The North American Society for Cardiac Imaging (NASCI) is an
international organization dedicated to the advancement of cardiovascular imaging.

The introduction of new imaging modalities based on digital technology presents exciting opportunities and challenges for cardiovascular diagnosis. Perhaps Magnetic Resonance Imaging is the best example of this dilemma. Its use for optimal patient management requires not only a sound clinical knowledge of cardiology but also sufficient knowledge of MRI techniques. Radiology and Cardiology face a number of serious issues:

1. The need for trainees (residents or fellows) and faculty to be comfortable and properly trained to perform these studies as well as having enough cardiac training in other modalities.
2. Cardiologists are showing more interest in MRI for cardiac as well as angio applications.
3. Possible decline in quality of patient care if turf battles were to erupt.
4. The need to develop a team approach. The cardiologists control the patients whereas the radiologists have the MRI equipment and radiology expertise, and should have the physics as well as cardiac knowledge base.

It should be no surprise to many of you that the issue of competency for the performance of cardiovascular MRI studies and potential turf battles have risen to the forefront. In response to this, and the prior actions by NASCI (the historical background is summarized later in this article), the American College of Radiology (ACR) has created "The Committee for Cardiovascular Imaging" headed by Michael J. Pentecost. This committee organized a one-day "brainstorming" meeting on July 8, 1999 to generate ideas about how to raise the standards of cardiovascular imaging. Martin Lipton, Andre Duerinckx, Paul Julsrud and many other NASCI members were invited to this first meeting. A report on the meeting will be forthcoming from the ACR leadership and will be communicated to all NASCI members. The ACR Committee for Cardiovascular Imaging may create a Task Force to implement their tactics, with representation from many societies, including NASCI.

NASCI leadership has given a lot of attention to the need to re-engineer cardiac imaging. We have taken the initiative to make the radiology community aware of these issues and have the support of other radiology organizations such as the ISMRM, STR, SCVIR, the Council on Cardiovascular Radiology of the American Heart Association, and the MR Angiography Club. The following strategies have emerged from our early discussions and debates:

1. Accreditation and credentialing of cardiovascular imaging should ultimately be handled at the ACR-ACC level.
2. Cardiac MRI and MR angiography should be viewed as one, including not just coronary MR angiography but also body and thoracic MRA.
3. Training programs need to be created and supported for radiologists with a parallel effort to train cardiologists.
4. We need to identify those who can do the training and how the training will be funded.

For those who may have missed the history behind these developments, we will briefly review some of the events that triggered the activity mentioned above. During the American Heart Association meeting in Dallas, in 1998, William Stanford, MD, Chairman of the New Imaging Modalities Subcommittee of the Council of Cardiovascular Radiology (CCR), received a draft copy of "Guidelines for Competency in Cardiovascular Magnetic Resonance" by the Society for Cardiovascular Magnet Resonance (SCMR). NASCI leadership raised objections to the proposed guidelines to the AHA because they appeared to exclude radiologists. We alerted our colleagues in radiology and cardiology and the ACR reacted by creating the "Committee for Cardiovascular Imaging". Since then, NASCI and SCMR are now working together to revise the guidelines and make them more universal.

Other developments are summarized below:

• NASCI formed an informal "Intersociety Radiology Guideline Committee", grouping representatives from NASCI, STR, ISMRM, SCVIR, AHA, the MRA Club and any other organizations interested in these issues.
• The committee held its first meeting during the 1999 ISMRM meeting in Philadelphia.
• The SCMR formed a joint cardiology/radiology guidelines committee, with Charles Higgins, Rod Pettigrew and Thomas Grist representing radiology. The committee met for the first time on May 23, 1999 at the beginning of the ISMRM meeting in Philadelphia.
• During this meeting, it was agreed by SCMR to broaden the guidelines so that board certified cardiologists and board certified radiologists would both qualify. In addition, an exam will be designed for other physicians who wish to become competent in the performance of cardiovascular MRI studies.

NASCI will continue to address these issues during its upcoming business meetings. It is also important to note that the existing 1998 ACR Physician credentialing and MRI center accreditation rules are being revised to accommodate the practice of Cardiovascular MRI by all physicians with adequate training in these techniques. This is an independent effort, with good timing, as it demonstrates the willingness of the ACR to deal with these issues up front.

Because this is a very important issue for many of our members, we will keep you informed of future developments and welcome your comments. Please contact a board member directly or send your comments to the society office.

In January 1999, the International Journal of Cardiac Imaging became the official journal of the North American Society for Cardiac Imaging. As part of the agreement between NASCI and Kluwer Academic Publishers, the International Journal of Cardiac Imaging will devote two of its six annual issues exclusively to selected papers from scientific meetings and educational sessions sponsored by the Society, as well as manuscripts from NASCI members. The first of these issues is the May/June 1999 issue (vol. 15:2). All NASCI members who are currently non-subscribers and prospective new members will receive a complimentary copy of this issue as an introduction to the journal. As part of our agreement with the journal, STR members may also receive the NASCI membership discount on an introductory subscription to the journal and will receive a letter from Kluwer inviting them to a complimentary copy of the May/June NASCI issue.

