand, I believe there is not more than a couple of places where MRI and CT are level III certified in 3 years, rather, you have to do an additional year.

 

[cardsfellow2007]

From a realistic perspective, to suggest that you are level III trained in all of these modalities is downright laughable. In other words, you are full of ****.

Read above...

I have enough enough numbers for level III in all, but would need an extra year in all others besides echo to be signed off on them to run my own lab. Being able to read the studies is quite different than being able to run the whole ship!

 

[jeffreyfrog]

Of course it's a real job. A radiologist is a physican who specializes in the interpretation of medical images such as MRI scans, CT scans, x-rays, nuclear medicine scans, mammograms and sonograms. They are specially trained to identify injury and disease in each of the body's systems, whether bone, tissue, organs or blood vessels. Radiologists may specialize in fields such as neuroradiology, angiography, cardiovascular-interventional radiology, pediatric radiology or nuclear medicine. pleasanton radiation oncologist.