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1. Physiological aspects of cardiac imaging
a. Normal cardiac cycle (systole and diastole)
i. Systole and diastole
ii. Ventricular function
iii. Atrial function
iv. Valvular function
b. Electrocardiography
i. Control of excitation and conduction in the heart
ii. Characteristics of normal sinus rhythm
iii. Common abnormalities in ECG
1. Premature atrial contraction / premature ventricular contraction
2. Atrial fibrillation / atrial flutter
3. Atrioventricular block
4. Current of injury (signs of myocardial ischemia and infarction)
c. Physiologic anatomy of cardiac muscle
d. Mechanics of cardiac contraction
e. Physical basis for blood flow, pressure and resistance
i. Ventricular volume and pressure relationship
1. Pre-load
2. Afterload
ii. Practical cardiac measurements
1. Ejection fraction
2. Stroke volume
3. Left ventricular mass
4. Flow calculation (Q = V x A)
5. Gradient calculation (Bernoulli equation, G = 4 x PV2)
6. Qp/Qs ratio
iii. Normal cardiac and pulmonary pressures
iv. Vascular regions supplied by the coronary arteries
v. Standard nomenclature for topographic imaging of the heart
2. Anatomy of the heart and great vessels
a. Normal morphology and structure
i. Embryology
ii. Fetal circulation
iii. Normal cardiac and peri-cardiac structures to include
1. Eustachian valve
2. Thebesian valve / coronary sinus
3. Right and left atrial appendages
4. Moderator band
5. Endocardial cushion
6. Atrioventricular valves (tricuspid and mitral)
7. Semilunar valves (aortic and pulmonic)
8. Sinuses of Valsalva
9. Coronary arteries and major branches
10. Coronary veins including coronary sinus
11. Superior vena cava and deep mediastinal veins (e.g. azygous vein)
12. Pericardium
13. Pulmonary arteries
14. Pulmonary veins
iv. Common variants
1. Anomalous coronary artery
2. Left superior vena cava
3. Azygous continuation of the inferior vena cava
b. Segmental Anatomy of the Heart
i. Atrial situs
ii. Ventricular situs
iii. Identification of great vessels
iv. Assess pulmonary arteries and veins
v. Identify systemic venous return
c. Normal Adult Heart Measurements
i. Left ventricular wall thickness, diameter, fractional shortening and
end-diastolic volume and volume index
ii. Left atrium size
iii. Right ventricular wall thickness and size
iv. Right atrial size
v. Diameter of the thoracic aorta
3. Techniques for imaging the heart and great vessels
a. Radiography
b. Computed tomography
i. Indications
1. Coronary calcium scoring
2. Cardiac CT
3. Coronary CTA
ii. Physics and cardiac imaging considerations including ECG gating techniques
1. Coronary artery calcium scoring
2. Coronary CTA
3. Aortic CTA
4. Pulmonary CTA
iii. Advantages and Limitations
c. Magnetic resonance imaging
i. Indications
ii. Physics and imaging considerations, including pulse sequences, ECG-gating
techniques, and respiratory compensation strategies
1. Wall motion studies
2. Myocardial perfusion and viability scanning
3. Valvular disease assessment
4. Blood flow quantification
5. Coronary MRA
6. MR of the aorta
7. Pulmonary MRA
8. Atherosclerotic plaque evaluation
iii. Advantages, Limitations and contraindications
d. Cardiac Scintigraphy (including PET)
i. Indications
ii. Physics and cardiac imaging considerations
1. Multiple-gated acquisition (MUGA)
2. Myocardial perfusion and viability scanning
3. Shunt evaluation
iii. Advantages and Limitations
e. Other (working understanding)
i. Echocardiography (transthoracic and transesophageal)
1. Indications
2. Technique including standard views and use of color Doppler
3. Advantages and Limitations
ii. Cardiac and coronary catheter angiography
1. Indications
2. Technique including standard views and transcatheter tools (e.g. intraluminal
