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The 64 Slice CT Scanner: The Latest Battleground in Specialty
Turf Disputes
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A 90-minute interactive audioconference
Friday, December 22, 2006
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Speaker profiles . . . .vii
Exhibit A . . . .1
Presentation by Todd Sagin, MD, JD, Michael Nicholas Brant-Zawadzki, MD, FACR, and
Timothy Albert, MDExhibit B . . . .17
Additional Resources on Cardiac CT Angiography
Exhibit C . . . .19
A Clinical Privelege White Paper from Briefings on Credentialing titled:”Cardiac CT angiography”
Resources . . . .33
C. Current indications
D. Should every hospital upgrade to 64 slice CT?
E. Anticipating Disruption to current technologies
II. Specialty perspectives on the implementation of 64 slice CT angiography
A Cardiology B. Radiology
III. Privileging Criteria advocated for the reading of 64 slice CT cardiology procedure
IV. Managing the turf battle
A. Procedural approaches to privileging – resolving the disupute B. Interspecialty Collaboration or competition?
C. Potential business models to bring multiple specialties together
V. Live Q&A
25 years of healthcare clinical, managerial, and legal experience to his work with physicians and hospitals across the United States.
Dr. Sagin applies his medical, legal and executive expertise to help physicians and hospitals develop solu- tions to their most challenging problems. He has consulted, authored, and presented on a wide-range of healthcare management and legal topics including quality and performance management, credentialing and privileging, medical staff affairs, liability issues, and healthcare and legal trends.
Dr. Sagin is a board-certified family physician and geriatrician. Prior to joining The Greeley Company, Dr.
Sagin’s experience included executive and senior level positions at numerous healthcare institutions and uni- versity medical centers. Dr. Sagin’s previous positions included chief executive officer, chief operating officer, chief medical officer, university department chairman, residency program director, and university instructor.
Dr. Sagin is a graduate of the University of Pittsburgh School of Medicine and the Temple University School of Law. He interned at the Cook County Hospital and was chief resident at Chestnut Hill Hospital.
Michael Nicholas Brant-Zawadzki, MD, FACR
Michael Nicholas Brant-Zawadzki is Medical Director of the Radiology Department at Hoag Hospital.. Dr.
Brant-Zawadzki is an internationally recognized educator, lecturer, and researcher in the field of Radiology.
Dr. Brant-Zawadzki earned his BA at Stanford University, and his medical degree from the College of Medicine at the University of Cincinnati, where he graduated first in his class. His residency in diagnostic radiology and subsequent fellowship in neuroradiology were completed at Stanford University Medical Center, where he remained on the faculty. He subsequently served as a professor for six years on the full time faculty in the Department of Radiology at University of California, San Francisco.
Timothy Albert, MD
Timothy Albert is an adult cardiologist sub-specializing in cardiovascular imaging. He has trained at the University of California, (San Francisco), University of Washington (Seattle), and Duke University, where he
Presentation by TToodddd SSaaggiinn,, MMDD,, JJDD,, MMiicchhaaeell BBrraanntt--ZZaawwaaddzzkkii,, MMDD,, FFAACCRR and TTiimmootthhyy AAllbbeerrtt,, MMDD
1
The 64 Slice CT Scanner:
The Latest Battleground in Specialty Turf Disputes
December 22, 2006
Todd Sagin, MD, JD Timothy Albert, MD
The 64 Slice CT Scanner
o
A new technology with great promise
o
Like many new technologies, accompanied by many challenges
o When and if to purchase
o What effect will it have on other revenue sources?
o Who is qualified to use the technology?
o Who should be allowed to use the technology?
o What business models need to be considered?
o What liabilities are associated?
o What unintended consequences might result?
Michael Brant-Zawadzki, MD, FACR
3
The 64 Slice CT Scanner
Current adoption and market penetration?
Hospitals
Ambulatory diagnostic facilities
Physician offices
Typical Capabilities of Scanners
5
Current Indications
Should Every Hospital Upgrade
to 64 Slice?
7
Coronary CTA: A Disruptive Technology?
