The following are key points from the 2025 ACC/AHA/ASE/ASNC/SCCT/SCMR Advanced Training Statement on Advanced Cardiovascular Imaging: A Report of the ACC Competency Management Committee:

1. The Advanced Cardiovascular Imager should possess the knowledge and skills to independently perform and interpret all cardiovascular imaging modalities – cardiovascular computed tomography, cardiovascular magnetic resonance, echocardiography, and nuclear cardiology – across a broad spectrum of clinical indications, including the ability to integrate imaging and clinical data in making clinical recommendations.
2. Multimodality cardiovascular imaging has become central to the diagnosis and management of patients across all aspects of cardiovascular disease, including coronary artery disease, heart failure, valvular heart disease, structural heart disease interventions, electrophysiology, congenital heart disease, and preventive cardiology.
3. Training in multimodality cardiovascular imaging requires additional training beyond the general cardiovascular disease fellowship in order to attain the necessary knowledge and skills across all modalities, including the ability to integrate information from different imaging tests with clinical data to make effective recommendations.
4. Because of the training requirements to attain competence for each cardiovascular imaging modality, cardiovascular disease training programs should explore opportunities to facilitate imaging training at an early stage in the fellowship. This may reduce the amount of additional training time required beyond general fellowship for individual modalities.
5. Imaging facilities and resources should support training needs and allow for integration of data acquired across the different imaging modalities. If aspects of multimodality cardiovascular imaging training are not available within a cardiovascular imaging training program, opportunities to acquire the training at other centers or through other resources should be provided.
6. Training program faculty should include experts in each cardiovascular imaging modality as well as individuals with specific expertise in multimodality imaging.
7. Multimodality cardiovascular imaging training should leverage knowledge and skills which are similar between modalities to improve training and minimize repetition. Trainees should understand the advantages and disadvantages of each cardiovascular imaging modality for a wide range of clinical scenarios. The multimodality imager should be able to provide imaging consultations, including how to select the best test for a given clinical scenario and how to use the results of prior imaging tests in test selection. Ultimately, the multimodality imaging specialist will be able to provide consultation on how to best use the results of imaging tests in making effective patient management decisions.
8. Detailed understanding of technical aspects of imaging, including understanding of physics principles, image acquisition techniques, and other technical factors, is required for the imaging specialist. Understanding these principles will aid in exam interpretation, improve image quality, ensure patient safety, and allow for a better understanding of how to select between different testing options.
9. The document emphasizes a multidisciplinary, patient-centered approach to multimodality imaging, supported by the 25 participating professional societies.
10. Physicians who choose to pursue more limited training in cardiovascular imaging (i.e., not involving all modalities) should consider acquiring the pertinent knowledge and skills outlined in this document, given it reflects significant advancements in the field.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Cardiology Magazine, ACC Publications, Cardiac Imaging Techniques, Magnetic Resonance Spectroscopy, Heart Defects, Congenital, Tomography, X-Ray Computed, Heart Valve Diseases, Thoracic Surgery, Heart Failure, Anesthesiologists, Radiology, Cardiomyopathies, Cardio-oncology, Echocardiography, Angiography