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The North American Society for Cardiac Imaging (NASCI) is an
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| From the President, Arthur E. Stillman | ||||||||||||||||||||||
I am pleased to update you on the most recent NASCI activities and encourage you
to not only renew your membership (if you have not already done so), but also
encourage your colleagues to join the society. We welcome all physicians,
physicists, nurses, trainees and technologists who are interested in
cardiovascular imaging to participate in NASCI.
With the publication of the American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging (Radiology 2005 235: 723-727), radiologists are now required to review 75 cases with supervised interpretation for both CT and MR for a total of 150 mentored cases. NASCI is responding to this new requirement by providing both the mentors and the cardiac imaging cases in partnership with the ACR. The ACR will offer the first of many collaborative venues to acquire your mentored cases at the ACR’s 83rd Annual Meeting on May 20-25, 2006. In addition, NASCI will offer mentored cases at its 2006 Annual Meeting, October 6-10, 2006. As a NASCI member, you will receive a discounted tuition to the NASCI mentored cases session at the NASCI Annual Meeting. NASCI CONTRIBUTES CASES TO THE AMERICAN BOARD OF RADIOLOGY
EXAMINATIONS NASCI PLANS OUTSTANDING ANNUAL SCIENTIFIC SESSION OCTOBER 6-10,
2006 IN LAS VEGAS Warmest regards, |
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| From the Executive Director, Robin Hoyle | ||||||||||||||||||||||
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I am pleased to report that since I joined NASCI as the Executive Director last August, NASCI has not only
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| From the Editor | ||||||||||||||||||||||
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| Program Director Wants Members to "Own the Meeting" | ||||||||||||||||||||||
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NASCI is the premier organization for radiologists and cardiologists, and Dr. Geoffrey Rubin, this year’s annual meeting program Chair, wants to bring more awareness about that fact. “Our goal is to maintain strong representation from both radiology and cardiology specialties,” Rubin said. With that background, Rubin wants to create a meeting program that is clinically practical and has immediacy for practicing physicians. He does not intend to emphasize esoterics or cover subjects that are not relevant to everyday practice.
The NASCI meeting has always supported the associated sciences and this year will be no different. There will be an exclusive 12-hour course for technologists and nurses. Paralleling the associated sciences course will be concurrent sessions and workshops designed to go into more practical depth than the plenaries. Topics will include cardiac CT and MR as well as extracardiac vascular imaging. There will also be dedicated sessions for residents and fellows. An all day session on Tuesday will feature 50 supervised cases of cardiac CT. The purpose of this marathon is to provide physicians with an opportunity to fulfill new ACR and ACC requirements for cardiac CT imaging. Attendees will receive a certificate at the conclusion of the session. As for the keynote speaker…well, that’s a secret. Let’s just say the mystery guest leads a national institution that funds biomedical imaging and bioengineering research. You won’t want to miss it. This year’s meeting (October 6-10 in Las Vegas) is cosponsored
by the Society of Interventional Radiology. More and more interventionalists are
embracing cardiovascular MR and CT. In fact, a one-day symposium at the SIR
meeting in April packed the meeting hall. “We want to support each other by
bringing cardiovascular imaging to the forefront ,” Rubin said. |
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| Case of the Season | ||||||||||||||||||||||
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By Robert M. Steiner, MD, Editor HISTORY:A 50 year old male with an anterior mediastinal