Potential Impacts On:
o
Stress testing (nuclear/echo)
o
Cardiac catheterization volumes
o
ER chest pain triage
Bottom line: “The jury is still out”
Why Do Cardiologists Care?
o
Coronaries are their turf
o
Cardiology is technology driven
o
Cardiologists are imagers too
o
Decreasing financial incentives for
diagnostic angiography
9
Radiologist Perspective on Implementation of 64 Slice
CTA
Privileging Criteria for CT Angiography Scan Interpretation
The American College of Radiology (ACR) recommends:
Completion of at least 30 hours of Category I CME in Cardiac imaging, including
Cardiac CT, anatomy, physiology, or pathology, or documented
Equivalent supervised experience in a center
Actively performing cardiac CT
Interpretation, reporting, or supervised review of at least
50 cardiac CT examinations in the last 36 months
11
Privileging Criteria: Cardiology
American College of Cardiology (ACC) guidelines published 2005:
o
Levels of clinical competence: 1, 2, and 3
o
Minimum levels of competence for independent interpretation
o
Grandfather period for non-academic track:
June 2008
Highest level.
Qualified for independent interpretation 150
50 Level 2
Basic exposure- no independent interpretation 50
--- Level 1
Clinical Competence Minimum
Number of Interpreted Exams Minimum
Number of Observed Exams
ACC Guidelines for Privileging
13
Resolving New Technology &
Cross-Specialty Privileging Dilemmas
The Competency Equation
Competency = evidence you did it +
Evidence that when you did it,
you did it well
15
Dilemma…
Will you allow physicians to experience their learning curve on your patients?
A Step-by-Step Approach to Preventing and Resolving
Privileging Conflicts
17
Step 1
Begin by understanding the four steps in credentialing and privileging
Establish policies and procedures (e.g. criteria)
Gather information
Assess and recommend
Review and grant
Step 2
Establish a moratorium on processing
crossover and new technology privilege
requests until a policy is in place to
address these
19
Step 3
Gather information
Other hospitals*
Specialty societies*
Literature search*
CRC White Papers
Use the web (e.g. www.credentialinfo.com)
*Put the burden on the applicant
Step 4
Solicit recommendations for privileging criteria from department chairs/subject matter experts
If they agree, you’re done. Adopt the criteria.
If they disagree, follow your policy.
21
Step 5
The credentials committee should appoint a task force to develop recommendations for privileging criteria
Task Force Membership
One representative from each involved
specialty plus at least one member of
the credentials committee to chair the task
force
23
Step 6
The task force gathers additional information, discusses the issue, and makes a recommendation to the credentials committee for privileging criteria (which may include one or more minority opinions)
Optional Step
Consider holding a dispute resolution meeting with interested providers utilizing conflict resolution tools
As much as possible, participants should work
within the framework of the results of the task
force’s research
25
Step 7
The credentials committee reviews the proposed criteria, votes on them, and refers the issue to the MEC
Members of the credentials committee
who practice in any of the specialties involved in the crossover privilege issue should recuse themselves from the vote
Step 8
The MEC reviews and votes on the proposed criteria
Members of the MEC who practice in any of the specialties involved in the crossover
privilege issue should recuse themselves from
the vote
27
Step 9
Apply the criteria
Inter-specialty Collaboration or Competition?
Marketplace considerations
Strategic credentialing
Exclusive contract
Unrestricted competition
29
Multiple Specialties Together?
Landmines in all directions: False claims, Stark violations, anti-Kickback
violations, antitrust concerns
Additional Resources on Cardiac CT Angiography
ACCF/AHA Clinical Competence Statement on Cardiac CT and MR
http://www.acc.org/qualityandscience/clinical/competence/imaging/index.pdfTask
ACC/AHA Force 12: Training in Advanced Cardiovascular Imaging (Computed Tomography)
http://www.scct.org/news/cocats.pdf
ACR Cardiac CT and Coronary CTA Member Resource Section
http://www.acr.org/s_acr/doc.asp?CID=2601&DID=24881Specialists Discover Common Ground in Cardiovascular CT
http://www.diagnosticimaging.com/techfocus/innovatorsaddctangiography2practice/04.jh tml
Cardiac CT is Making a Real Difference
http://www.healthimaging.com/content/view/3951/84/
A Clinical Privelege White Paper from BBrriieeffiinnggss oonn CCrreeddeennttiiaalliinngg titled:”Cardiac CT angiography”
Source:. HCPro, Inc. Reprinted with permission.
