CV imaging for fellows in training: challenges and opportunities.

oday’s trainees and early career physicians in cardiology have seen unprecedented changes in the health care landscape. Rapidly advancing imaging technology has helped clinicians take great strides in the diagnosis and management of cardiovascular disease. Diagnostic tools have augmented patients’ medical histories and physical examinations in cardiology more than in most other medical fields. From the first cardiac ultrasound exams and nuclear stress testing a few decades ago to contemporary cardiac computed tomography and magnetic resonance imaging, the cardiovascular imaging toolbox has never been more robust. Imaging opportunities abound for cardiovascular fellows in training (FITs), but this richness also brings with it unique challenges. In the nascent days of cardiovascular imaging, clinicians interested in noninvasive imaging would often learn 1 advanced technique. As the field has advanced, multimodality cardiovascular imaging has matured as a bona fide subspecialty. FITs today are interested in gaining multimodality expertise to serve a vital role in advanced diagnostics and complement cardiovascular interventional and surgical therapeutics. However, accreditation bodies do not formally recognize training programs in multimodality imaging. Unlike many other cardiovascular subspecialties, such as electrophysiology, interventional cardiology, advanced heart failure, and transplantation cardiology, multimodality imaging is not an accredited fellowship, and no true standardization of training exists. Thus, the quality of training across centers can have a greater degree of variability and may become skewed on the basis of local expertise and patient population. Lack of accreditation also makes justification of a multimodality imaging