A new multi-society Advanced Training Statement on Advanced Cardiovascular Imaging addresses the core competencies and training requirements necessary for advanced cardiovascular imagers across all four imaging modalities – echocardiography, cardiac computed tomography (CCT), nuclear cardiology and cardiac magnetic resonance (CMR).

The statement, published in JACC and co-chaired by Lauren Anne Baldassarre, MD, FACC, and Lisa A. Mendes, MD, FACC, provides a closer look at the rapidly evolving cardiovascular imaging landscape which has given rise to new imaging specialties like CCT and CMR and increased demand for dedicated cardiovascular imagers.

"The new training statement defines the imager of the future by laying out the new definition of an advanced imager as a cardiologist who practices all four major imaging modalities," said ACC President Christopher M. Kramer, MD, FACC. "This is a bold definition that will push trainees to expand their horizons and search out programs that are able to train them in all of the modalities."

Broken into several sections, the statement highlights general standards for faculty, facilities and equipment and multidisciplinary collaboration. It also addresses the training workflow and specific components of training as they relate to didactic programs, imaging modality selection, image acquisition and quality assessment, patient safety and management, occupational risks and management, imaging study interpretation and integration, and research and scholarly activity.

Specific training requirements are also provided, with the goal of providing a framework that "will allow trainees to become consulting cardiovascular imaging specialists who can guide decision-making regarding the appropriate imaging test or series of tests that may be required to inform patient management and optimize patient outcomes," write the authors.

Requirements focus on competency development and evaluation, including curricular milestones and common professional behavior competencies, as well as procedural and technical experience, ranging from minimum procedural volume to recommendations for cross modality imaging correlations and integration for diagnosis and clinical management of cardiovascular conditions (i.e., myocardial disease, valvular heart disease, stress testing, adult congenital heart disease, etc.) Necessary leadership and administrative skills are also a focus.

"Notably, this statement emphasizes the importance of integrating findings among the different imaging modalities as a foundational skill and provides examples to guide trainees and programs," write the authors. "Appropriate measures for assessing competence in the context of cardiovascular imaging training are also provided."

The statement was developed by the ACC, along with the American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. Other collaborating and endorsing societies include the American Association for Thoracic Surgery, American Association of Physicists in Medicine, American College of Radiology, Association of Black Cardiologists, American Society for Preventive Cardiology, Heart Failure Society of America, Heart Rhythm Society, International Cardio-Oncology Society, North American Society for Cardiovascular Imaging, Radiological Society of North America, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine and the Society of Thoracic Radiology.

In a related viewpoint article, Naman Upadhyay, MD; Paco E. Bravo, MD; and Vivek T. Kulkarni, MD, FACC, explain, "We are now at a pivotal point. Although the 2025 multisociety Advanced Training Statement provides essential guidance for training programs, significant barriers remain, ranging from variability in program structure and experience to lack of consistent funding and institutional support, an unpredictable application process, limited early exposure to imaging for general fellows, and ongoing challenges within the job market ... In combination with existing COCATS guidance, board certification examinations, and this training statement, formalized accreditation would help propel advanced cardiac imaging education to the same high-level standardized education that we expect from other cardiac specialties. The road may be long, but the destination is worth the effort."

Join experts from ACC's Cardiovascular Imaging Member Section on Tuesday, Nov. 25 at 6 p.m. ET for a webinar reviewing the development of the new statement, its key themes and role in advancing competency-based education. Learn more and register.