Background
Cardiac computed tomography (CT) angiography, also known as coronary CT angiogra- phy, is an x-ray examination that allows physicians to noninvasively determine whether fatty or calcium deposits have built up in the coronary arteries. Because these arteries supply blood to the heart muscle, areas of buildup, called plaque, can cause a heart attack/stroke.
Cardiac CT is a proven imaging system for the detection and characterization of cardio- vascular disease. The introduction of the 64-slice CT scanner—with 128- and 256-slice systems on the horizon—has increased the interest in utilizing the technology to per- form coronary angiography, a procedure that until recently required invasive cardiac catheterization. Multislice CT, combined with the advent of subsecond rotation, pro- vides both high resolution and high speed, allowing high quality images of the coro- nary arteries.
Cardiac CT angiography uses a fan-shaped, thin x-ray beam that passes through the body at several angles to allow for cross-sectional images. The corresponding x-ray transmission measurements are collected by a detector array, digitized into pixels, and rendered into a three-dimensional image for viewing on a computer monitor. Today, 64-slice CT scanners provide improved temporal resolution, which should lead to lower motion artifacts and possibly higher diagnostic rates.
Clinical applications of cardiac CT include noncontrast (coronary calcium evaluation) and contrast (coronary angiography). Performance and interpretation of CT angiogra- phy involves the intravenous administration of 60 ml–140 ml of iodinated contrast dur- ing a prolonged breath-hold, and is therefore considered more challenging than
coronary calcium assessment. (For more information about coronary calcium assess- ment, see Clinical Privilege White Paper, Cardiac scoring—Procedure 206.)
In addition, medication—generally beta blockers—may be administered during cardiac CT angiography to slow the patient’s heart rate. This improves the image quality and helps to ensure a diagnostic study. Other medications may be used if beta blockers can- not be administered.
Despite growing interest in cardiac CT angiography, the procedure has one major draw- back—patients are exposed to a high level of radiation during a scan and can have
Cardiac CT angiography
Although it is unclear whether cardiac CT angiography will replace the catheter-bas- ed procedure, it will undoubtedly change testing for cardiovascular disease. Cardiac catheterization could become primarily a therapeutic procedure.
Both radiologists and cardiologists are interested in performing cardiac CT angiogra- phy. Consequently, there is a dispute brewing over which specialty is qualified to interpret the studies. Although cardiologists contend that they are specially trained to interpret cardiac CT scans, radiologists assert that they are responsible for the official interpretation. Radiologists also claim that split interpretations, in which the cardiolo- gists read the cardiac portion and the radiologists overread the scan for noncardiac findings, has possible legal repercussions.
Cardiologists, radiologists, interventional cardiologists, interven- tional radiologists, and nuclear physicians
The American College of Cardiology (ACC) and the American Heart Association (AHA) have published Task Force 12: Training in Advanced Cardiovascular Imaging (Computed Tomography), a report that addresses fellowship training requirements for car- diac CT angiography. The statement is endorsed by the
American Society of Nuclear Cardiology (ASNC), the Society for Cardiovascular Angiography and Interventions (SCAI), the Society of Atherosclerosis Imaging and Prevention (SAIP), and the Society of Cardiovascular Computed Tomography (SCCT).
According to Task Force 12, cardiology fellowship training should include instruction in the basic aspects of cardiac CT, but only those fellows who go beyond the basic level are trained suffi- ciently for independent interpretation of CT studies. Every trainee should be educated in the use of CT and in cardiovascu- lar anatomy, physiology, and pathophysiology, as well as in the physics of CT and radiation generation and exposure.
Trainees should master the relation between the results of the CT examination and the findings of other cardiovascular tests (e.g., catheterization, nuclear cardiology, magnetic resonance, and echocardiography). Every cardiology fellow should be famil- iar with the technical performance, interpretation, strengths, Involved specialties
Positions of societies and academies
ACC/AHA
CT and the interrelation of this technique with other diagnostic methods. This level of expertise will not qualify a trainee to perform CT or interpret CT independently.
