JOURNAL OF NUCLEAR CARDIOLOGY NEWS UPDATE ASNC’S INTERNATIONAL OUTREACH JNC President’s Page
E. Gordon DePuey, MD
There is an enormous potential for growth of Nuclear Cardiology in developing nations. Whereas cardiac mortality is very high in countries such as China, India, and Brazil, utilization of both nuclear medicine and nuclear cardiology in the developing world is much lower than that in the United States and the five economically most advanced European nations. Although nuclear cardiology scans comprise approximately 40% of nuclear medicine procedures in the United States and Europe, they comprise only approximately 25% in the developing world. Over the past two years in my role as President Elect, and now President, of ASNC, I have had the very fortunate opportunity to speak with numerous nuclear cardiologists and nuclear medicine physicians from around the world, leaders of international societies, such as the International Atomic Energy Agency, the World Federation of Nuclear Medicine and Biology, the European Association of Nuclear Medicine, and J Nucl Cardiol 2014;21:1255–7. 1071-3581/$34.00 Copyright Ó 2014 American Society of Nuclear Cardiology. doi:10.1007/s12350-014-0010-6
representatives of several national nuclear medicine and cardiology societies. They have all identified and shared with me barriers to the development and perpetuation of nuclear cardiology, particularly in developing nations. Although each country seems to have unique potentials and limitations, there is some commonality. Nuclear medicine technologists are often not well trained in nuclear cardiology techniques. Nuclear medicine physicians, who interpret the majority of nuclear cardiology scans outside of the United States, are sometimes not well trained in cardiology and nuclear cardiology and may not have the communication skills necessary to convey relevant information to referring physicians. In turn, referring physicians often lack confidence in the quality of nuclear cardiology scans and their interpretations. In developing countries, maintenance and quality assurance of nuclear instrumentation and an uninterrupted supply of radiopharmaceuticals are also problematical. For these and other reasons, including economic considerations, cardiac CT is often requested in preference to nuclear imaging. In many instances, no diagnostic imaging whatsoever is performed in patients for whom noninvasive risk stratification would be otherwise appropriate. Therefore, I have made ASNC’s international outreach program a high priority of my presidency. Since the foundation of our organization, our leaders have understood the importance of engagement of the international community, and indeed we have always had active members from all over the world. Under the previous leadership of Dr. Greg Thomas, the ASNC International Advisory Panel (IAP) developed strong and lasting relationships with international key opinion leaders. He and many other ASNC representatives have delivered lectures promoting nuclear cardiology and strengthening our international ties. During the past year, I have tried to generate increased enthusiasm for our international outreach program among our leaders, members, and commercial partners. We have substantially strengthened our relationships with international organizations, particularly the IAEA. We have dramatically increased our educational offerings, including some that are now translated into Spanish. With the help of unrestricted grants from several of our commercial 1255
1256
News update
partners, we now provide discounted memberships for nuclear physicians and technologists in developing countries. Dr. Joao Vitola, Chair of the IAP, and Dr. Mouaz Al Mallah, the panel’s Vice-Chair, with the invaluable assistance of Jocelyn Adamoli of the ASNC staff, have promoted ASNC’s offerings and the considerable benefits of ASNC membership worldwide. The following are some of the programs and services we now offer to our international members and affiliated physicians and technologists. The Best Practices in Nuclear Cardiology webinar series sponsored jointly by ASNC and the IAEA, continues full-force ahead, with five new presentations scheduled within the next year. Basic topics pertinent to an international audience include ‘‘A Practical Approach to Patient-Centered Imaging,’’ ‘‘Attenuation Correction in SPECT,’’ ‘‘Benefit Versus Risk: Approaching Radiation with Science and Common Sense,’’ ‘‘Tracers and Protocols,’’ and ‘‘Optimal RiskBenefit Ratio for Stress Myocardial Perfusion SPECT.’’ Nearly sixty percent of webinar attendees reside outside of the United States. We are hoping to expand these international webinars and make them even more popular by offering them at times convenient for participants around the globe. The new Nuclear Cardiology Knowledge SelfAssessment Product (NCKSAP), edited by Dr. Mouaz Al-Mallah, will be available to our international audience. The series is comprised a total of eight modules designed to follow the nuclear cardiology blueprint CBNC Board exam, and each will be available in an online format only. Each module will have a total of thirty multiple-choice questions, answers, rationales, and references, all designed to help learners assess their knowledge in nuclear cardiology. The first four modules available in the fall of 2014 include ‘‘Physics and Instrumentation,’’ ‘‘Risk Stratification,’’ ‘‘Radiopharmaceuticals,’’ and ‘‘General Cardiology Image Interpretation.’’ Additional modules will be added as they become available. Others planned include ‘‘Myocardial Viability,’’ ‘‘Ventricular Function Imaging,’’ ‘‘Radiation Safety,’’ and ‘‘Nuclear Cardiology Diagnostic Tests and Procedures/Protocols’’ A Fundamentals of Nuclear Cardiology Course is also being developed. Material from the ASNC Fellowsin-Training course offered at the Annual ACC Meeting will be produced as online course. This will be an audio and slide only program, initially in English, but may be translated into other languages. This course is very pertinent to all technologists and physicians just beginning their practices in nuclear cardiology, either in the United States or abroad. Topics include ‘‘Acquisition and Processing,’’ ‘‘Appropriate Use Criteria,’’ ‘‘Risk Stratification & Prognosis,’’ ‘‘Perfusion Cardiac PET,’’
Journal of Nuclear CardiologyÒ November/December 2014
‘‘Viability Imaging,’’ ‘‘LV Function Assessment,’’ ‘‘Cardiac CT,’’ ‘‘Radiation Exposure in CV imaging,’’ and ‘‘Read with the Experts.’’ We feel that the Education for Technologists series that is based on an ASNC 2013 live program will be particularly helpful to technologists in developing countries starting up a nuclear cardiology laboratory. Seven online modules will be released September 2014 through 2015. Topics include ‘‘Myocardial Anatomy & Physiology and ECG Basics,’’ ‘‘Exercise and Pharmacological Stress Testing Protocols and End Points,’’ ‘‘Pharmaceuticals and Radiopharmaceuticals used in Nuclear Cardiology,’’ ‘‘Acquisition and Processing Considerations,’’ ‘‘Understanding Quality Control and Identifying Artifacts,’’ ‘‘Utilizing Appropriate Use Criteria and Prior Authorizations in Your Laboratory,’’ and ‘‘Understanding and Implementing Effective Radiation Dose Reduction Techniques.’’ ASNC is continuing its series of user-friendly Practice Points, which are distributed to all ASNC members and are provided to each ASNC meeting attendee and available at ASNC exhibits throughout the year. These guidelines are available to ASNC website visitors to download for free. They do not include CME, but offer valuable resources to all involved in the imaging field. This series provides nuclear professionals with published information in a short and simple format that can be easily accessed online and shared. We feel these will be of particular value to our international members as a means to assure that their practices adopt current, up-to-date ASNC recommendations. Practice Points currently available include ‘‘Radiation Exposure in Myocardial Perfusion Imaging,’’ ‘‘The Role of Radionuclide Myocardial Perfusion Imaging in Asymptomatic Individuals,’’ and the ‘‘ASNC Preferred Practice Statement: Patient-Centered Imaging.’’ Clearly, to effectively engage an international audience, materials must be translated into the languages of the learners. Currently, we are translating several of the ASNC Guidelines into Spanish and hope to provide translations into other languages, particularly Chinese. Guidelines currently being translated into Spanish include ‘‘Stress Protocols and Tracers,’’ ‘‘Single Photon Emission Computed Tomography,’’ ‘‘PET Myocardial Perfusion and Glucose Metabolism Imaging,’’ ‘‘Appropriate Use Criteria for Cardiac Radionuclide Imaging,’’ ‘‘Strategies for Defining an Optimal RiskBenefit Ratio for Stress Myocardial Perfusion SPECT,’’ and ‘‘Patient-Centered Imaging.’’ The ASNC Registry, ImageGuide, is primarily designed to assure appropriate utilization and quality in the performance and interpretation of nuclear cardiology studies, with regular feedback to participants. We feel that the Registry will, therefore, be of great value to
