Reading vascular studies

[unlucky87]

Hi everyone,

I am trying to figure out what's the best way of learning to read vascular studies (courses?, books?). I'm a third year fellow, will be graduating this summer. Our program does not have dedicated vascular rotation and most vascular studies are read by a radiologist. Some of the jobs require to read vascular.

What's your experience been in real world reading vascular studies as a cardiologist?

Thanks in advance!

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[cards67]

Not sure about where to learn vascular outside of fellowship. But in a couple areas I'm familiar with very few cardiologists read vascular studies, most are done by radiology or surgery.

 

[mimelim]

For learning, the easiest is to simply do the pegasus lectures and question bank. Lectures+ questions will run you like $600, questions only will be $300.

RPVI - Pegasus Lectures

Your other option is to buy a vascular ultrasound book in place of the lectures. I was cheap and had a rep buy me a book and then I bought the question bank. But, then again, getting RPVI certified is a mandatory part of becoming board certified for us. If you want book recommendations, send me a PM.

 

[unlucky87]

For learning, the easiest is to simply do the pegasus lectures and question bank. Lectures+ questions will run you like $600, questions only will be $300.

RPVI - Pegasus Lectures

Your other option is to buy a vascular ultrasound book in place of the lectures. I was cheap and had a rep buy me a book and then I bought the question bank. But, then again, getting RPVI certified is a mandatory part of becoming board certified for us. If you want book recommendations, send me a PM.

Thank you for replying. Is board certification/exam required to read vascular studies? I'm graduating in June and I have two non-invasive/elective months left, so I'm thinking if it's worth doing it. We do not have a dedicated vascular teaching or formal rotation, however I can find attendings who are willing to read vascular studies with me to get the numbers.

 

[mimelim]

Thank you for replying. Is board certification/exam required to read vascular studies? I'm graduating in June and I have two non-invasive/elective months left, so I'm thinking if it's worth doing it. We do not have a dedicated vascular teaching or formal rotation, however I can find attendings who are willing to read vascular studies with me to get the numbers.

You need 500 studies to certify for RPVI. That is a lot, though can be done in 2 months if you have enough available studies to read. Since we are required to be RPVI certified to sit for our written boards, residencies have dedicated teaching for it, but it varies wildly. The big problem is insurance companies as to if is required. In the locale that I'm in, one of the big carriers does not require board certification, virtually every other one does. If they won't reimburse you for reading, hospitals won't let you read and will hire someone who can. I don't know how universal the insurance issue is across the US.

 

[badasshairday]

How would this be helpful for a cardiologist? It isn't heart related number 1. Number 2, at all hospitals I have seen mostly radiologists or to a lesser extent vascular surgeons read these studies. For outpatient clinic billing/imaging?

 

[maxxor]

How would this be helpful for a cardiologist? It isn't heart related number 1. Number 2, at all hospitals I have seen mostly radiologists or to a lesser extent vascular surgeons read these studies. For outpatient clinic billing/imaging?

I guess the Cardiologists near you haven't rebranded themselves as Cardiovascular medicine and pissed off both DR/IR and Vascular surgery simultaneously...

 

[IMreshopeful]

How would this be helpful for a cardiologist? It isn't heart related number 1. Number 2, at all hospitals I have seen mostly radiologists or to a lesser extent vascular surgeons read these studies. For outpatient clinic billing/imaging?

The fellowship is called cardiovascular medicine, so it’s well within our purview. We also have a LOT more ultrasound education and so a lot of this comes rather naturally.

There are numerous cardiology practices I’ve seen job alerts for which value having these skills I imagine primarily for outpatient vascular studies, less so inpatient.

 

[IMreshopeful]

I guess the Cardiologists near you haven't rebranded themselves as Cardiovascular medicine and pissed off both DR/IR and Vascular surgery simultaneously...

That’s been the name of the fellowship and the field for a while
Not sure why you guys are trying to turn this into a pissing contest

 

[maxxor]

The fellowship is called cardiovascular medicine, so it’s well within our purview. We also have a LOT more ultrasound education and so a lot of this comes rather naturally.

There are numerous cardiology practices I’ve seen job alerts for which value having these skills I imagine primarily for outpatient vascular studies, less so inpatient.

"A lot more ultrasound education" than whom? Compared to Radiologists (the most)? Vascular Surgeons (second most)? What? Yeah Cards reads a lot of echocardiography, but that doesn't magically make one qualified to read peripheral vascular studies.

