Certification Board Of Cardiovascular Computed Tomography

Content Outline

CBCCT conducted an initial analysis of the practice to identify the tasks performed by physicians practicing cardiovascular CT and the knowledge required to perform these tasks. The purpose of this practice analysis is to ensure that the examination content accurately reflects the current practice of cardiovascular CT. To accomplish this, a carefully constructed survey was sent to a representative sample of physicians practicing within the profession. The results were analyzed by a cross section of experts in the field. The result is the following outline of knowledge areas upon which the examination in cardiovascular CT will be based.

  1. RADIATION AND RADIATION SAFETY 10%
    1. Radiation science, generation and physics
    2. Radiation safety procedures (e.g., ALARA, dose reduction devices, periodic regular measurement of radiation dose)
    3. Government regulations pertaining to radiation safety
    4. Clinical application of radiation safety (e.g., pregnancy, children)  
  2. COMPUTED TOMOGRAPHY FUNDAMENTALS 8%
    1. Mechanical aspects of CT (e.g., axial, helical, fan beams, rotational velocity)
    2. Differentiation between different CT technologies (e.g., uses and limitations of 16, 64, 256, EBT, dual source, etc.)
    3. Collimation
    4. Resolution (e.g., temporal, spatial, contrast)
    5. Table speed pitch
    6. Signal-to-noise ratio
    7. Contrast-to-noise ratio
    8. Voxel (e.g., size and shape)
    9. Output settings
  3. PATIENT SELECTION, PREPARATION AND MANAGEMENT 11%
    1. Patient Selection
      1. Cardiac CT indications, contraindications, risks and benefits based on specific patient characteristics and medical history
      2. Alternative diagnostic modalities
      3. Impact of negative patient characteristics (e.g., obesity, heavy calcium, arrhythmias) resulting in modifying or canceling the CT scan as appropriate
      4. Factors associated with suboptimal and optimal scans
    2. Patient Preparation
      1. Beta blockers, nitroglycerin and calcium blockers (e.g., indications, contraindications, risks, proper dosage, and administration)
      2. Sedation (e.g., indications, contraindications, risks, proper dosage, administration, post-sedation care)
      3. Breath-holding techniques
      4. Screening and pretreatment for underlying renal insufficiency or allergies
      5. Procedures for monitoring patients following the administration of cardiac drugs and contrast
      6. Preparation of a patient with a permanent pacemaker
    3. Patient Management
  4. IMAGE ACQUISITION AND PROTOCOLS 11%
    1. Scan Set-up and Protocols
      1. ECG gating (e.g., prospective, retrospective, ectopy)
      2. Scan set-up based on patient characteristics (e.g., obesity, slow heart rate)
      3. Timing protocols (e.g., timing bolus, test bolus, bolus tracking)
      4. Injection protocols (e.g., uniphasic, biphasic, triphasic)
      5. Protocols for specific types of patients (e.g., patients with grafts, combined aortic and coronary artery disease, triple rule out)
    2. Contrast Media
      1. Contrast kinetics (e.g., flow rate, changes related to cardiac output, peak opacification of target sites, myocardial enhancement patterns)
      2. Contrast attenuation (e.g., iodine flux, dose)
    3. Image Quality
      1. Body mass
      2. Contrast bolus timing or threshold triggering for bolus tracking
      3. Heart rate and heart rate variability
      4. Breath holding
  5. RECONSTRUCTION AND POST-PROCESSING  9%
    1. Reconstruction (Processing on the Scanner)
      1. Filters and kernels
      2. Intervals (phases)
      3. Spatial resolution
      4. Slice thickness
      5. Slice overlap
      6. Defined field of view
      7. Multisegment reconstruction
      8. Iterative reconstruction
      9. Multi-phased reconstruction
    2. Post-Processing (Features and Functionality of Workstation)
      1. Windows/levels
      2. Multiplanar reformation, straight and curved
      3. Straightened Vessel View
      4. Slab thickness
      5. Conventional orthogonal view (axial, sagittal, coronal)
      6. Minimum and maximum intensity projections
      7. Volume rendering technique
  6. ARTIFACTS  6%
    1. Artifacts Related to Bright Structures
      1. Beam hardening (e.g., related to stents, contrast, vascular clips, other metal, bone)
      2. Partial volume averaging
    2. Image Processing Artifacts
      1. Stair step artifact
      2. Banding 
    3. Motion Artifacts
      1. Cardiac motion artifact due to high heart rate and variability
      2. Cardiac motion artifact due to improper selection of phase
      3. Respiratory motion artifact
      4. ECG-gating artifacts
      5. Streak artifacts
      6. Ring artifacts
      7. Helical interpolation artifacts
  7. CORONARY VESSELS (Anatomy and Pathology) 24%
    1. Anatomy, Variations and Anomalies
      1. Coronary (e.g., coronary artery, coronary venous, coronary by-pass grafts)
      2. Other coronary pathology (e.g., intramyocardial course, fistula, AVM, aneurysms)
      3. Anomalous coronaries (e.g., identification and localization of the type and course)
    2. Coronary Artery Disease
      1. Coronary heart disease
      2. Plaque characterization
      3. Quantification of coronary artery stenosis
      4. Totally occluded vessels
      5. Bypass graft analysis (e.g., localization)
      6. Pre-operative planning (e.g., graft localization)
      7. Stent analysis (e.g., limitations, post-processing techniques)
    3. Coronary Calcium
      1. Quantification methods
      2. Epidemiology of CAC
      3. Diagnostic utility
      4. Prognostic utility
  8. NON-CORONARY CARDIAC (Structural and Functional Pathology) 14%
    1. Myocardium and Chambers
      1. Cardiac structural disease (e.g., cardiac masses, aneurysms, shunts)
      2. Left atrial anatomy (e.g., appendage, PFO recognition, size)
      3. Left ventricle (e.g., size, function, EF)
      4. Right ventricle (e.g., size, function, fatty infiltrate due to ARVD)
      5. Septal defects (e.g., ASD/VSD)
      6. Rest perfusion/scar
      7. Complex congenital heart disease
    2. Valves
      1. Mitral valve (e.g., recognition of annular/valvular calcification, mitral stenosis, vegetations, planimetry of valve area)
      2. Aortic valve (e.g., trileaflet vs. bicuspid, calcific disease, stenosis with valve planimetry, signs of insufficiency)
      3. Pulmonic and tricuspid valves (e.g., stenosis)
      4. Valve interventions (TAVR)
    3. Pericardium
      1. Pericardium (e.g., masses)
      2. Constriction (e.g., calcification, dilated)
      3. Effusion (e.g., evidence for tamponade)
  9. NON-CARDIAC (NonVascular Anatomy and Pathology) 7%
    1. Vascular
      1. Aortic pathology [e.g., variant anatomy, congenital (TGV), coarctation, PAU, dissection, aneurysm]
      2. Pulmonary artery pathology (e.g., embolism, congenital)
      3. Pulmonary venous anatomy (e.g., anomalous return, stenosis, anatomy for ablation)
      4. Other great vessel pathology and variants (e.g., SVC syndrome, persistent left SVC)
      5. Vascular interventions (aortic stent)
    2. Non-Vascular
      1. Common lung diseases
      2. Mediastinal and hilar pathology
      3. Tumors
      4. Pulmonary nodules
      5. Pleural effusion
      6. Other non-vascular (e.g., upper abdominal and chest wall disease)