Journal of Nuclear CardiologyÒ Volume 21, Number 6;1255–7
nuclear cardiology laboratories in developing countries where automated reporting is seldom available and where peer-review is more difficult to access than in developed nations. The Registry is now being updated/ reconfigured to include web-based data entry, allowing easier access for our international colleagues, facilitating tracking of fundamental demographic and quality improvement information. We are now proud to offer an ASNC International Developing Country Membership Category. This includes a discounted ASNC membership and a free online Journal of Nuclear Cardiology subscription. These discounted memberships have been made possible by generous contributions from several of our commercial partners. Physicians and scientists residing in developing countries, as defined by the World Bank Developing Countries List, who have earned an advanced academic degree (MD, DO, PhD, or equivalent), are in good standing in their respective communities, and are actively engaged in nuclear cardiology practice and/or research, are eligible for this
News update
1257
discounted membership. We are hoping to extend memberships that are even more deeply discounted to technologists in developing countries. ASNC now boasts international members in 41 countries. Seven of these, all developing nations, have joined our ranks just within the past year. In addition, the online education programs enumerated above, I feel that one-on-one, face-to-face contact with our international members is essential to engender good will and promote nuclear cardiology globally. At our Annual Meeting this year in Boston, two international sessions were held. One was followed by a cocktail reception, which was very well attended, providing an opportunity to meet many new international members attending the ASNC meeting for the first time. ASNC is also providing speakers for and/or cosponsoring several international scientific meetings and symposia within the next year, which will further provide an opportunity to share ideas and learn more about the opportunities and challenges facing nuclear cardiology around the world.
E. Gordon DePuey, MD
There is an enormous potential for growth of Nuclear Cardiology in developing nations. Whereas cardiac mortality is very high in countries such as China, India, and Brazil, utilization of both nuclear medicine and nuclear cardiology in the developing world is much lower than that in the United States and the five economically most advanced European nations. Although nuclear cardiology scans comprise approximately 40% of nuclear medicine procedures in the United States and Europe, they comprise only approximately 25% in the developing world. Over the past two years in my role as President Elect, and now President, of ASNC, I have had the very fortunate opportunity to speak with numerous nuclear cardiologists and nuclear medicine physicians from around the world, leaders of international societies, such as the International Atomic Energy Agency, the World Federation of Nuclear Medicine and Biology, the European Association of Nuclear Medicine, and J Nucl Cardiol 2014;21:1255–7. 1071-3581/$34.00 Copyright Ó 2014 American Society of Nuclear Cardiology. doi:10.1007/s12350-014-0010-6
representatives of several national nuclear medicine and cardiology societies. They have all identified and shared with me barriers to the development and perpetuation of nuclear cardiology, particularly in developing nations. Although each country seems to have unique potentials and limitations, there is some commonality. Nuclear medicine technologists are often not well trained in nuclear cardiology techniques. Nuclear medicine physicians, who interpret the majority of nuclear cardiology scans outside of the United States, are sometimes not well trained in cardiology and nuclear cardiology and may not have the communication skills necessary to convey relevant information to referring physicians. In turn, referring physicians often lack confidence in the quality of nuclear cardiology scans and their interpretations. In developing countries, maintenance and quality assurance of nuclear instrumentation and an uninterrupted supply of radiopharmaceuticals are also problematical. For these and other reasons, including economic considerations, cardiac CT is often requested in preference