That’s been the name of the fellowship and the field for a while
Not sure why you guys are trying to turn this into a pissing contest

It's strange for a Cardiology fellow to not know the minimum requirements for a skillset "well within our purview". It's far from universal for Cardiology trainees to read enough cases to sit for RPVI. This does not even get into the tremendous gripefests amongst all 3 specialties regarding peripheral vascular disease and stenting, which is what my comment was hinting at.

 

[IMreshopeful]

"A lot more ultrasound education" than whom? Compared to Radiologists (the most)? Vascular Surgeons (second most)? What? Yeah Cards reads a lot of echocardiography, but that doesn't magically make one qualified to read peripheral vascular studies.


It's strange for a Cardiology fellow to not know the minimum requirements for a skillset "well within our purview". It's far from universal for Cardiology trainees to read enough cases to sit for RPVI. This does not even get into the tremendous gripefests amongst all 3 specialties regarding peripheral vascular disease and stenting, which is what my comment was hinting at.

We routinely get the 500 cases (and easily across the various categories necessary) needed for RPVI at my institution, and many choose to qualify for it and take the exam. I plan to this year. But sure I clearly don’t know the requirements

Yes, I would say our ultrasound education is probably not as comprehensive as that of a radiologist, but we learn ultrasound physics in excruciating depth (major part of our boards) and yes, we utilize echocardiography and that gives us a good background that can help a LOT in vascular study reading. I’m not so sure I would call vascular surgeons “second place” in that regard but I’m not going to argue half baked opinions

What exactly is your aim though? To come into a cards forum and gripe about the fact that we do stuff that sometimes you guys also do? That’s cool bro

 

[maxxor]

We routinely get the 500 cases (and easily across the various categories necessary) needed for RPVI at my institution, and many choose to qualify for it and take the exam. I plan to this year. But sure I clearly don’t know the requirements

Yes, I would say our ultrasound education is probably not as comprehensive as that of a radiologist, but we learn ultrasound physics in excruciating depth (major part of our boards) and yes, we utilize echocardiography and that gives us a good background that can help a LOT in vascular study reading. I’m not so sure I would call vascular surgeons “second place” in that regard but I’m not going to argue half baked opinions

What exactly is your aim though? To come into a cards forum and gripe about the fact that we do stuff that sometimes you guys also do? That’s cool bro

I pass by the Cards forum every now and then because I read Cardiac CT and Cardiac Nucs. I don't think our fellows get enough cases for RPVI unless they do dedicated vascular medicine years.

 

[Scottish Chap]

"A lot more ultrasound education" than whom? Compared to Radiologists (the most)? Vascular Surgeons (second most)? What? Yeah Cards reads a lot of echocardiography, but that doesn't magically make one qualified to read peripheral vascular studies.


It's strange for a Cardiology fellow to not know the minimum requirements for a skillset "well within our purview". It's far from universal for Cardiology trainees to read enough cases to sit for RPVI. This does not even get into the tremendous gripefests amongst all 3 specialties regarding peripheral vascular disease and stenting, which is what my comment was hinting at.

If you’re dedicated to this subset of patients which I agree is well within the scope of practice of a cardiologist, I recommend doing a one year vascular medicine fellowship. There you will gain all the skills you need to sit for RPVI and the general vascular medicine board exam. Having the minimum documented studies to qualify to sit for an exam and being a content expert are two completely different things.

Somebody well-trained in comprehensive echocardiography will usually do well on the RPVI with preparation but be warned: we’ve had Cardiology Fellows pass the echoardiography exam only to flunk RPVI because they underestimated it.

 

[nlax30]

There are many other areas of medicine, whether diagnostic studies, procedures, diganoses, etc... that can be handled competently by 2 or 3 different specialists so bickering amongst ourselves (physicians) does nothing IMHO. I think certain vascular studies are certainly rightly in the purview of Cards, Vascular AND radiology. Who is actually reading this is likely more a function or local politics and practice patterns. Where I did general cards they read their own Carotid studies in the office though everything in the hospital was Radiology.

I will say that in a typical 3 year Gen Cards fellowship you will probably have to pick and choose which imaging modalities you want to focus on as it's unrealistic to truly get competent and adequate numbers (opinion, obviously) for ECHO, Nuc, Cardiac CT, MRI AND vascular US. I ended up getting "certified" in ECHO and Nuc. Briefly considered Cardiac CT and MRI though would've required another month or two of dedication to getting required case load and we just didn't do that many of those where I was at the time.

