The recent advances in cardiac imaging techniques have created an increasing interest in training cardiology fellows in multiple different imaging modalities. Advanced training or Level III training in echocardiography, nuclear cardiology, cardiac CT (CCT) and cardiac MRI, or combination of the above, pose a dilemma to the cardiology fellows and the training programs nowadays.

Based on the COCATS 4 document, level III training in one or more imaging modalities requires additional experience beyond the standard three-year cardiovascular fellowship to acquire specialized knowledge and competences in performing, interpreting and training others to perform specific procedures or render advanced care at a high level of skill.

Of course, that means more training time, effort and time for the trainees and organization, expert faculty and staff, advanced equipment and structured curriculums for the training programs to be able to cover the standards for training fellows in multimodality imaging.

Why Pursue Multimodality Imaging Training?

The obvious answer in an interview for a multimodality imaging position would be because the trainee would like to deeply understand the different modalities, their indications, and their strengths and weaknesses in cardiac diagnoses, and combine them in an effort to provide the best possible care to cardiac patients.

Though the answer may be true to an extent, it probably does not tell the whole story.

Speaking from my personal experience (level III training in echocardiography, level II training in nuclear cardiology, CCT and vascular interpretation) and having had discussions with my fellows and other cardiac imagers, one of the main reasons for multimodality imaging training is to make ourselves more marketable.

There is a perception that advanced training in multiple imaging techniques would enhance job prospects in a quite competitive market.

Another reason is that multimodality imaging training could help the trainee pursue an academic career in cardiology that would combine performing and interpreting different cardiac imaging techniques and developing research opportunities through that combination.

Where Do Cardiologists With Multimodality Imaging Training Work?

Currently, there is not enough data regarding the job placement for cardiologists pursuing multimodality imaging training. Some limited data show that despite advanced training, many of these cardiologists have a large burden of clinical responsibilities and are asked by the employer to focus on one or two imaging modalities in their practice, rather than using their broad spectrum of expertise.

Though majority of cardiologists with multimodality imaging background try to pursue jobs in academic institutions, we have no clear information on how many end up in private practices and how their knowledge is used.

Using my own experience, I work in a hospital-based, mostly clinical group and only focus on echocardiography, performing and interpreting all forms of it and providing echocardiography support for the structural procedures in our institution.

Discuss the Financial Burden in Obtaining Board Certifications in Multiple Cardiac Imaging Modalities

Board certification examinations are currently provided by different organizations for each imaging modality. The National Board of Echocardiography offers the certifying exam for echo. The Alliance for Physicians Certification and Advancement offers the Certification Board of Nuclear Cardiology and the Certification of Cardiovascular Computed Tomography.

The financial burden for separate certifying exams for each imaging modality is huge for the cardiology trainee. The effort and time to achieve the requirements and prerequisites for each of these exams and the money spent in preparation can be prohibitive for many cardiologists, especially at the early career stage.

Suggestions for Improvement

It would be helpful to have data on the jobs obtained by multimodality-trained cardiologists. The creation of database where the training programs can provide this information to an organization like ACC would be ideal.

The goal should be to take full advantage of the advanced training and expertise of these individuals by placing them into positions that they can further develop and advance and pass their expertise to the next generation of cardiologists.

Though difficult to occur at that time, we may need to start thinking of a combined imaging society that not only assures consistency in recommendations and training but also reduces the financial burden of the multiple certifying exams.