Noninvasive Cardiovascular Imaging Laboratories
Dr. Warren Manning supervises the Noninvasive Cardiovascular Imaging Laboratories which provide diagnostic services for both inpatients and outpatients. During rotations through the individual laboratories, fellows take an active role in the performance, analysis, and interpretation of a wide variety of cardiac tests, including two-dimensional (2D) and Doppler echocardiography, exercise and pharmacologic stress testing, radionuclide imaging, and cardiovascular magnetic resonance (CMR) studies. Rotations are designed for fellows to develop a comprehensive understanding of the indications for effective and cost-efficient use of diagnostic testing, the methodology of noninvasive cardiac techniques, and their application to the solution of clinical problems. Fellows participate in the ongoing teaching and research activities of the noninvasive section.
Echocardiography Laboratory. The Echocardiography Laboratory is an active service, performing over 13,000 studies per year.
The echocardiographic clinical experience is designed to enable each fellow to attain Level 2 training as defined by the American Society of Echocardiography. Among other responsibilities, fellows learn the basics of transthoracic echocardiography, perform examinations under the supervision of a cardiac sonographer, and assist in saline contrast studies, dobutamine stress monitoring, and portable/emergency studies.
A third-year fellowship in Echocardiography is offered for qualified fellows following completion of clinical training. The purpose of this advanced fellowship is to develop skills in echocardiographic-based research and undergo focused training in stress and transesophageal echocardiography. Third-year fellows are also responsible for teaching more junior fellows, as well as preparing case review and journal club conferences. The vast majority of those completing this year of additional training have gone on to academic appointments.
Cardiac MR Center. The BIDMC Cardiac MR has gained both a national and an international reputation for CMR innovation and expertise, specifically with regards to coronary artery imaging and imaging of atherosclerosis/subclinical disease utilizing a new 1.5T Phillips system. Clinical studies are referred from across the U.S. for the investigation of ventricular function, pericardial disease, myocardial viability, valvular disease, cardiomyopathy assessment, and coronary anomalies/coronary integrity. Attendance by all cardiology fellows assigned to the noninvasive imaging rotation is required, although all cardiology and radiology fellows are welcome and encouraged to attend. A broad range of research opportunities exists for fellows at all levels of training and interest. Attendance at the clinical reading sessions and January-June weekly CMR seminar allows all fellows to achieve Level I training in CMR.
Exercise Testing/Clinical Physiology. The Exercise/Clinical Physiology Laboratories are under the direction of Drs. Ernest Gervino and Robert Healy and include exercise treadmill, cycle ergometry, and pharmacologic tests used in over 6,000 maximal and submaximal evaluations each year. During their one-month annual rotation, fellows are exposed to the principles of exercise physiology and actively participate in clinical exercise testing for purposes of diagnosis, therapy evaluation, and prognostic assessment, as well as for understanding hemodynamic observations.
Electrocardiography Laboratory. The Electrocardiographic Laboratory, under Director Dr. John E. Markis, processes over 59,000 studies per year. This laboratory also serves as an important divisional teaching and training resource for the development of expertise in ECG interpretation by cardiology trainees as well as Harvard Medical students on the cardiology elective rotations. The resources of the laboratory, in collaboration with Dr. Ary L. Goldberger, also support clinical investigations in surface electrocardiography and the development of computer-based instruction ("ECG Wave-Maven" program).
Nuclear Cardiology. Under the direction of Dr. Thomas Hauser, Nuclear Cardiology is a collaborative effort with the Nuclear Medicine Division of BIDMC's Department of Radiology, providing fellows with the experience necessary to appropriately utilize and interpret a wide spectrum of cardiac radionuclide exams. During joint reading sessions with members of both the Cardiovascular Division and the Nuclear Medicine Division (three times per week) fellows interpret exercise and pharmacologic stress perfusion studies with thallium-201 and technetium-99m agents, radionuclide ventriculograms (RVGs), and first-pass examinations. All fellows fulfill Level I requirements for training in nuclear cardiology, necessary for admittance to the cardiovascular board examination. During the second and third years, arrangements may be made to gain further experience necessary for Level II or III training, required for nuclear cardiology certification examinations and Nuclear Regulatory Commission "licensure." The program also affords ample opportunity to participate in clinical research and other educational events such as the New England Nuclear Cardiology Working Group meetings.
Cardiovascular Computed Tomography (CCT). Co-directed by Drs. Thomas Hauser (Cardiology) and Melvin Clouse (Radiology), the CCT program at BIDMC is an active clinical service. Fellows gain exposure to CCT beginning early in the first year, and achieve level I proficiency in CCT by attending weekly clinical sessions, directed by the cardiology staff. Those interested in pursuing more advanced training in CCT, have an opportunity to ultimately achieve level II and III training, typically during their third or fourth year of training. Topics in CCT comprise a large portion of the Monday noon Fall Advanced Non-Invasive Imaging Lecture series, which occurs weekly. BIDMC was recently one of the few sites for the pivotal CORE-64 clinical trial, and there are a number of other opportunities for clinical research within the section. Three 64-slice CCT scanners are currently available (including one in the emergency department) with a 320-slice CCT scanner installation planned for May 2008.