Level 2 fellowship training in cardiac CT requires two months, or the equivalent, spent interpreting a minimum of 50 noncontrast and 150 contrast studies total. Of these, at least 35 cases should be performed with the fellow present under appropriate supervi- sion. In addition, Level 2 and Level 3 fellowship training should include the review of all cardiac CT cases for noncardiac findings.
The review of 150 cardiac CT cases for incidental findings should include the review of a dedicated teaching file of 25 cardiac CT cases with significant noncardiac pathology. Further, core curric- ula should include specific lectures on noncardiac CT pathology.
Level 3 training represents the highest level of expertise enabling an individual to serve as a director of an academic cardiac CT sec- tion or director of an independent cardiac CT facility or clinic.
The American College of Cardiology Foundation (ACCF), the AHA, and the American College of Physicians (ACP) Task Force on Clinical Competence and Training have published ACCF/
AHA Clinical Competence Statement with Computed Tomography and Magnetic Resonance, a report that explains the training require- ments and guidelines for practicing physicians who would like to perform cardiac CT angiography procedures. This report was developed in collaboration with the American Society of Echo- cardiography, the ASNC, the SAIP, and the SCAI. It is endorsed by the SCCT.
According to the statement, a thorough knowledge and under- standing of cardiac and vascular anatomy is necessary. This re- quirement can be met by completion of an Accreditation Council for Graduate Medical Education (ACGME)-approved cardiovas- cular fellowship, nuclear medicine residency, or general radiology residency.
The statement contends that characteristics of the heart in health and disease by traditional cardiac imaging methods (e.g., echo- ACCF/AHA/ACP
training represent a cumulative experience. It is expected that the training will not be continuous for many practicing clini- cians. Time spent at didactic continuing medical education (CME) courses specifically targeting cardiac CT can contribute to the total time. Due to the advancement in the sophistication and widespread availability of electronic training medias, some training can now be obtained outside of the laboratory setting.
However, for all Level 2 and Level 3 requirements, minimum time in a CT laboratory is half of the time listed.
Level 2 training is defined as the minimum recommended training for a physician to independently perform and interpret cardiac CT. This is an extension of Level 1 training and is in- tended for individuals who wish to practice or be actively in- volved with cardiac CT performance and interpretation.
Physicians seeking Level 2 training inclusive of contrast and noncontrast studies will need to interpret 50 noncontrast cases with more time and cases specifically targeting contrast. Train- ing in contrast and noncontrast CT may occur concomitantly.
The minimum requirement for the dual credentialing is eight weeks of cumulative experience in a program actively perform- ing cardiac CT examinations in a clinical environment. In-lab training time is defined as a minimum of 35 hours per week.
Twenty hours of didactic CME courses in cardiac CT can con- tribute to the total time.
During training, candidates should actively participate in cardiac CT study interpretations under the direction of a qualified (pref- erably Level 3-trained) physician/mentor. The candidate should be involved with the interpretation of at least 150 cardiac CT studies. The candidate should be physically present and involved in the acquisition and interpretation of the case in at least 50 studies. For clinicians to obtain expertise in performance of CT angiography, a majority of the cases must be directed at the per- formance of these contrast studies. Cases should reflect the broad range of coronary artery and bypass graft pathology.
The ACCF/AHA statement says practicing physicians can
attesting to competency from a Level 2 or Level 3 physician.
Practitioners who have been performing cardiac CT studies before the creation of these guidelines can qualify for comple- tion of Level 2 or Level 3 training by engaging in at least two months of formal training. For Level 2 training, requirements are substantive activities in cardiac CT during the past three years, with documented involvement in the performance and interpretation of at least 150 studies (at least half with contrast enhancement) and at least 20 hours of coursework devoted to cardiac CT.
All practitioners must provide evidence of continuing expertise in cardiac CT. Maintaining Level 2 training requires a minimum of 20 hours of coursework devoted to cardiac CT during a three-year period and the performance and interpretation of at least 50 cardiac CT angiography examinations annually.
Candidates can advance to Level 2 or Level 3 by pursuing inde- pendent advanced studies from a learning center specializing in cardiac CT. Trainees are required to document and continue Category I CME in the area.