The editorial board is interested in submission of case reports, original research, tutorials, editorials and any other relevant contributions to be considered for publication in the International Journal of Cardiac Imaging. We especially encourage contributions based upon papers or posters presented at NASCI sponsored educational sessions and scientific meetings. NASCI members and speakers will contribute up to 40% of the articles for the official Journal of the society. The second NASCI issue will be the Nov/Dec 1999 issue (Vol. 15:6). We want to thank the many NASCI members who volunteered to review manuscripts. Please let Dr. Duerinckx know if you wish to help as a reviewer.

Manuscripts should be directly submitted to Andre J. Duerinckx, MD-PhD NASCI Editor of the International Journal of Cardiac Imaging VA Greater Los Angeles Health Care System West Los Angeles Medical Center (Wadsworth) Radiology Svc. (Mail Route: W114), MRI - Bld. #507 11301 Wilshire Blvd, Los Angeles, CA 90073, USA Telephone: 1-310-268-4223 FAX: 1-310-268-3258 Email: ajd@ucla.edu

NASCI held a successful first meeting of the working group of ARVC/D in November 1998, in Dallas, Texas. Questions were raised as to the sensitivity, specificity and interobserver variability in the use of the MRI to aid in the diagnosis of ARVC/D. If an MRI is performed on a patient who has all the clinical features of the disease, including an enlarged right ventricle with saccular outpouching of the right ventricle in the "triad of dysplasia", the MRI would be confirmatory of these findings by echocardiography or angiography. The MRI could also contribute to the diagnosis of tissue characterization by showing fatty infiltration of the right ventricular free wall. However, that is not the usual diagnostic dilemma. Frequently, the patient is a mildly symptomatic young person with PVCs or non-sustained VT or an asymptomatic member of an afflicted family, who has an MRI for diagnostic purposes. The problem then arises of whether there is mild or minimal thinning of the right ventricular free wall or whether the normal epicardial fat is infiltrating below the epicardium. There may be some extension of fat from the epicardium into the mid myocardium in normal individuals. What is normal? Frequently the differential diagnosis is between ventricular arrhythmias arising from the right ventricular outflow tract, a generally benign entity with a good prognosis and not genetic vs. ARVC/D, a disease that can cause sudden death and is transmitted in an autosomal dominant pattern.

The precise role of the MRI for the diagnosis of ARVC/D remains to be defined. NASCI is participating in a multi-institutional study coordinated by the University of Arizona to determine the interobserver variability of the MRI for ARVC/D. Fifteen experts will be asked to read a total of 45-50 MRIs from patients who have the overt disease, those who are suspected of having this condition, those who have other diseases of the right ventricle, as well as normals. The next step is to query a group of radiologists who have a special interest in the diagnosis of ARVC/D by MRI and solicit suggestions for a standard protocol. This will be the subject of the next meeting of the task force for ARVC/D to be held prior the upcoming meeting of the American Heart Association on November 6, 1999 in Atlanta, Georgia.

Beginning with this year's annual meeting, Cardiovascular Imaging 1999, we will have a abstract/poster competition supported by one of our industrial sponsors. This will give more visibility to the people submitting materials to our annual program. The attendance at our meetings has been constantly increasing with an average attendance of 150 participants. A detailed listing of our scientific and educational activitiesis is given elsewhere.

Elsewhere you will find the exciting program for Cardiovascular Imaging 1999, NASCI s 27th Annual Meeting and Scientific Sessions, to be held on Saturday, November 6, 1999 at the Westin Peachtree, in Atlanta, Georgia. You still have an opportunity to contribute by submitting an abstract for POSTER presentation (deadline: October 1, 1999) Please submit all proposals via e-mail directly to Arthur Stillmann, MD-PhD or via our WEB-server. Deadline is October 1, 1999.

We encourage all the invited speakers at our educational symposia to submit manuscripts or review articles based on their presentation(s) for publication in the NASCI journal. Send articles to the NASCI Editor-in-Chief Andre Duerinckx via mail.

Perhaps our members will be able to provide the training needed for future and present generations of radiologists and cardiologists as needed. An alternative would be to create a center equivalent to the Armed Forces Institute of Pathology (AFIP), specifically devoted to the teaching of cardiovascular imaging techniques for radiologists. In order to better evaluate our options, we need to know what is available via our members. The NASCI education committee will compile a directory of NASCI training opportunities in cardiac MRI and cardiac imaging using a questionnaire with your feedback.

To request a FAX copy of our questionnaire please contact Joan Oefner-Saluzzi.

All NASCI members are invited to attend the Society's general business meeting from 12 - 1 PM on Saturday, November 6, 1999 during "Cardiovascular Imaging 1999" at the Westin Peachtree Hotel in Atlanta, Georgia.

Another Board meeting (open to all members) will be held during the RSNA meeting on Sunday, November 28, 1999 from 4 - 5 PM at the Ritz-Carlton Hotel in Chicago.

Executive leadership holds regular meetings as needed to discuss issues important to our members. Please feel free to contact leadership if there are any topics that you would like the Executive Committee to address during their next business meeting.

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