Department of Radiology
School of Medicine Queen's University
 

Cardiac Rotation Welcome Document

Cardiac CT and MRI Rotation Expectations

Welcome to your Cardiac Rotation. Dr. Dominique DaBreo, Dr. Rob Dhillon, and Dr. Justin Flood are your friendly Cardiothoracic Radiologists found in the Cardiothoracic Reporting Room 22.1.166.

 

CARDIAC CT/MRI Goals

  1. Understand proper protocols for cardiac CT/MRI
  2. Understand standard, evidence-based indications for cardiac CT/MRI
  3. Understand limitations of cardiac CT/MRI
  4. List potential artifacts in cardiac MRI and CT and strategies for avoiding/overcoming them
  5. List ways for dose reduction in Cardiac CT
  6. Understand application of MRI results in adult congenital heart disease population
  7. Understand future applications for CT/MRI in cardiac care

Daily Work Flow - Cardiac MRI

  1. Be on time, please arrive by 8:00 AM to Cardiothoracic reporting room. Please look ahead to Radiologists schedule to see who you will be working with.
  2. Morning MR protocolling to be done by the resident, red folder in MR room. Please reference Cardiac MRI protocols and must be reviewed with Radiologist.
  3. Cardiac MRI take place Monday, Tuesday and Friday 11:00am to 3:00pm.Please meet with MRI technologists daily in the AM to find out cases on the board.
  4. Observe daily Cardiac MRI acquisitions during your rotation at least one of each protocol cardiomyopathy, viability, congenital, shunt etc.
  5. Observe post processing Cardiac MRI on Argus workstationin Cardiothoracic Imaging Room. During rotation at least one of each protocol cardiomyopathy, congenital, shunt etc.
  6. Report all Cardiac and Thoracic MRIs while on rotation.
  7. Attend Cardiology Radiology Rounds Biannually



Daily Workflow - Cardiac CT

  1. Cardiac CT takes place Wednesday AM at HDH. Please arrive at 8:00 AM.
  2. Observe and supervise Cardiac CT
  3. Observe post processing Cardiac CT on Vitrea workstation including Coronary CTA, TAVI and gated aortograms
  4. Report all Cardiac CTs performed at HDH
  5. Report pulmonary veins, TAVI and coronary CT performed at KGH. Found in the Cardiac CT queue.
  6. Review the 50 cases in teaching file, contact Dr. DaBreo for file.

Cardiac CT and MRI templates

Please ensure for Dr. Flood, Dr. Rob Dhillon and Dr. Dominique DaBreo to use the templates for Chest reporting. Please reference Cardiac CTA, CT pulmonary vein, TAVI, Cardiac MRI and Aorta MRI templates. Please clone templates into your macros in advance of the rotation.

SUGGESTED READING/TUTORIALS PRIOR TO START OF ROTATION

https://www.med-ed.virginia.edu/courses/rad/cardiacmr/index.html

http://pubs.rsna.org/doi/pdf/10.1148/rg.2015140181 Current and Novel Imaging Techniques in Coronary CT

http://pubs.rsna.org/doi/pdf/10.1148/rg.291085052 A Pattern-based Approach to Assessment of Delayed Enhancement in Nonischemic Cardiomyopathy at MR Imaging

 

 

 

 

 

Cardiac CT protocols

1. CORONARY CTA (ECG gated heart) +/- CALCIUM SCORE

2. ASCENDING AORTA (can be done with or without IV contrast and gated or non-gated).

3. PULMONARY VEIN (ECG -Gated heart).

4. TAVI (Retrospective ECG gated heart, nongated CTA CAP)

5. DISSECTION: LDT chest without and contrast enhanced chest arterial phase.  If positive study for Type B should extend study to include abdomen +/- pelvis. If high pretest probability for Type A, perform study gated.

6. DOUBLE RULE OUT: Specific protocol designed for optimal enhancement of both the pulmonary arteries and thoracic aorta. Rule out PE and aortic dissection. We DO NOT perform triple rule protocols.


Cardiac MRI protocols

  1. Aorta (quick)
  2. ARVC
  3. Cardiogenic stroke
  4. Coronary Artery
  5. Iron cardiomyopathy
  6. Mass
  7. Cardiomyopathy Myocarditis/Amyloid/Sarcoid/HOCM
  8. Pulmonary hypertension
  9. Pericarditis

10. Shunt ASD, VSD, PAPVR

11. Vasculitis

12. Viability

 

Please reference North American Society of Cardiovascular Imaging NASCI website Cardiovascular Imaging Curriculum: http://www.nasci.org/Education/Education-with-NASCI

 

Please see Cardiothoracic Teaching Folder on the V drive for reference articles. Reference ABR core study guide articles for Cardiac Imaging http://pubs.rsna.org/page/radiographics/abr-core-exam-study-gu