Technologists seek to fill gaps in cardiac imaging expertise

Cardiovascular imaging demands new skills and a new focus from imaging technologists. While technologists evince plenty of interest in cardiovascular imaging, training opportunities remain in the early stages.

Imaging technologists need to have a firm grasp of scanner technology, coronary anatomy, and imaging protocols in order to be able to perform well in the relatively new arena of coronary imaging. Training needs differ depending on the technologist's background.

New coronary imaging technologists tend to come from either the CT imaging suite or the catheterization lab. Both types of technologists bring strengths to a practice, but they need further training to bolster their effectiveness.

Technologists who come from a CT background will have to concentrate much of their training on coronary anatomy, function, and pathology, said Praveen Nadkarni, manager for cardiac CT at Siemens Medical Solutions. That's because many physicians now depend on technologists to not only acquire the coronary image, but also to perform postprocessing.

The emphasis on coronary anatomy can't be overstressed, said Joey Glass, director of cardiovascular CT for Cardiology Associates of Mobile, AL.

"Technologists need to know their coronary anatomy inside and out," Glass said. "You have to know what to look for: if there's a stenosis, if they've had bypass surgery, where the surgeons are typically going to put the bypass graft, what vessels they use to bypass with, and what the cardiologist needs to see reading a scan. It's not pushing buttons anymore."

Others will come to coronary imaging from the cath lab. These technologists will know coronary anatomy but need training on the physics, usage, and operation of a scanner.

"A technologist coming from the cath lab knows coronary anatomy, but the physics, the process of learning the CT scanner, injection rates of the isotopes, pitches of the table, gantry rotation - that's all Greek to them," said Cathleen Biga, president and CEO Cardiovascular Management of Illinois, which provides strategic planning and practice management for about 50 cardiologists in Chicago area.

Ideally, technologists from both backgrounds would work in a practice, Biga said. But until a practice has a high volume of cardiovascular imaging patients, that arrangement may not be realistic.

Scanner vendors provide a variety of training opportunities for technologists. Dedicated training centers provide a mix of lectures, anatomy lessons, and hands-on time with the equipment. Vendors also provide onsite training and follow-up visits.

Biga's group, one of the first private practices to perform cardiovascular imaging with a 64-slice scanner, depended heavily on GE Healthcare for training when it started. The mix of outside training and onsite visits worked well.

"We think it takes almost a month of solid training: a week with the vendors for the 64-slice scanner, a week on coronary anatomy, then two weeks onsite," she said.

But that training schedule works only if a practice has a high volume of coronary imaging patients, according to both Biga and Glass. If a practice has only a few cardiovascular imaging cases a day, onsite training may have to last longer.

One way around this problem is for technologists to shadow their peers working at high-volume practices. Both Atlantic Medical Imaging and Cardiology Associates are high-volume cardiac imaging practices that offer technologist master classes.

Glass runs the two-day technologist master class at Cardiology Associates. Techs spend the first day shadowing experienced practitioners and watching them prep patients, administer beta blockers, and perform scans. The second day is spent on postprocessing at workstations.

"You must have patients, and you must have a mix of them," Glass said. "You must have enough patients to do it over and over and over again. It's not something you can see once or twice and just have it. That's what I love about people coming in and watching us all day on Friday. We concentrate on what we run into on a day-to-day basis, in real life, not with canned, pretty patients. Anyone can scan a normal patient. It's the ones with a heart rate that doesn't drop below 80 or 75 - you must know the functions of the heart to know what you can do to get those images and make them look diagnostic."