Images 1-2: PA and Lateral chest radiographs followed by contrast enhanced CT Image 3: On the same day Images 4-5: Coronal reformatted images demonstrates both the mediastinal mass invading the SVC and the path of the pulmonary arteries Image 6: shows the stents in the mainstem bronchi in the axial view THE ANSWER:Pulmonary sling complicating an embryonal cell carcinoma. DISCUSSION: Pulmonary sling is described as an anomalous left pulmonary artery that takes its origin from the proximal right pulmonary artery and passes posterior to the trachea and right main steam bronchus before entering the left hilum. The pulmonary sling is unique in that it is one of the rare anomalies that pass between the trachea and the esophagus rather than behind the esophagus. This anomaly is related to the failure of formation of the ventral portion of the left sixth aortic arch leading to absence of a segment of the left pulmonary artery. The vascular complex in the left lung during intrauterine development communicates with the right pulmonary artery resulting in the development of the sling. In infancy, at which time most pulmonary slings are identified the patient presents with acute stridor and wheezing in part related to complete tracheal cartilaginous rings which occur in about 50% of patients. This results in a “ring-sling complex” with a “napkin ring” distal trachea. In infancy many patients with pulmonary sling will have associated congenital heart disease especially atrial septal defect, ventricular septal defect, patent ductus arteriosus and left superior vena cava. In the adult, pulmonary sling is usually an asymptomatic anomaly. In this patient however, because of the large anterior mediastinal mass stridor and wheezing occurred and most certainly the pulmonary sling contributed to the patient’s symptoms and signs. The patient was treated with tracheal bronchial stenting followed by radiation to the mass and systemic chemotherapy. Bibliography: 1. Backer CL et al, Pulmonary Arterial Artery Pulmonary Artery Sling: Results of surgical repair in infancy. 1992. JTCVS.103:683. 2. Gatzoulis MA, Webb GD, Daubeney, P.E.F. Adult Congenital Heart Disease 1st Edition. Churchill Livingston Publishers, London, 2003. |
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| Chest Pain in the ER: Is the Triple Rule Out Procedure Ready for Primetime? | ||||||||||||||||||||||
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By: Lewis Wexler, M.D., Emeritus Professor of Radiology, Stanford University Medical Center and NASCI Past President A meeting between NASCI member representatives and European Society for Cardiac Radiology member representatives took place in Curacao this past February to discuss the possibility of utilizing a single CT protocol for the evaluation of acute chest pain in the emergency department. Matthias Oudkerk, University Hospital, Groningen, Netherlands, moderated the joint session. It was preceded by presentations covering various clinical problems, available technology, relevant literature, current guidelines, and proposed guidelines. Christophe Becker, Munchen, Germany, led off the morning’s program by describing the potential of MDCT to evaluate acute chest pain, particularly the acute coronary syndrome (ACS). He proposed a CT protocol using the current 64-slice technology. Dr. Becker’s talk was followed by a description of the Italian Guidelines for acute chest pain presented by Ricardo Murano from Chieti, Italy. Dr. Oudkerk then presented the 2006 Dutch consensus guidelines on pulmonary embolism. His presentation was followed by two sets of guidelines by cardiologists to manage ACS: Dr. Buszman described the current guidelines in Poland and Dr. de Feyter of Rotterdam discussed the potential use of CT for the evaluation of non-ST elevation ACS. The American perspective was introduced by U. Joseph Schoepf, Medical University of South Carolina who presented a proposed algorithm for the evaluation of pulmonary embolism followed by a description of the use of CTA for the evaluation of acute aortic dissection by Gautham Reddy, University of California, San Francisco. At this point, the concept of using MDCT in the “triple rule out” of ACS, pulmonary embolism and acute aortic dissection was explored by NASCI President, Art Stillman, Emory University, who emphasized the importance of pre-test probability for the evaluation of the efficacy of MDCT for acute chest pain. Charles White, University of Maryland and Udo Hoffman, Massachusetts General Hospital followed Dr. Stillman’s presentation with descriptions of the studies in which MDCT was used to evaluate acute chest pain syndrome conducted at their institutions. An intense discussion ensued among participants including Dr. van Beek of the University of Iowa, Guiseppi Tarulli, President, Ontario Association of Radiologists, Toronto, Canada, NASCI Past President Martin Lipton of Harvard University, and me. The availability of 64- slice MDCT was considered along with different practices in modern urban referral