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Cardiovascular Institute

Training

Cardiac MRI is rapidly advancing across the country as a rapid, reproducible and reliable modality with unparalleled resolution and intrinsic 3D spatial representation. It is the "gold standard" for many of the critical measurements that clinicians use on a daily basis, including (but not limited to) LV/RV ejection fraction, stroke volume and mass. Additionally, it has been shown to be the gold standard for anomalous coronary arteries. It has equivalent sensitivity and slightly higher specificity than leading imaging techniques for detection of aortic, as well as thorocoabdominal dissections, without any obligatory invasiveness. To complete its litany, CVMRI can be performed without the risk of contrast nephropathy, radionuclides, or need for esophageal penetration, and typically without need for an IV.

The Cardiovascular MRI program at Allegheny General Hospital, Pittsburgh, PA, is the only one in the city or the state to have a dedicated cardiac MRI program.  The magnet is a GE HD EXCITE 8-channel coil and, at less than 1 year old, it has the highest slew rate in the industry.

The Cardiovascular MRI program is headed by Robert W. W. Biederman, MD, FACC, who graduated from the Medical University of South Carolina and did his Internship and Residency at Pennsylvania State University at Hershey Medical School. He did a four-year Cardiology Fellowship at the University of Alabama in Birmingham, including an NIH/UAB Fellowship in Cardiovascular MRI. He has trained with both Gerry Pohost, M.D. and Nathaniel Reichek, M.D. and learned ventricular mechanics from Blase Carabello, M.D. during his three years in a Cardiovascular Mechanics Animal Lab while in South Carolina. His interests include non-invasive evaluation of LV function using radiofrequency tagging, evaluation of surgical reconstruction of cardiomyopathy (Dor procedure), delayed hyperenhancement in the pursuit of CVMRI viability and novel applications of CVMRI.

Cardiologists and other trainees will have the opportunity to spend time learning about CVMRI, during which they will be exposed to the imaging capabilities of this modality. Trainees will receive didactic exposure throughout the course of their training through a combination of periodic lectures, conferences or CVMRI imaging sessions. Those interested cardiologists should identify themselves early to the CVMRI staff such that a dedicated course of action and pursuit of both a clinical and research experience may be so afforded. Those who performed in an exemplary fashion will have the opportunity to receive Level One, Two or Three certification per the prerequisites outlined by Task Force 12: Training in CV MRI/ COCATS and the Society of Cardiovascular MRI under the auspices of the American Heart Association.  In 2002-2003, two cardiologists achieved this distinction; in 2003-2005, three cardiologists were so awarded.

Interested trainees will receive instruction in clinical imaging and research applications, including but not limited to:

IMAGING BASICS

  • Overview of Cardiovascular Magnetic Resonance Imaging
  • Cardiovascular Magnetic Resonance Imaging Equipment
  • Imaging Methods
     

CLINICAL APPLICATION

  • Cardiovascular Magnetic Resonance Imaging Patient Positioning
  • Cardiovascular Magnetic Resonance Imaging Protocols
  • Measurement Analysis
  • Anatomy
  • Left and Right Ventricular Structure and Function
  • Valvular Heart Disease
  • Thoracic Magnetic Resonance Angiography
  • Extra Cardiac Magnetic Resonance Angiography
  • Myocardial Perfusion and Viability
  • Cardiac and Extra Cardiac Tumors
  • Congenital Heart Disease
  • Alternative Uses for Contrast Imaging
  • Miscellaneous Uses of Cardiovascular Magnetic Resonance Imaging
     

ADVANCED TRAINING

  • Gradient Echo
  • Cardiac Triggering
  • Inflow Refreshment Angiography
  • 3D Contrast Angiography
  • Imaging Parameters
  • Spin Echo
  • Fat and Water Properties in Cardiovascular Magnetic Resonance Imaging
  • K-Space
  • Magnet Design
  • Parallel Imaging
  • Steady State Free Precession
  • Cardiac Tagging
  • Perfusion and Viability
  • Phase Velocity Mapping
  • Slice Selection
  • Rapid Cardiovascular Magnetic Resonance Imaging
  • Jet Flow Imaging
  • K-Space Revisited: an Informal View
  • Artifacts
  • Patient Safety in Cardiovascular Magnetic Resonance Imaging

Trainees will have ample opportunity to join in on original and hypothesis-driven research, as well as partake in numerous local and worldwide multi-center trials where AGH CVMRI is either a participating site or Core Lab. Previous trainees have submitted abstracts at major meetings (AHA, ACC, SCMR), presented at statewide AHA/ACC competitions, and/or submitted grant proposals. Notable honors include:  placing third at the PA/ West Virginia AHA Fellows competition (2002); top 30% for PA/Del AHA Beginning Grant-in-Aid (2001); first place Resident Research Competition (2002, -- in conjunction with Cardiothoracic Surgery); and third place for an oral presentation at the Pittsburgh Cardiovascular Updated Young Investigator competition. One resident placed third in an AHA Research Competition in 2003 and 2004 and also  received distinction for an oral presentation in Barcelona at the annual SCMR meeting in 2004. In each of the last 3 years, the AGH CVMRI program has ranked in the top 5 in the country for number of accepted papers at The Society of Cardiovascular Magnetic Resonance Imaging (SCMR) International Society Meeting.  At the 2007 annual SCMR meeting, held in Rome, the program was tied for 4th in the USA and 7th in the world for number of accepted papers.

Recent papers/lectures have been presented by CVMRI Staff in Rome (2nd annual CVMRI meeting--organized by one of the MRI staff), Australia (World Congress of Cardiology), Hawaii (ISMRM), Florida (SCMR), Georgia (ACC), California (AHA), Buenos Aires (NIH), Barcelona (SCMR) and San Francisco. For the past seven years, the AGH CVMRI program has been invited to make presentations at the annual meetings of the American College of Cardiology and the American Heart Association.

Level 3 (CVMRI Fellowship), encompassing one year, is also available upon request. Information on schedule and fees (if applicable) is available by contacting rbiederman@wpahs.org or jmeister@wpahs.org


CVMRI STAFF PUBLISHES BOOK
CARDIOVASCULAR MRI TUTORIAL:  LECTURES AND LEARNING

Published in the Fall of 2007 by Lipincott, Williams and Wilkins. Three staff members of the CVMRI (Dr. Robert Biederman, Dr. Mark Doyle, and June Yamrozik, B.S., RT(R), MR)  joined together to create the first comprehensive Cardiovascular MRI text book of its kind to be directly aimed at the physicians, technologists, and physicists intimately involved in this technology. With 450 pages, 37 chapters, over 1000 images, and a DVD in Power Point (with additional videos and supporting lecture material) this book was recently predicted to become a classic in the field  by Valentine Fuster, M.D., Ph.D. (former President of both the American Heart Association and the World Heart Association).

For more information on this book, please contact rbiederm@wpahs.org or jmeister@wpahs.org

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