 

[DocTAWood]

Here is the overlap.... cardiology has the patients. IR and Vascular Surg are 100% referral dependent and will image and operate but don’t ubiquitously manage risk factors/secondary prevention. If you are following a cardiac patient for 5-25yrs and you aren’t looking beyond CAD for PAD, AAA, carotid disease and managing the risk factors for all you’re probably doing your pt a disservice. Most practices have recognized this and have incorporated the diagnostic testing to service those needs.

I got my RPVI by 3rd year of gen card, completed IC followed by a vascular/Endovascular fellowship and finished boarded in gen card, IC, vascular, Endovascular to go with RPVI. In my practice we’ve built a hospital system wide AAA screening program, multidisciplinary vascular clinic, claudication screening questionnaire program all extending beyond our practice effectively creating a clinical funnel. I medically manage 2/3 of my vascular patients (prescribe any statins radiology?) and use vascular rehab heavily since covered by CMS last fall. Still generate about 100-150 Peripheral interventions per year. Working with vascular surg I ceded EVAR to them and manage the pats up to that point, I do all their TF carotid stunting and now have added 50-75 TCAR per year with them... it’s not always adversarial. The one thing cardiology will always have is the high risk for vascular disease patient pool, and typically before other specialties do so it depends on how groups, systems, and yes.... politics... embrace that or not.

 

[DocTAWood]

As a 2nd thought... IMO.... ICAVL >>> ACR for vascular ultrasound accreditation and quality control which tends to favor vascular surgery and cardiology run labs over gen ultrasound department done vascular studies as long as the volume is there.... RVT techs > gen ultrasound... so honestly, the quality of the studies is often more dependent on the structure of the imaging department, volume, and staffing than it is which specialty reads the final product

 

[badasshairday]

Just depends where you are at. In an aggressive radiology practice we can choke hold all of the hospital based imaging including vascular lab because of our resources. Also... I put patients on statins and antiplatelets. Let us not kid ourselves, PAD medical management is not rocket science.

 

[TheNextLevel]

Just depends where you are at. In an aggressive radiology practice we can choke hold all of the hospital based imaging including vascular lab because of our resources. Also... I put patients on statins and antiplatelets. Let us not kid ourselves, PAD medical management is not rocket science.

I LoLd - you seriously sound like a medical student. What % of statin and antiplatelet prescription do you think vascular IR accounts for? How are you assessing compliance and troubleshooting side effects? What is your process for screening patients for CAD and managing ASCVD associated risk factors? Are your clinic staff obtaining PCKS9 inhibitor prior authorization for statin intolerant patients? How many of these patients are you following for >10 years? How are you maintaining certification and demonstrating proficiency in medical management of these patients? What makes you think you know the slightest about the work that goes into chronic medical management of any disease process?

I'd rather refer to a surgeon who understands what it means to take care of a patient than someone with the quoted attitude.

IR has an important role but you are a hospital utility service.

Be careful about making your views well known if you want to keep getting referrals. Cardiologists are clinicians first and we don't appreciate those who belittle patient care.

 

[badasshairday]

I LoLd - you seriously sound like a medical student. What % of statin and antiplatelet prescription do you think vascular IR accounts for? How are you assessing compliance and troubleshooting side effects? What is your process for screening patients for CAD and managing ASCVD associated risk factors? Are your clinic staff obtaining PCKS9 inhibitor prior authorization for statin intolerant patients? How many of these patients are you following for >10 years? How are you maintaining certification and demonstrating proficiency in medical management of these patients? What makes you think you know the slightest about the work that goes into chronic medical management of any disease process?

I'd rather refer to a surgeon who understands what it means to take care of a patient than someone with the quoted attitude.

IR has an important role but you are a hospital utility service.

Be careful about making your views well known if you want to keep getting referrals. Cardiologists are clinicians first and we don't appreciate those who belittle patient care.

Really? "belittle patient care"? I don't provide that? hmmm... news to me. Not even worth continuing a conversation with someone with this attitude. I guess I should consult cardiology every time IM or intensivist consults me on vascular issues be it DVT, PE, PAD. Don't worry about my referrals, I get plenty with my attitude. I could say a whole lot more but don't want to hurt your fragile ego. Feel free to DM me, Dr.