The American College of Radiology (ACR) publishes the ACR Practice Guideline for Performing and Interpreting Diagnostic Com- puted Tomography (CT). According to the guidelines, all CT ex- aminations must be performed under the supervision of and interpreted by a physician who has the following qualifications:
ä Certification in radiology or diagnostic radiology by the American Board of Radiology (ABR), American Osteopathic Board of Radiology, or the Royal College of Physicians and Surgeons of Canada (RCPSC). The physician must also have been involved with the supervision, performance, interpreta- tion, and reporting of 300 CT examinations during the past 36 months. (Completion of an accredited radiology residency during the past 24 months will be presumed satisfactory experience for the reporting and interpreting requirement.) ä Completion of an accredited diagnostic radiology residency
and involvement with the performance as well as interpreta- tion and reporting of 500 CT examinations during the past 36 months. (Completion of an accredited radiology residency ACR
in the performance and interpretation of CT in the subspe- cialty in which CT reading occurs, as well as 500 cases interpreted and reported during the past 36 months in a supervised situation.
ä Documentation of training in the physics of diagnostic radi- ology. Additionally, the physician must demonstrate training in the principles of radiation protection, the hazards of radi- ation exposure to both patients and radiologic personnel, and appropriate monitoring requirements.
ä Thorough acquaintance with the morphologic and patho- physiologic manifestations and artifacts demonstrated on CT.
Additionally, supervising physicians should have appropriate knowledge of alternative imaging methods, including the use and indications for general radiography and specialized studies (e.g., angiography, ultrasonography, magnetic reso- nance imaging, and nuclear medicine studies).
The physician must interpret and report 100 CT examinations per year to maintain competence. For the physician who uses limited CT imaging for specific anatomic areas, the examina- tions should reflect those anatomic areas.
ACR also publishes the Practice Guideline for the Performance and Interpretation of Cardiac Computed Tomography (CT), which ad- dresses qualifications for cardiac CT angiography. According to the guideline, the radiologist or another physician who meets its qualifications must have substantial knowledge of radiation biology, the physics of CT scanning, the principles of CT image acquisition, and postprocessing, which includes use of diagnos- tic workstations and the design of CT protocols, including rate and timing of contrast administration.
Some physicians will also have substantial experience in other methods of cardiac imaging, assessment of cardiac function, or experience specifically in cardiac CT. These physicians are quali- fied to interpret coronary artery calcium scoring based on their prior experience. To achieve competency in cardiac CT angiog- raphy, the practitioner should also meet one of the following requirements:
Maintenance of competence
Coronary artery calcium scoring does not qualify as meeting these requirements.
or
ä Completion of at least 30 hours of Category I CME in cardiac imaging, including
- cardiac CT, anatomy, physiology, or pathology, or docu- mented equivalent supervised experience in a center actively performing cardiac CT
- interpretation, reporting, or supervised review of at least 50 cardiac CT examinations in the last 36 months Coronary artery calcium scoring does not qualify as meeting these requirements.
Also, according to the report, physicians who administer phar- macologic agents as part of cardiac CT imaging should be know- ledgeable about the administration, risks, and contraindications of the pharmacologic agents used. The physicians must also be capable of monitoring the patient throughout the procedure.
All physicians performing cardiac CT examinations should demonstrate evidence of continuing competence in the inter- pretation and reporting of those examinations. If competence is assured primarily on the basis of continuing experience, per- formance and interpretation of a minimum of 75 examinations every three years is recommended in order to maintain the physician’s skills.
The American Board of Internal Medicine (ABIM) grants a cer- tificate in the subspecialty of cardiovascular disease. To gain cer- tification, candidates must satisfy the following requirements:
ä Have been previously certified in internal medicine by the ABIM
ä Completed the requisite subspecialty training
ä Demonstrated clinical competence in the care of patients Maintenance of competence
Positions of other interested parties
ABIM
agnosis and management of a broad spectrum of cardiovascular diseases.
