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CARDIAC



CARDIAC ROTATION

Faculty Representative : Dr. Concepcion and Dr. Gupta

Hours:  Day typically starts around 9:30-10 AM. The day lasts until dismissed by the attending.

Location: Typically at West: 4th floor Radiology Ballroom. Confirm with attending the day prior.

Schedule:

Below is the typical schedule for a week. Residents are expected to give a brief 10-minute presentation (up to 10 ppt slides) on a cardiac topic each Friday.


Mondays – MSW

Cardiac CTA/MR: Dr. Concepcion 

*Choose a topic for your 10-minute presentation.


Wednesdays – MSW

Cardiac CTA/MR: Dr. Gupta


Thursdays – MSW

Cardiac CTA/MR: Dr. Gupta


Fridays – MSW

Cardiac CTA/MR: Dr. Gupta and Dr. Concepcion

*10-minute presentation


Conference: Chest Tumor Board every Monday at MSW. 



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 should be 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.
  • Residents are encouraged to be present at the CMR and CT scanners during cases to learn about image acquisition, optimization, and trouble shooting.
  • Residents are encouraged to pre-process scans 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 sessions.


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?