to nuclear imaging. In many instances, no diagnostic imaging whatsoever is performed in patients for whom noninvasive risk stratification would be otherwise appropriate. Therefore, I have made ASNC’s international outreach program a high priority of my presidency. Since the foundation of our organization, our leaders have understood the importance of engagement of the international community, and indeed we have always had active members from all over the world. Under the previous leadership of Dr. Greg Thomas, the ASNC International Advisory Panel (IAP) developed strong and lasting relationships with international key opinion leaders. He and many other ASNC representatives have delivered lectures promoting nuclear cardiology and strengthening our international ties. During the past year, I have tried to generate increased enthusiasm for our international outreach program among our leaders, members, and commercial partners. We have substantially strengthened our relationships with international organizations, particularly the IAEA. We have dramatically increased our educational offerings, including some that are now translated into Spanish. With the help of unrestricted grants from several of our commercial 1255
1256
News update
partners, we now provide discounted memberships for nuclear physicians and technologists in developing countries. Dr. Joao Vitola, Chair of the IAP, and Dr. Mouaz Al Mallah, the panel’s Vice-Chair, with the invaluable assistance of Jocelyn Adamoli of the ASNC staff, have promoted ASNC’s offerings and the considerable benefits of ASNC membership worldwide. The following are some of the programs and services we now offer to our international members and affiliated physicians and technologists. The Best Practices in Nuclear Cardiology webinar series sponsored jointly by ASNC and the IAEA, continues full-force ahead, with five new presentations scheduled within the next year. Basic topics pertinent to an international audience include ‘‘A Practical Approach to Patient-Centered Imaging,’’ ‘‘Attenuation Correction in SPECT,’’ ‘‘Benefit Versus Risk: Approaching Radiation with Science and Common Sense,’’ ‘‘Tracers and Protocols,’’ and ‘‘Optimal RiskBenefit Ratio for Stress Myocardial Perfusion SPECT.’’ Nearly sixty percent of webinar attendees reside outside of the United States. We are hoping to expand these international webinars and make them even more popular by offering them at times convenient for participants around the globe. The new Nuclear Cardiology Knowledge SelfAssessment Product (NCKSAP), edited by Dr. Mouaz Al-Mallah, will be available to our international audience. The series is comprised a total of eight modules designed to follow the nuclear cardiology blueprint CBNC Board exam, and each will be available in an online format only. Each module will have a total of thirty multiple-choice questions, answers, rationales, and references, all designed to help learners assess their knowledge in nuclear cardiology. The first four modules available in the fall of 2014 include ‘‘Physics and Instrumentation,’’ ‘‘Risk Stratification,’’ ‘‘Radiopharmaceuticals,’’ and ‘‘General Cardiology Image Interpretation.’’ Additional modules will be added as they become available. Others planned include ‘‘Myocardial Viability,’’ ‘‘Ventricular Function Imaging,’’ ‘‘Radiation Safety,’’ and ‘‘Nuclear Cardiology Diagnostic Tests and Procedures/Protocols’’ A Fundamentals of Nuclear Cardiology Course is also being developed. Material from the ASNC Fellowsin-Training course offered at the Annual ACC Meeting will be produced as online course. This will be an audio and slide only program, initially in English, but may be translated into other languages. This course is very pertinent to all technologists and physicians just beginning their practices in nuclear cardiology, either in the United States or abroad. Topics include ‘‘Acquisition and Processing,’’ ‘‘Appropriate Use Criteria,’’ ‘‘Risk Stratification & Prognosis,’’ ‘‘Perfusion Cardiac PET,’’
Journal of Nuclear CardiologyÒ November/December 2014
