The Future of the ACC Imaging Section: A Discussion With Todd C. Villines, MD, FACC
In the following interview, Andrew D. Choi, MD, FACC, co-director of cardiac CT and MRI at the George Washington University, discusses the current state and future vision of the ACC Imaging Section with Todd C. Villines, MD, FACC, immediate past-president of the Society of Cardiovascular Computed Tomography and new chair of the ACC Imaging Section.
AC: What are your current roles within cardiovascular medicine?
TV: Like most cardiologists, I wear several "hats." I am a clinically-active general cardiologist and multi-modality imager who practices in the inpatient and outpatient cardiology settings. In addition, I am the cardiology fellowship program director, director of Cardiac CT and director of cardiovascular research at the Walter Reed National Military Medical Center in Bethesda, Maryland.
AC: You also hold a number of key editorial roles, including with JACC: Cardiovascular Imaging, ACC'S CT-SAP, Journal of Cardiovascular Computed Tomography (JCCT) and have published over 150 peer-reviewed manuscripts in high-impact journals. How did you decide to enter cardiology and cardiac imaging? Any important mentors?
TV: Like too many Americans, cardiovascular diseases affected several of my family members, providing me with numerous opportunities as a young child to interact with cardiologists and motivation to help curb the epidemic of heart disease. I was fortunate to gain acceptance to the U.S. Military Academy at West Point where I learned that I could compete for one of a few spots that would allow me to go directly to medical school following my time as a cadet. Following medical school, I trained in internal medicine, was a chief resident, and then a cardiology fellow at Walter Reed where I was blessed to work closely under the mentorship of Allen J. Taylor, FACC. Through his leadership and vision, I was able to learn cardiac CT angiography, first at the Washington Hospital Center and then helped start a cardiac CT program at Walter Reed as a junior faculty.
AC: What do you see as your most important impact in the field of cardiac imaging?
TV: I have a passion for teaching. I hope that I have been able to impart lasting skills in the area of advanced cardiac imaging to my fellows, residents, referring providers and learners of all levels, both at the hospital level and through courses, research, editorials and sessions at international meetings.
AC: Your teaching has been an amazing way to "pay it forward" for many imagers both locally, in print and at international meetings. As the new chair of the ACC Imaging Section, what are your goals for the next two years?
TV: We have so much to do! First, the Imaging Section Leadership Council serves as an important voice within the ACC, providing input to college leadership on all topics related to imaging. We have already been active in assessing gaps in current ACC educational offerings related to imaging, feedback on payer and CMS policy changes and input into ACC.19 program planning.
Going forward, the Council has actively engaged with the editorial board of JACC Cardiovascular Imaging to work on manuscripts assessing trends in imaging utilization and management recommendations regarding choice of imaging tests in heart failure and coronary artery disease. In addition, we are planning to reinvigorate the ACC Imaging Section meeting at ACC.19, as well as expanding the Imaging Highlights sessions at ACC.19, where we plan to incorporate more Fellows in Training (FITs) and social media interaction. Lastly, we hope to advocate for reduced barriers to advanced imaging for patients. There is far too much heterogeneity in payer coverage for many imaging procedures, such as cardiac MRI and cardiac CT.
AC: There are many actions already being taken by the ACC Imaging Section nationally and there have been many rapid advances in cardiac imaging that include technological development, outcomes and comparative effectiveness research and machine learning. What do you believe will be the most important advances in cardiac imaging in the next five years?
TV: I am very excited to see the integration of machine learning and artificial intelligence to improving the accuracy and efficiency of all our cardiovascular imaging modalities. In addition, I feel that imaging findings will ultimately be proven to provide patients and providers with important prognostic information that require changes to preventive treatments that improve outcomes. Lastly, we have to continue to challenge the current testing strategies and look for ways to improve cost-effectiveness in how we test for coronary artery disease and evaluate patients with heart failure. However, the biggest advances may be proliferation of expertise and changes to coverage policies that better align with guidelines. In many parts of the U.S. and the world, access to cardiac CT, PET and cardiac MRI are far too limited due to payer restrictions or lack of test availability.
AC: Limited patient access is a key issue – in a recent Society of Cardiovascular CT President's Page you discuss significant heterogeneity regarding insurer coverage for cardiac CT despite broadening evidence and randomized trial data. This challenge is germane to cardiac imagers of all modalities. Would you be able to give an update to ACC efforts to address this need through recent initiatives such as ACC Imaging Section advocacy (Imaging and ACC PARTool) and potential new guidelines from the ACC Imaging Leadership Council?
TV: The ACC is tackling the issue of patient access to imaging care head on. Cardiologists and primary care providers are often frustrated by pre-authorization requirements that are laborious and obstructionist. I encourage ACC members to report such experiences using ACC's Prior Authorization Reporting Tool (PARTool) so that the ACC can engage with you and payers. Additionally, the science and guidelines are evolving. We are actively awaiting new guidelines for the evaluation of patients with chest pain that should help to improve the availability of testing options, such as coronary CTA, stress MRI and PET for patients. Lastly, the imaging council engages with leaders of all the subspecialty imaging societies to help coordinate efforts to improving imaging care.
AC: The PARTool has been an important way for the ACC to assess this problem nationally and section members are highly encouraged to report issues help guide the ACC Imaging Leadership Council. Shifting gears, what is your career advice for ACC FITs and Early Career Section members that have an interest in cardiac imaging?
TV: We need your help! There is a tremendous need for well-trained cardiovascular imagers. I would strongly urge fellows to consider seeking advanced training in cardiovascular imaging. However, it is imperative that all imagers remain focused on patients first. It is not about the modality or pretty pictures; our tests must provide cost-effective value to the patient and the entire health care system. Developing a reputation first as a clinically excellent cardiologist will only enhance a fellows' career in imaging. Seek out a mentor, volunteer within the ACC and imaging subspecialty societies, and network. Almost all ACC and subspecialty committees have at least one FIT or Early Career Section member.
AC: What opportunities are there from your perspective for ACC cardiac imaging FITs and members to get more involved with the ACC Imaging Section?
TV: There is at least one FIT and Early Career Section member on the ACC Imaging Council, so I encourage interested fellows to apply for the council. In addition, the ACC is very interested in inviting fellows to present cases as a part of ACC.19 and there are opportunities for fellows within the social media and ACC.org leadership. Lastly, if you are interested, please email me, any of our council leadership members, or Stefan Lefebvre (our ACC imaging section liaison) at email@example.com.
AC: What are some of your current interests outside of medicine?
TV: I enjoy hiking, fly fishing, basketball, running and helping coach sports for my son and daughter.
AC: Thank you for your outstanding enthusiasm, insights and leadership of the ACC Imaging Section! To follow-up on Villines' comments, here is how one can get further involved with the ACC Imaging Section:
First, make sure you are an Imaging Section member! Call ACC Member Care at (800) 253-4636, ext. 5603, or e-mail firstname.lastname@example.org. At the time of your regular ACC dues renewal, you can also "opt-in" to join the ACC Imaging Section.
Discuss this article and engage with members of #ACCImaging via Twitter on relevant and important updates on recent advocacy, education and science. Also visit the ACC Imaging Section page as new articles are frequently being posted.
Finally, remember to utilize the Advanced Imaging Training Program Database to identify advanced cardiovascular imaging training programs.