ultrasound)
3. Advantages and Limitations
4. Congenital heart disease: basic
a. Cyanotic versus acyanotic presentations
b. Most common lesions:
i. Ventricular septal defect
ii. Patent ductus arteriosus
iii. Atrial septal defect
iv. Tetralogy of Fallot
v. Pulmonary stenosis
vi. Obstruction of the aorta (coarctation and interruption of the aorta)
vii. Transposition of the great vessels (D- vs. L-transposition)
viii. Endocardial cushion defect
ix. Aortic valvular disease
x. Anomalous pulmonary venous connections
xi. Truncus arteriosus
xii. Vascular rings
c. Situs anomalies (asplenia and polysplenia)
5. Unusual congenital heart disease: advanced
a. Double outlet right ventricle
b. Single ventricle
c. Cor Triatriatum
d. Hypoplastic left heart syndrome
i. Aortic atresia
ii. Mitral atresia
e. Hyopoplastic right heart syndrome
i. Tricuspid atresia
ii. Uhl’s anomaly
iii. Right ventricular dysplasia
iv. Pulmonary valve atresia
v. Ebstein’s anomaly
f. Congenital absence of the pericardium
g. Indications for and post-operative assessment of
i. Mustard
ii. Senning
iii. Rastelli
iv. Fontan
v. Norwood
vi. Jatene
vii. Blalock-Taussig
viii. Potts
ix. Waterston-Cooley
x. Glenn
xi. Rashkind
xii. Ross Procedure
h. Late or Adult presentations of congenital heart disease
i. Mitral valve prolapse
ii. Aortic stenosis (e.g. valvular and subvalvular)
iii. Sinus of Valsalva aneurysm
iv. Marfan’s syndrome
v. Bicuspid aortic valve
6. Ischemic heart disease
a. Risk factors, primary prevention and screening
b. Inducible myocardial ischemia
c. Acute MI
d. Chronic MI
e. Post-MI complications
i. Cardiac rupture
ii. LV aneurysm
iii. Papillary muscle rupture
iv. Congestive heart failure
v. Dressler’s syndrome
f. Myocardial viability
i. Stunned myocardium
ii. Hibernating myocardium
g. Therapeutic and interventional options
7. Valvular Disease
a. Aortic stenosis
i. Valvular stenosis
ii. Subvalvular stenosis
iii. Supravalvular stenosis
1. William’s syndrome
b. Aortic insufficiency
c. Mitral stenosis / mitral insufficiency
i. Parachute mitral valve
d. Tricuspid stenosis / tricuspid regurgitation
e. Miscellaneous:
i. Degenerative calcification
1. Calcified aortic stenosis
2. Mitral annular calcification
ii. Myxomatous degeneration
iii. Carcinoid syndrome
iv. Infective endocarditis
v. Rheumatic heart disease
f. Therapeutic and interventional options
8. Cardiac and pericardial masses
a. Primary lesions
i. Myxoma
ii. Lipoma
iii. Angiosarcoma
iv. Rhabdomyoma
b. Metastasis
c. Therapeutic and interventional options
9. Acquired diseases of the thoracic aorta
a. Aneurysms
i. Atherosclerotic
ii. Marfan’s syndrome
iii. Ehlers-Danlos syndrome
b. Pseudoaneurysms
i. Mycotic
Post-traumatic and post-surgical
c. Dissection
i. Intramural hematoma
d. Aortitis
e. Atherosclerosis
i. Plaque
ii. Penetrating ulcer
f. Therapeutic and interventional options
10. Cardiomyopathy
a. Hypertrophic cardiomyopathy
i. Idiopathic hypertrophic subaortic stenosis
b. Dilated Cardiomyopathy
i. Ischemic
ii. Non-ischemic
c. Restrictive (also infiltrative) cardiomyopathy
i. Amyloidosis
ii. Sarcoidosis
iii. Storage diseases
iv. Infection
v. Radiation
d. Therapeutic and interventional options
11. Diseases of the Pericardium
a. Acute pericarditis
b. Constrictive pericarditis
c. Pericardial effusion
d. Pericardial cyst
e. Pericardial defect
f. Therapeutic and interventional options
12. Miscellaneous:
a. Arrhythmogenic Right Ventricular Dysplasia (ARVD)
b. Coronary artery / sinus of Valsalva aneurysm and fistula
c. Pulmonary arterial hypertension
d. Pulmonary embolism
e. Cardiac transplantation
f. Automatic Inplantable Cardioverter Defibrillator (AICD)
g. Pacemakers
h. RF ablation for atrial fibrillation
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