CARDIAC
LOCATION & LIST
Faculty Representative: Dr. Mamatha Gowda | Attendings: Radiology- Dr. Adam Jacobi, Dr. Mamatha Gowda, Dr. Haneen Ali Cardiology - Dr. Kukar, Hunaina Shahab
Location: Mount Sinai West, 4th floor Radiology Ballroom
PACS worklist: Cardiac CT-MR, West CT Cardiac
CTA/MR Dictation Software: PRECESSION LOG IN INFO
Hours:
Day typically starts around 9:00 AM.
The day lasts until dismissed by the attending, average is 5:00 PM, but can be as late as 6:00 PM. Patient care always comes first.
Schedule:
Below is the typical schedule for a week.
Note: R2-R3s (optional for R4s) may be assigned a brief 5-10 minute cardiac topic to present (can be verbal or up to 10 ppt slides) - during one of the Fridays of their 2-4 week block.
Conferences:
Cardiothoracic Tumor Board, Mondays 4 PM
Pulmonary Fellows, Every other Thursday 12 PM
Attendings will send out meeting information
Presentation:
Choose a topic for your 5-10 min presentation
*10-minute presentation
Dictating/Programs:
Calcium Scores
Vitrea
WFM
Powerscribe
CTA Coronaries
Vitrea
WFM
GOALS AND EXPECTATIONS
Welcome to the Cardiac CT/MR Rotation! We are continuing to grow and happy to have you on with us to learn as much as possible. Please find below logistical information as well as expectations for the rotation.
Goals:
Cardiac CTA:
Perfect cardiac anatomy knowledge
Learn how to evaluate coronary arteries
Appreciate differences in plaque characteristics
Learn how to process and report a cardiac CTA including complex cases, CABG/PCI.
Learn how to evaluate for intracardiac thrombi and measure pulmonary vein ostia
Appreciate complex cardiovascular pathology
Learn how to make clinical decisions based on the findings
Cardiac MR:
Learn the details of image acquisition for CMR including planes/anatomy
Gain an understanding of the various sequences and their utility in assessing cardiac pathology.
Learn how to process a CMR including the various internal checks utilized for verification of volumes
Learn different delayed enhancement patterns and the differential diagnosis for each.
Gain exposure to a broad variety of cardiac pathology including HOCM, Sarcoidosis, Amyloidosis, myocarditis, CAD, among others.
Expectations:
Expectations:
We are devoted to providing an excellent service and teaching residents and fellows. We expect the following in return.
Days off should be requested in advance by a minimum of 3 days.
In a two-week block, no more than 1 absence is permitted.
In a four-week block, no more than 2 absences are permitted.
Residents are encouraged to be present at the CMR and CT scanners during cases to learn about image acquisition, optimization, and trouble shooting.
Residents are encouraged to pre-process MR scans after a day or two of learning the software. All scans will be reviewed with the attending of the day and corrections, if needed, will be made during the read out sessions.
Prioritize scans ordered by the following: "MDs Wissam Raad and Daniel Nicastri or NPs Geetika Arora and Karina Aloferdova" for interpretation.
TECHNIQUES
1) CALCIUM SCORING
Open 3 mm cuts in Vitrea
Draw ROIs around each calcification
Mesa calculator to calculate prematurity and severity
2) FUNCTIONAL
MULTI 0-90% - thick data set for functional analysis, cardiac functional from menu, LVfunctional analysis
Get data for ES, ED, SV, EF
If LV size is incorrect, for each phase, change the size markers, press compute
Check aortic valve # leafs, wall thickness, chamber and heart size, wall motion
3) CORONARY ARTERIES
Highlight and load all 0.5 cm thick slices to Vitrea
Cardiac arteries CT
3D analysis
Choose tab on the bottom with the least motion
65-70% RR interval is usually best
LEFT: count obtuse, marginals, circumflex, diagonals of LAD, ? ramus
RIGHT: SA nodal branch, conus branch
R/L dominant?
Use Precession to read Cardiac MRI
MS CVI Webpax (used to read cMRI)
Step-by-Step Guide: How to read Cardiac MR at MS West