B. Introduction

1.  History:    This fellowship is recognized by Harbor-UCLA GMEC.   There is no officially recognition by the Accreditation Council for Graduate Medical Education (ACGME) for such a program.  However, this fellowship has been training residents/fellows/Cardiologists and Radiologists for many years. Almost 100 candidates have completed training since conception.  

 

2. Duration.  Each fellow spends a minimum of 1 year in the training program. In certain cases the training will be 2 years.

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3. Prerequisite Training/Selection Criteria. Candidate Qualifications: 

MDs with specialty in internal medicine, cardiology or radiology.   Fellow applicants will be chosen from an application/interview process.  Previous research experience, letters of recommendation and prior training will be used as criteria for selection. 

 

Graduates of international medical schools participating in clinical studies must have passed the credentialing requirements of Educational Commission for Foreign Medical Graduates.

 

4. Goals and Objectives for Training. 

This fellowship program is designed to develop broad-based expertise in cardiovascular CT and MR, biostatistics, and image processing. Upon completion of the program, fellows will be able to image all forms of cardiovascular disease with cardiovascular imaging and to answer clinical questions with a greater degree of expertise and freedom than is generally available currently.  They will be eligible to sit for the Cardiovascular CT board examination and achieve Level 3 in Cardiovascular CT and could achieve level 2 MR training during the year.

 

The major purpose of this fellowship training is to prepare individuals for careers in academic cardiology. Therefore, emphasis is placed on the understanding not only of the technical aspects of imaging, but also on physiology and pathophysiology. Fellows will be trained in writing protocols, manuscripts, and grant proposals. It is anticipated that at the end of their training, these highly qualified and skilled individuals will be able to launch a productive research career and be able to teach this modality to other physicians.  The primary goal of this program is to allow physicians to become clinical experts in cardiac CT and MR scanning, growing modalities with widespread utilization in practice.   Furthermore, opportunities to expand echocardiography and nuclear imaging as desired by the fellow.

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All MDs who desire expertise in clinical imaging need to perform enough examinations in order to qualify as a director of clinical laboratories at their institutions. The number of examinations is in accordance with the level III competence level determined by the American College of Cardiology. All fellows who successfully complete this program will achieve level III competency under the Society of Cardiovascular Computed Tomography.  

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5. Program Certifications – the CT scanner program is accredited by the Intersocietal Accreditation Commission (IAC) for CT laboratories and a recognized cardiac CT training program by the Society of Cardiovascular Computed Tomography and the American College of Cardiology. 

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C. Resources

1. Teaching Staff. List the teaching staff involved in providing the educational

experience and their supervisory responsibilities over the participant(s). 

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The primary faculty will be Matthew Budoff, MD, who has been doing cardiac CT scanning for over 25 years.  Dr. Budoff has written the Competency Guidelines for Cardiac CT for the American Heart Association/American College of Cardiology, as well as first authored the only two versions of the COCATS Training Requirements for Cardiovascular Training.  He was the primary author on the Scientific Statement from the American Heart Association on Cardiac CT, and currently sits as a founding member of the ICACTL (accreditation board for CT labs) and CBCCT (certification board of CCT).   Other faculty involved in direct training and supervision include Professors Hans Fisher (Cardiac Radiologist), Ronald Oudiz (Cardiologist). Sion Roy (Cardiology) and Jina Chung (Cardiologist).

 

2. Facilities. All training will be conducted is Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Center.

 

D. Educational Program - Basic Curriculum

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1. Clinical and research components.

Fellows will perform in-depth training in CT and MR.  Fellows will work in the experimental and clinical imaging laboratory.  The clinical responsibilities include administering and interpreting cardiac CT scans daily in the scanning suite, as well as participation in all cardiac imaging lectures.  There are multiple ongoing clinical trials utilizing cardiovascular computed tomography and the fellow will be responsible to assist/participate in multiple clinical trials during the advanced imaging fellowship.

 

2. Participant’s supervisory and patient care responsibilities

The fellow will also have teaching responsibilities for cardiac fellows and/or radiology residents who rotate through the cardiac imaging rotation, as well as outside physicians or trainees.    Fellows will have direct supervision responsibilities for inpatients and outpatients undergoing cardiac CT scans during the year. 

 

3. Procedural requirements

Fellows will be required to perform intravenous access, as well as supervision and interpretation of cardiovascular computed tomography during the year.  

