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CARDIAC



CARDIAC ROTATION

Faculty Representative : Dr. Nina Kukar

Hours:  8:00 am – 5:00 pm

Location: Varies

Schedule:

As we run a dual site system with multiple attendings, the best course of action is to email all of the attendings (Dr. Harvey Hecht, Dr. Stephen Zink, Dr. Ahmadi, and Dr. Nina Kukar) the week prior to the rotation to clarify dates/locations/attendings. Below is the typical schedule for a week. Readout sessions are generally held between 4-5pm but may vary according to the attending of the day.


Mondays – MSSL

Cardiac CTA: Dr. Hecht

Cardiac MR: Dr. Kukar/Dr. Zink


Tuesdays – MSSL

Cardiac CTA: Dr. Hecht


Wednesdays – MSW - Echo lab 4th floor

Cardiac CTA: Dr. Kukar/Dr. Ahmadi

Cardiac MR: Dr. Kukar


Thursdays – MSSL

Cardiac CTA: Dr. Hecht/Zink

Cardiac MR: Dr. Kukar


Fridays – MSSL

Cardiac CTA: Dr. Zink

Cardiac MR: Dr. Kukar


Conference: N/A



GOALS AND EXPECTATIONS

Welcome to the Cardiac CT/MR Rotation! We are continuing to grow and happy to have you on with us to learn as much as possible. Please find below logistical information as well as expectations for the rotation.


Goals:


Cardiac CTA:

  • Perfect cardiac anatomy knowledge
  • Learn how to evaluate coronary arteries
  • Appreciate differences in plaque characteristics
  • Learn how to process and report a cardiac CTA including complex cases, CABG/PCI.
  • Learn how to evaluate for intracardiac thrombi and measure pulmonary vein ostia
  • Appreciate complex cardiovascular pathology
  • Learn how to make clinical decisions based on the findings


Cardiac MR:

  • Learn the details of image acquisition for CMR including planes/anatomy
  • Gain an understanding of the various sequences and their utility in assessing cardiac pathology.
  • Learn how to process a CMR including the various internal checks utilized for verification of volumes
  • Learn different delayed enhancement patterns and the differential diagnosis for each.
  • Gain exposure to a broad variety of cardiac pathology including HOCM, Sarcoidosis, Amyloidosis, myocarditis, CAD, among others.


Expectations:

We are devoted to providing an excellent service and teaching residents and fellows. We expect the following in return.

  • Days off are requested in advance by a minimum of 3 days.
  • In a two-week block, no more than 1 absence is permitted. In a four-week block, no more than 2 absences are permitted.
  • On the first day of your rotation, report to the MSSL Nuclear Medicine Department. The Cardiac Imaging Fellows will be your colleagues during this course.
  • M/W/F residents/fellows will be present at the CMR scanner during cases to learn about image acquisition, optimization, and trouble shooting.
  • Tu/Th and in between CMRs on M/W/F, residents/fellows will be present at the CT scanner during cases to learn about image acquisition, optimization, and trouble shooting.
  • Scans will be pre-processed by the resident/fellow after a day or two of learning the software. All scans will be reviewed with the attending of the day and corrections, if needed, will be made during the read out session.


RESOURCES

Introductory presentations from UVA on cardiac MR
Intro lectures from CTISUS

1) CALCIUM SCORING 
  • Open 3 mm cuts in Vitrea
  • Draw ROIs around each calcification
  • Mesa calculator to calculate prematurity and severity
2) FUNCTIONAL
  • MULTI 0-90% - thick data set for functional analysis, cardiac functional from menu, LVfunctional analysis
  • Get data for ES, ED, SV, EF
  • If LV size is incorrect, for each phase, change the size markers, press compute
  • Check aortic valve # leafs, wall thickness, chamber and heart size, wall motion
 
3) CORONARY ARTERIES
  • Highlight and load all 0.5 cm thick slices to Vitrea
  • Cardiac arteries CT
  • 3D analysis
  • Choose tab on the bottom with the least motion
  • 65-70% RR interval is usually best
  • LEFT: count obtuse, marginals, circumflex, diagonals of LAD, ? ramus
  • RIGHT: SA nodal branch, conus branch
    R/L dominant?