The ABIM requires that candidates be competent in the follow- ing diagnostic and therapeutic procedures:
ä Advanced cardiac life support (ACLS), including cardioversion
ä Electrocardiography, including ambulatory monitoring and exercise testing
ä Echocardiography
ä Arterial catheter insertion
ä Right-heart catheterization, including insertion and management of temporary pacemakers
The ABIM requires substantiation that candidates for certifica- tion in the subspecialties are competent in the following:
ä Patient care, which includes medical interviewing, physical examination, and procedural skills
ä Medical knowledge
ä Practice-based learning and improvement ä Interpersonal and communication skills ä Professionalism
ä Systems-based practice
Through its tracking process, the ABIM requires verification of the subspecialty fellows’ clinical competence from the director of the subspecialty training program.
The ABR grants certification in diagnostic radiology. The ABR requires that candidates for certification have five years of ap- proved training. Residents must be graduates of an accredited U.S. or Canadian program.
Candidates must meet the following criteria:
ä Completed five years of the following training:
– One year in clinical training. The first postgraduate year must be accredited clinical training in internal medicine, pediatrics, surgery or surgical specialties, obstetrics/gyne- cology, neurology, family practice, emergency medicine, Clinical competence
requirements Requisite diagnostic and therapeutic procedures
ABR
ACGME or by the RCPSC. A minimum of four months of the four-year diagnostic training program must be spent in nuclear medicine, three months in mammogra- phy, and no more than 12 months in any one discipline.
ä Completed basic cardiac life support certification. ACLS certification is encouraged.
ä Demonstrate that that they are specialists in diagnostic radi- ology and are recognized by their peers to have high moral and ethical standards in the profession.
ä Show proof of valid state licensure.
ä Pass all ABR written and oral exams.
Matthew Budoff, MD, associate professor of medicine and director of cardiac CT at Harbor-UCLA Medical Center in Tor- rance, CA, says both radiologists and cardiologists are qualified to do cardiac CT angiography. “Cardiologists need to learn how to perform CT, and radiologists need to learn how interpret the cardiac portion of CT scans,” he says. “It is a coming together of the two specialties.”
Budoff, the lead author on both ACC/AHA clinical competence statements on cardiac CT, says fellowship trainees and practic- ing physicians need to meet the same qualifications to perform and interpret cardiac CT. “There has not been fellowship train- ing in cardiac CT until now, so many physicians who want to perform cardiac CT angiography need to attend formal training programs,” he says.
In addition, Budoff recommends that both cardiologists and radiologists meet the ACC/AHA training requirements. For competency, “both cardiologists and radiologists need to inter- pret at least 150 [cardiac CT] cases, and be physically present and involved in the acquisition and interpretation of at least 50 of these studies,” he says.
Further, Budoff stresses the importance of proctoring. “There should be a mentor present in all 150 cases as well as the 50 studies where the physician is physically present and involved in the acquisition and interpretation of the study,” he says. He Harbor-UCLA Medical Center,
Torrance, CA
completing a training course or the equivalent in practice ex- perience. “We have given physicians three years from when we wrote the document to meet the required qualifications,”
he says.
Budoff acknowledges that split interpretation—in which the cardiologist is responsible for the cardiac findings and the radi- ologist overreads the noncardiac portion—is a contentious issue. “Hospitals make their own decisions on contracts be- tween cardiology and radiology for CT angiography interpre- tation,” he concludes.
David A. Dowe, MD, chief operating officer, medical director, and director of the coronary CT angiography program at Atlantic Medical Imaging in Galloway, NJ, acknowledges that there has been a heated discussion about which specialists are most quali- fied to perform cardiac CT angiography. He contends that there is a place for radiologists in the cardiac CT arena because they are recognized for their expertise in imaging. “Only radiologists are able to interpret the whole study, which is the only legal way to bill for it,” he says.
Moreover, Dowe recommends that practitioners who want to perform and interpret cardiac CT angiography meet the requirements set forth in the ACR practice guidelines. “It’s 30 hours of training in [cardiac CT] and the interpretation, report- ing, and supervised review of 50 live cases if you have prior CT training, which all radiologists do,” Dowe says. “Physicians can get [cardiac CT] training by attending courses and doing visiting fellowships.”
Dowe also stresses the importance of proctoring for initial cases.
“A major flaw in the education system now [for radiologists and cardiologists] is that people are training off of simulated cases and teaching files,” he says. “You don’t learn how to ride a bike by looking at pictures of a bike.”