 

[TheNextLevel]

I LoLd - you seriously sound like a medical student. What % of statin and antiplatelet prescription do you think vascular IR accounts for? How are you assessing compliance and troubleshooting side effects? What is your process for screening patients for CAD and managing ASCVD associated risk factors? Are your clinic staff obtaining PCKS9 inhibitor prior authorization for statin intolerant patients? How many of these patients are you following for >10 years? How are you maintaining certification and demonstrating proficiency in medical management of these patients? What makes you think you know the slightest about the work that goes into chronic medical management of any disease process?

I'd rather refer to a surgeon who understands what it means to take care of a patient than someone with the quoted attitude.

IR has an important role but you are a hospital utility service.

Be careful about making your views well known if you want to keep getting referrals. Cardiologists are clinicians first and we don't appreciate those who belittle patient care.

Sounds good. Enjoy the hospital utility procedures. The folks taking care of the patient at the bedside have decided the patient needs a procedure before they call you.

 

[badasshairday]

Sounds good. Enjoy the hospital utility procedures. The folks taking care of the patient at the bedside have decided the patient needs a procedure before they call you.

Right.... Good luck.

 

[badasshairday]

Sounds good. Enjoy the hospital utility procedures. The folks taking care of the patient at the bedside have decided the patient needs a procedure before they call you.

And for the record. I disagree with you. I will continue medically managing. Cry me a river my friend. And my fav hospital utility procedure is injecting common femoral artery pseudoaneurysm by people who aren't very good at vascular access.

 

[Militarydoc1]

This back and forth is getting petty and not helping anyone. Just as you may feel competent in medically treating PAD, we are just as qualified in reading vascular ultrasounds. As everyone knows, there is a lot of overlap among various specialties in terms of scope of practice. That's why we are afforded the opportunity to have multiple board certifications. So if you can medically treat PAD, good for you. High five! But coming into a cardiology forum to discourage the OP or anyone interested from reading vascular ultrasounds makes you look like a troll with a chip on his shoulder.

OP,
In terms of market or demand for vascular readers, the opportunities are out there, especially in the outpatient setting. It's definitely a good source of extra revenue. Fortunately, at our hospital, we also read the inpatient vascular studies, but as others have already mentioned, inpatient readers are determined by local politics and influence. At the risk of over-generalizing, I feel interpreting vascular studies are relatively easier than reading echos and an easier transition than deciding to read nucs or cardiac CT. Best of luck and don't let any radiologist tell you any different!

 

[IMreshopeful]

And for the record. I disagree with you. I will continue medically managing. Cry me a river my friend. And my fav hospital utility procedure is injecting common femoral artery pseudoaneurysm by people who aren't very good at vascular access.

One of the easiest procedures in vascular medicine? I’ve learned how to do that long ago

 

[IMreshopeful]

This back and forth is getting petty and not helping anyone. Just as you may feel competent in medically treating PAD, we are just as qualified in reading vascular ultrasounds. As everyone knows, there is a lot of overlap among various specialties in terms of scope of practice. That's why we are afforded the opportunity to have multiple board certifications. So if you can medically treat PAD, good for you. High five! But coming into a cardiology forum to discourage the OP or anyone interested from reading vascular ultrasounds makes you look like a troll with a chip on his shoulder.

OP,
In terms of market or demand for vascular readers, the opportunities are out there, especially in the outpatient setting. It's definitely a good source of extra revenue. Fortunately, at our hospital, we also read the inpatient vascular studies, but as others have already mentioned, inpatient readers are determined by local politics and influence. At the risk of over-generalizing, I feel interpreting vascular studies are relatively easier than reading echos and an easier transition than deciding to read nucs or cardiac CT. Best of luck and don't let any radiologist tell you any different!

Agree, as I think mentioned, not sure why there’s so much butthurt here. We get excellent training in reading vascular studies. I’m taking the RPVI exam relatively soon. Everyone has their niche.

 

[Chaki]

i read above thread. But i saw one of my colleague has Pegasus lecture and question bank. The question bank is not that much. Like our echo and nuclear board we have good amount of question bank.
Any recommendation for question bank for RPVI?

 

[Scottish Chap]

i read above thread. But i saw one of my colleague has Pegasus lecture and question bank. The question bank is not that much. Like our echo and nuclear board we have good amount of question bank.
Any recommendation for question bank for RPVI?

Read more images under the guidance of someone well-qualified. The RPVI does not have many question banks for study because the exam is written in a way that you have to read the studies the way you would for clinical practice, and not miss anything. Echo has way more minutia and so you'll find more books and question banks.