European Society of Radiology: Could you please give a detailed overview of when and for which diseases you use cardiac imaging?
Aloha Meave: Technological developments in cardiac non-invasive imaging have reached every aspect of cardiology practice, with improvements in diagnosis and impact on patient management and follow-up. Cardiac imaging provides us with indispensable methods in ischaemic and non-ischaemic disease diagnosis, as well for diagnosis and follow-up of complex congenital heart diseases.
ESR: Which modalities are usually used for what purpose?
AM: Nowadays magnetic resonance imaging (MRI) is a routine method in cardiology, because of its capacity to assess biventricular function and tissue characterisation. Computed tomography (CT) is used to rule out coronary artery disease and characterisation of cardiac morphology. Echocardiography is an ideal imaging technique in the quick assessment of cardiac structures and cardiac function.
ESR: What is the role of the radiologist within the ‘heart team’? How would you describe the cooperation between radiologists, cardiologists, and other physicians?
AM: Our cardiovascular imaging workgroup is multidisciplinary, made up of cardiologists, paediatrician cardiologists, and radiologists. Every single team member has received appropriate training and has experience in cardiovascular imaging, allowing us to integrate an accurate diagnosis. The radiologist plays an important role by bringing expertise in MRI and CT physics, a skill that is a key element for teamwork with the cardiologist, who has complete knowledge of the pathology. Both specialists decide together what the best approach for the patient is.
ESR: Radiographers/radiological technologists are also part of the team. When and how do you interact with them?
AM: We interact closely with technologists, from patient arrival until their dismissal, including planning, preparation, image acquisition, and processing. Radiological technologists undergo a special training in cardiovascular imaging.
ESR: Please describe your regular working environment (hospital, private practice). Does cardiac imaging take up all, most, or only part of your regular work schedule? How many radiologists are dedicated to cardiac imaging in your team?
AM: My practice is full day at the Heart Institute in Mexico City, a national reference centre where we perform 2,000 CMR scans and 1,800 CT scans each year. We have academic activity every morning with lectures, journal club and case reviews. Research is also an important part of our daily activity.
In the cardiac imaging group, we have five radiologists and six fellows in training, besides cardiologists and cardiac paediatricians.
ESR: Do you have direct contact with patients and if yes, what is the nature of that contact?
AM: We have patient contact from the moment they arrive at the unit. Radiologists always speak and explain to patients some technical aspects of the study. There is always an expert who is present during image acquisition, making decisions.
ESR: If you had the means: what would you change in education, training and daily practice in cardiac imaging?
AM: It would be great to include mentoring in radiology training programmes, to speak with residents about the possibilities and advantages of cardiovascular imaging. It would also be of value to prepare events with worldwide-recognised speakers for radiologists and residents, where the different modalities and the capacity of cardiovascular imaging are exposed. I think cardiovascular imaging must be included more in the radiology training programme so that residents are exposed and motivated to specialise in this area. We need more radiologists to become interested in cardiovascular imaging, and mentoring would really help.
ESR: What are the most recent advances in cardiac imaging and what significance do they have for improving healthcare?
AM: I would say the improvement of tissue characterisation techniques that will allow the diagnosis and follow-up of patients with cardiomyopathies. An interesting advance is the employment of 3D printing for teaching and in digital simulations.
ESR: In what ways has the specialty changed since you started? And where do you see the most important developments in the next ten years?
AM: Many things have changed since I started fifteen years ago. In my country, the first cause of attention was ischaemic disease and the second cause was valve disease; nowadays the first cause of attention is ischaemic disease, but the second cause is now adult congenital heart disease, which is interesting because both CMR and CT are very important in the study of this patients.
We will see developments in CMR such as improvement of tissue characterisation sequences, new ventricular strain sequences and the development of non-contrast angiogram techniques. There will be another important improvement in velocity encoding flow sequences (4D flow), which will enable the studying of the intracavitary haemodynamic. And of course, we will also see advances in cinematic rendering software that will take us to the implementation of virtual reality.
In CT we will see advances in myocardial perfusion protocols.
ESR: Is artificial intelligence already having an impact on cardiac imaging and how do you see that developing in the future?
AM: Artificial intelligence has been present in cardiac imaging for some years now, thanks to the importance of quantitative analysis, which is important for precise diagnosis, therapeutic monitoring and prognosis determination. We will see more and more research in this area.
Dr. Aloha Meave is a cardiovascular radiologist and chair of the magnetic resonance unit at the Heart Institute in Mexico City. She is in charge of the cardiovascular imaging training programme at the National University where forty-three Mexican and Latin American experts have been trained. She trained in CMR at the Royal Brompton Hospital in London and in CT at the University Cardiac Department in Erlangen, Germany. She is founder and editor in chief of the website named Cardioimagen.org, a website started three years ago and dedicated to cardiovascular magnetic resonance, computed tomography, nuclear medicine and in a special segment for congenital heart disease. Dr. Meave is a major advocate for the academic use of social media, and Cardioimagen can be found on Facebook and Twitter, where the complete academic activity performed at the institute can be followed. She has published more than forty publications, nine book chapters and a cardiac imaging book. She has been part of the editorial board of Archivos de Cardiología and Journal of Cardiovascular Magnetic Resonance (JCMR), and is a reviewer for the Journal of American College Cardiology (JACC), JAAC Cardiovascular Imaging and the Journal of Cardiovascular Computed Tomography (JCCT). Dr. Meave is part of the Society of Cardiac Magnetic Resonance (SCMR) and Society of Cardiac Computed Tomography (SCCT) international boards. She founded and now chairs the Women in Medicine Initiative in Mexico and has been a passionate promoter of diversity, leadership, excellence and innovation in medicine.