centers vs. small rural hospitals without interventional cardiologists. The question, “is it possible or desirable to utilize a single triple rule out protocol or should the CT examination be optimized for each clinical presentation? was debated. Since emergency physicians is the group that typically makes triage decisions for patients who present with acute chest pain and many were already using MDCT, it was important that emergency physicians be a part of any discussion on resulting guidelines. On the second day of the meeting, in an attempt to reach consensus, Dr. Oudkerk introduced a ‘questionnaire’ about ACS for the meeting participants to answer with a “yes” or “no” response. It was agreed that the scope of the discussion be broadened to include pulmonary embolism and acute aortic dissection before consensus could be achieved. As the meeting concluded, the participants agreed to write a
first draft of guidelines that might be followed in emergency departments to
assist in the valuation of patients with acute chest pain. Writing assignments
were given to participants as well as to NASCI and ESCR members who could not
participate at Curacao. Additional input from emergency physicians would also be
solicited. It is expected that the guidelines document will be published later
this year in NASCI’s official journal: The International Journal of
Cardiovascular Imaging. |
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| Meet the Board of Directors | ||||||||||||||||||||||
Established in 1973, the North American Society for Cardiac Imaging (NASCI) is an International nonprofit professional association dedicated to the advancement of cardiovascular imaging. Its members ar radiologists, cardiologists, medical physicists and others active in the application of imaging methods to the study of the heart and vascular diseases in both the experimental laboratory and clinical settings. For more information about upcoming meetings, online abstract submission & registration, membership and the International Journal of Cardiovascular Imaging, please browse the Society’s web site at: www.nasci.org
The New Ad hoc Communications Committee Contributions to the NASCI Beat North American Society for Cardiac Imaging Executive Director: RobinHoyle@NASCI.org |
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| | Disclaimer | | © 2005 NASCI. All rights reserved. |
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most interest them. The
Program Committee reviewed the suggestions and will include topics most
requested by the membership in this year’s meeting program. A Call for Abstracts
was mailed to you early in April and you are encouraged to submit an abstract.
In addition to the successful hands-on workshops, NASCI plans mentored cases
sessions, reading with the experts, intersociety collaborative sessions, and new
this year, “Cardiac Imaging Jeopardy” where you can test your acumen against
other attendees. Watch your electronic mail, mail and
www.NASCI.org
for the Preliminary Program and
registration information. On behalf of the Board of Directors, I thank you for
your interest and membership in NASCI.
NASCI Members are busy authoring many excellent resources for
Cardiac and Vascular Imaging. Here are a few of the most recent titles
available: Clinical
Magnetic Resonance Imaging, 3rd ed.
Robert R. Edelman, MD, John R.
Hesslin MD, Michael Zlatkin MD, John Croes MD.(Elsevier, 2006)
Cardiac Imaging 2006
Gautham Reddy MD, MPH and Robert
Steiner, MD (Elsevier, 2006)
Body MR Angiography, Body MRI
Clinics Vincent Ho, MD (W.B.
Saunders, 2005) MRI and CT
of the Cardiovascular System 2nd
ed.
Charles B. Higgins, MD, Albert De
Roos, MD. (Lippincott, Williams & Wilkins, 2006)
Cardiac Imaging: The Requisites
Stephen Miller, MD (W.B.
Saunders, 2004)
Rubin
hopes to attract more members to our society,. He would like radiologists to
know how important cardiovascular imaging is for our future. To get members
involved in taking ownership of the meeting, Rubin solicited their help in
designing the program. He has received an excellent response. What many members
want is more of a focus on extracardiac vascular imaging. And that’s what
they’ll get. Attendees can attend a Friday afternoon cardiovascular “boot camp.”
This four-hour session is intended to allow any radiologist or cardiologist to
prime themselves on cardiovascular anatomy before the first plenary session on
Saturday. Plenary sessions on Saturday, Sunday, and Monday will explore MR
characterization of myocardial abnormalities, coronary CT angiography, and
peripheral arterial disease.