Dowe supports the ACR position that a single qualified physician be responsible for the supervision and interpretation of cardiac Atlantic Medical Imaging
Galloway, NJ
The following draft criteria are intended to serve solely as a start- ing point for the development of an institution’s policy regarding this procedure.
Basic education: MD or DO
Minimum formal training: Successful completion of an ACGME-/
AOA-accredited postgraduate program in cardiovascular disease, radiology, or nuclear medicine. If the applicant’s postgraduate program did not include cardiac CT angiography training, appli- cants must demonstrate that they have successfully completed one of the following:
ä A formal course in cardiac CT, that included CT angiography and proctored initial cases
ä The equivalent in practice experience
Note: Physicians must also be able to demonstrate training in the principles of radiation protection, the hazards of radiation exposure to both patients and radiologic personnel, and appropriate monitoring requirements.
Required previous experience: Applicants must be able to de- monstrate the successful performance and interpretation of at least 50 cardiac CT angiograms in the past 12 months.
A letter of reference should come from the director of the appli- cant’s cardiac CT angiography training program. Alternately, a letter of reference should come from the director of the cardiac CT angiography laboratory at the institution where the appli- cant most recently practiced.
Reappointment should be based on unbiased, objective results of care according to the organization’s existing quality assurance mechanisms.
Applicants must demonstrate that they have maintained compe- tence by documenting that they have successfully performed and CRC draft criteria
Minimum threshold criteria for requesting core privileges in cardiac CT angiography
References
Reappointment
American Board of Internal Medicine 510 Walnut Street, Suite 1700
Philadelphia, PA 19106-3699 Telephone: 215/446-3500 Web site: www.abim.org American Board of Radiology
5441 East Williams Boulevard, Suite 200 Tucson, AZ 85711
Telephone: 520/790-2900 Fax: 520/790-3200 Web site: www.theabr.org
American College of Cardiology Heart House
9111 Old Georgetown Road Bethesda, MD 20814-1699 Telephone: 301/897-5400 Fax: 301/897-9745 Web site: www.acc.org
American College of Radiology 1891 Preston White Drive Reston, VA 20191
Telephone: 703/648-8900 Web site: www.acr.org American Heart Association 7272 Greenville Avenue Dallas, TX 75231
Telephone: 214/373-6300 Web site: www.americanheart.org Atlantic Medical Imaging 44 East Jimmie Leeds Road Galloway, NJ 08205
Telephone: 609/677-9729
Web site: www.atlanticmedicalimaging.com
Cardiac CT angiography
In order to be eligible to request clinical privileges in CCT angiography, an applicant must meet the following minimum threshold criteria:
ä Basic education: MD or DO
ä Minimum formal training: Successful completion of an ACGME-/AOA-accredited postgrad- uate program in cardiovascular disease, radiology, or nuclear medicine. If the applicant’s postgraduate program did not include cardiac CT angiography training, applicants must de- monstrate that they have successfully completed one of the following:
– A formal course in cardiac CT that included CT angiography and proctored initial cases – The equivalent in practice experience
Note: Physicians must also be able to demonstrate training in the principles of radiation protection, the hazards of radiation exposure to both patients and radiologic personnel, and appropriate monitoring requirements.
ä Required previous experience:Applicants must be able to demonstrate the successful per- formance and interpretation of at least 50 cardiac CT angiograms in the past 12 months.
ä References: A letter of reference should come from the director of the applicant’s cardiac CT an- giography training program. Alternately, a letter of reference should come from the director of the cardiac CT angiography laboratory at the institution where the applicant most recently practiced.
ä Reappointment: Reappointment should be based on unbiased, objective results of care accord- ing to the organization’s existing quality assurance mechanisms.
Applicants must be able to demonstrate that they have maintained competence by documenting that they have successfully performed and interpreted at least 50 cardiac CT angiograms annu- ally over the reappointment cycle.
In addition, continuing education related to the performance and interpretation of cardiac CT angiograms should be required.
I understand that by making this request, I am bound by the applicable bylaws or poli- cies of the hospital and hereby stipulate that I meet the minimum threshold criteria for this request.
Physician’s signature: ________________________________________________________
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