‘‘Viability Imaging,’’ ‘‘LV Function Assessment,’’ ‘‘Cardiac CT,’’ ‘‘Radiation Exposure in CV imaging,’’ and ‘‘Read with the Experts.’’ We feel that the Education for Technologists series that is based on an ASNC 2013 live program will be particularly helpful to technologists in developing countries starting up a nuclear cardiology laboratory. Seven online modules will be released September 2014 through 2015. Topics include ‘‘Myocardial Anatomy & Physiology and ECG Basics,’’ ‘‘Exercise and Pharmacological Stress Testing Protocols and End Points,’’ ‘‘Pharmaceuticals and Radiopharmaceuticals used in Nuclear Cardiology,’’ ‘‘Acquisition and Processing Considerations,’’ ‘‘Understanding Quality Control and Identifying Artifacts,’’ ‘‘Utilizing Appropriate Use Criteria and Prior Authorizations in Your Laboratory,’’ and ‘‘Understanding and Implementing Effective Radiation Dose Reduction Techniques.’’ ASNC is continuing its series of user-friendly Practice Points, which are distributed to all ASNC members and are provided to each ASNC meeting attendee and available at ASNC exhibits throughout the year. These guidelines are available to ASNC website visitors to download for free. They do not include CME, but offer valuable resources to all involved in the imaging field. This series provides nuclear professionals with published information in a short and simple format that can be easily accessed online and shared. We feel these will be of particular value to our international members as a means to assure that their practices adopt current, up-to-date ASNC recommendations. Practice Points currently available include ‘‘Radiation Exposure in Myocardial Perfusion Imaging,’’ ‘‘The Role of Radionuclide Myocardial Perfusion Imaging in Asymptomatic Individuals,’’ and the ‘‘ASNC Preferred Practice Statement: Patient-Centered Imaging.’’ Clearly, to effectively engage an international audience, materials must be translated into the languages of the learners. Currently, we are translating several of the ASNC Guidelines into Spanish and hope to provide translations into other languages, particularly Chinese. Guidelines currently being translated into Spanish include ‘‘Stress Protocols and Tracers,’’ ‘‘Single Photon Emission Computed Tomography,’’ ‘‘PET Myocardial Perfusion and Glucose Metabolism Imaging,’’ ‘‘Appropriate Use Criteria for Cardiac Radionuclide Imaging,’’ ‘‘Strategies for Defining an Optimal RiskBenefit Ratio for Stress Myocardial Perfusion SPECT,’’ and ‘‘Patient-Centered Imaging.’’ The ASNC Registry, ImageGuide, is primarily designed to assure appropriate utilization and quality in the performance and interpretation of nuclear cardiology studies, with regular feedback to participants. We feel that the Registry will, therefore, be of great value to
Journal of Nuclear CardiologyÒ Volume 21, Number 6;1255–7
nuclear cardiology laboratories in developing countries where automated reporting is seldom available and where peer-review is more difficult to access than in developed nations. The Registry is now being updated/ reconfigured to include web-based data entry, allowing easier access for our international colleagues, facilitating tracking of fundamental demographic and quality improvement information. We are now proud to offer an ASNC International Developing Country Membership Category. This includes a discounted ASNC membership and a free online Journal of Nuclear Cardiology subscription. These discounted memberships have been made possible by generous contributions from several of our commercial partners. Physicians and scientists residing in developing countries, as defined by the World Bank Developing Countries List, who have earned an advanced academic degree (MD, DO, PhD, or equivalent), are in good standing in their respective communities, and are actively engaged in nuclear cardiology practice and/or research, are eligible for this
News update
1257
discounted membership. We are hoping to extend memberships that are even more deeply discounted to technologists in developing countries. ASNC now boasts international members in 41 countries. Seven of these, all developing nations, have joined our ranks just within the past year. In addition, the online education programs enumerated above, I feel that one-on-one, face-to-face contact with our international members is essential to engender good will and promote nuclear cardiology globally. At our Annual Meeting this year in Boston, two international sessions were held. One was followed by a cocktail reception, which was very well attended, providing an opportunity to meet many new international members attending the ASNC meeting for the first time. ASNC is also providing speakers for and/or cosponsoring several international scientific meetings and symposia within the next year, which will further provide an opportunity to share ideas and learn more about the opportunities and challenges facing nuclear cardiology around the world.
