The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging

Abstract

Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of ‘Interventional Imaging’ for SHD interventions and a new dedicated professional figure, the ‘Interventional Imager’ with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.

Echocardiographic guidance in transcatheter structural cardiac interventions

“…The interventional imager can be subjected to high levels of radiation exposure due to their proximity to the X-ray source. Thus, a number of simple measures, such as the use of a protective lead coat, portable lead shielding, radiation reducing gloves, and distancing from the X-ray source, must be taken to minimise exposure and the associated risks 62 . In addition, the imager should be monitored for radiation doses during procedures and a record of the cumulative dose maintained.…”

“…Despite an increased demand for physicians with specific technical skills and competencies in SHD imaging, there is no standardised core curriculum for SHD interventional imagers so far 62 .…”

Let there be light! The meteoric rise of cardiac imaging

“…Finally, the role of echocardiography in the development of new treatment options for structural heart diseases has grown dramatically over the past decade, with novel catheter-based approaches such as transcatheter aortic valve implantation (TAVI), MitraClip, transcatheter mitral valve replacement, left atrial appendage occlusion and atrial septal defects closure 28. Multimodality imaging has played a crucial role in the success of these procedures, introducing routine echocardiography into the catheter lab.…”

Kompetenz und Innovation in der kardiovaskulären MRT: Stellungnahme der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung

“…Daher findet sich auch in vielen Empfehlungen der DRG zur Durchführung/ Befundung von CMR-Untersuchungen der Hinweis auf die enge Kooperation und Abstimmung mit kardiologischen oder kinderkardiologischen Kollegen [16,17]. Zusätzlich haben die Komplexität der Krankheitsbilder und deren Therapiemöglichkeiten innerhalb der Kardiologie in den letzten Jahren erheblich zugenommen, sodass am Beispiel der strukturellen Herz-erkrankungen und damit einhergehender Diagnostik, Planung der Prozeduren sowie diagnostischer Therapiekontrolle exemplarisch dargestellt werden kann, welche Expertise vorhanden sein muss, damit kardiologische Patienten optimal und entsprechend den heutigen Möglichkeiten/Kenntnisstand versorgt werden können [18].…”