 

4. Didactic components

Fellows will go through and help act as proctors for formal Level 2 and Level 3 courses on Cardiac CT (which are currently offered bi-monthly) as well as two national CME courses.  One course is the Society of Cardiovascular Computed Tomography Annual Meeting and the other is the ACC and/or AHA meeting.  Fellows will also have recommended attendance in the weekly Cardiovascular catheterization conference, weekly cardiac imaging conference and Cardiology grand rounds.  

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In addition to the modality-specific training that they will acquire from attendance in the Level 2 and 3 courses held in cardiac CT and MR, each fellow will undergo formal training in biostatistics from the Los Angeles Biomedical Research Institute lecture series, as well as courses in Responsible Conduct of Research, Fundamentals of Clinical Research and specific technical courses on radiation safety, environmental hazards, and research ethics. 

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Weekly sessions are held on physiology and pathophysiology, role of imaging in various disease processes, management of patients based on imaging parameters, and outcomes analysis. A bi-monthly laboratory meeting is held to present work in progress and receive feedback. 

 

E. Evaluation

 

Each fellow is evaluated by faculty in the Cardiovascular CT Imaging Center who have had direct contact with the fellow. Counseling/guidance/feedback are provided to each fellow twice a year during a one-on-one meeting with the fellow's supervisor and director of the Cardiovascular Advanced Imaging Center. Dr. Matthew Budoff will act as the program director.  Areas of weakness are identified and approaches to address these weaknesses are suggested at these evaluation meetings. Fellows also evaluate the program in general and the supervisor and other mentors in particular. 

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At the end of the training, the principal mentor (supervisor) will certify that the requirements at a particular level of skills have been met. The levels of skills needed, are determined a priori for each individual fellow depending on their training needs as well as the skills they have already obtained. A certificate of completion of fellowship training in Cardiovascular Advanced Imaging Fellowship is awarded to each fellow at the end of the training period. 

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F.  Magnetic Resonance Imaging Exposure

 

All CT fellows will have exposure to cardiac MR scans when performed by Dr Jina Chung.  This volume is increasing in our institution and we expect a signficant time afforded to MR for our advanced imaging fellows.  There is an extensive MR teaching file and lecture series by Dr Chung as part of the core curriculum.  Exposure to nuclear and echocardiography is available and can be individualized to fellows interests. 

 

G.  Salary

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Advanced Imaging fellows will make annual stipend per year, plus benefits including healthcare coverage.  Moonlighting opportunities exist and are permitted to supplement the above salary.  The fellowship will cover expenses to travel to the American College of Cardiology and Society of Cardiovascular Computed Tomography meetings each year. 

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Matthew Budoff, M.D., F.A.C.C.

Cardiovascular Medicine Fellowship Training Director

Harbor-UCLA Medical Center

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REFERENCES:

 

1. Garcia MJ, Blankstein R, Budoff MJ, Dent JM, Drachman DE, Lesser JR, Grover-McKay M, Schussler JM, Voros S, Wann LS. COCATS 4 Task Force 7: Training in Cardiovascular Computed Tomographic Imaging. J Am Coll Cardiol. 2015 May 5;65(17):1810-21. doi: 10.1016/j.jacc.2015.03.028. Epub 2015 Mar 13. PMID: 25777650

2. Kramer CM, Budoff MJ, Fayad ZA, Ferrari VA, Goldman C, Lesser JR, Martin ET, Rajagopalan S, Reilly JP, Rodgers GP, Wechsler L. ACCF/AHA 2007 Clinical Competence Statement on Vascular Imaging With Computed Tomography and Magnetic Resonance: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol 2007:50;1097-114. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JAC, Rader DJ, Rubin GD, Shaw LJ, Wiegers SE.  Assessment of Coronary Artery Disease by Cardiac Computed Tomography, A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006;114(16):1761-91.​

3. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC Jr, Taylor AJ, Weintraub WS,Wenger NK.  2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.  J Am Coll Cardiol, 2010; 56:50-103

4. Mark DB, Berman DS, Budoff MJ, Carr JJ, Gerber TC, Hecht HS, Hlatky MA, Hodgson JM, Lauer MS, Miller JM, Morin RL, Mukherjee D, Poon M, Rubin GD, Schwartz RS. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010 Jun 8;55(23):2663-99 PMID: 20687247​​