SCCT Prez: Is cardiac CT training up to snuff?

The Society of Cardiovascular CT (SCCT) will assemble an ad-hoc committee to review cardiac CT training requirements in an effort to improve scan and interpretation quality, according to SCCT president John R. Lesser, MD.

In his President’s Page column, published online ahead of print in the Journal of Cardiovascular Computed Tomography (JCCT), Lesser wrote that many people who perform cardiac CT are concerned about the variability of scan quality and interpretation.

Coronary CT angiography (CTA) has been shown to have high negative predictive value and accuracy in patients with chronic chest pain, and its use in the emergency department is cost-effective and safe. However, noted Lesser, these results are based on research performed in experienced, high-volume centers.  

“Given that the real value of the technique will depend on the results seen after widespread implementation in clinical practice, what can patients and ordering physicians expect? Specifically, can the results seen in CT trials also be reproduced when performed at low-volume centers with Level 2 readers,” asked Lesser.

He summarized the limited published information on training, citing a 2010 JCCT study that showed two inexperienced physicians improved diagnostic specificity and interobserver reproducibility in reviewing coronary CTA scans over time. Likewise, a 2009 study in Radiology that followed four physicians showed little advancement within six months, but the diagnostic odds ratio for two of the readers did improve by the end of one year. Other studies demonstrated the importance of experience and training models that stress error reporting and feedback.

Despite the research, Lesser said it’s currently accepted that a cardiologist or radiologist in practice can acquire the necessary experience in less than one week to achieve Level 2 training and become an independent reader in an accredited CT lab. He lamented the lack of rigorous time frame requirements and said it could have implications for coronary CT.

“Clearly, the available data supporting any specific minimal training requirement is sparse, but the importance of adequate training is critical to the long-term acceptance and survival of cardiac CT,” wrote Lesser.

He suggested the first step is to begin the process of determining whether there’s agreement on the existence of a problem, and to that end, a short survey about scan quality and current training requirements will be sent to experienced cardiac CT readers. The ad-hoc committee will review the training requirements for those out of fellowship.

It is SCCT’s role, according to Lesser, to oversee the quality of cardiac CT and to ensure it lives up to its research potential.

Lesser is director of cardiovascular CT and MRI at the Minneapolis Heart Institute/Abbott Northwestern Hospital and an adjunct associate professor of medicine at the University of Minnesota.