Updates from the SCMR COVID-19 Task Force
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Dear Friends and Colleagues,
As COVID-19 continues to dominate most of our professional and personal lives, SCMR continues its efforts to support the global CMR community with tools to help deal with the pandemic. We are excited to announce several new initiatives that are part of the
SCMR’s COVID-19 Preparedness Toolkit
.
Led by our
Case of the Week
editors Sylvia Chen and Kevin Steel, we have set up a
COVID-19 CMR Case Collection
.
The goal of this repository is to provide CMR practitioners from around the world with an easily accessible and broad resource of cases to aid local reporting and education.
The SCMR COVID-19 Task Force, in collaboration with our colleagues at the European Association of Cardiovascular Imaging has set up a brief CMR COVID-19 survey, which we will send to all of you in the coming days. This survey can be completed on a smartphone or any computer and takes less than 5 minutes per patient to complete. If you are involved in reporting CMR scans in patients with or recovering from COVID-19, please use this survey to give us quick feedback on your scans. The data will be made available to the community and serve as an overview of the use and value of CMR in the COVID-19 pandemic.
We are also progressing our work towards a more comprehensive COVID-19 CMR registry. This will link with the SCMR registry as well as other national and international efforts to develop a global resource for more in-depth understanding of the cardiovascular effects of the infection. Please consider participating in this important global effort.
Sincerely
Sven Plein
Treasurer SCMR
Joint-lead of the SCMR COVID-19 Task Force
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SCMR COVID-19 Survey
There is a need for a global perspective on the use, value and impact of CMR in the COVID-19 pandemic. The COVID CMR survey is a joint initiative of SCMR and the European Association of Cardiovascular Imaging. It aims to provide a rapid tool to capture the use of CMR in COVID-19 around the globe. The design of the survey is deliberately limited to a small number of data fields to allow completion by imagers on a mobile device or computer immediately after scan completion and reporting. It can be completed in less than 5 minutes. The survey will be released soon. Further details on how to participate will be posted on the SCMR website.
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SCMR COVID-19 Case Collection
SCMR is creating a repository of CMR cases in patients with COVID-19 infection. The goal is to provide a rapid reference of common CMR findings associated with the infection and a new educational resource. Submitted cases will be fast-tracked through peer-review and can be listed as a peer reviewed web publication on CV’s. Cases will initially be posted on the SCMR homepage and then be available in an archive. All cases will include brief clinical information and key CMR images, with other information added where available. We need your help in making this a helpful resource for anyone reporting COVID-19 cases. Please
submit your cases
below.
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SCMR COVID-19 Registry Task Force
by Tim Wong
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The SCMR COVID-19 Registry Task Force is organizing a unified effort to leverage the collective expertise of the Society to assist clinical and research efforts to understand and disseminate observations regarding cardiovascular complications of COVID-19. CMR provides robust characterization of cardiac structure and function and is well suited to characterize myocarditis, myocardial infarction with nonobstructive coronary arteries, and other findings associated with COVID-19 infection. Given the rapidly changing knowledge base, wide heterogeneity in disease presentation and course, and varying levels of direct experience with infected patients, a collective effort is anticipated to yield comprehensive and generalizable observations of clinical and scientific interest to the CMR community at large.
Specifically, we propose a broad effort utilizing social media platforms for informal discussions and surveys, as well as creating a dedicated clinical registry of clinical data elements and images for more formal research study. An emphasis will be made toward inclusivity and flexibility to permit participation to the maximal extent that local conditions permit. Finally, the task force will initiate and foster dialogue with medical societies, health foundations, and other stakeholders for collaborative initiatives focused on COVID-19.
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The CARDOVID Pediatric Study
by Francesca Raimondi
The CARDOVID pediatric study is an observational data collection study of children with suspected COVID-19 infection and cardiac symptoms all over the world. The aim is to perform comprehensive cardiac MRI assessment including cardiac functional evaluation and myocardial tissue characterization of COVID-19 related disease in pediatric patients with cardiac involvement in the acute phase and during follow up.
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SCMR Registry Committee Update
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by Lon Simonetti, Chair, SCMR Registry Committee
The SCMR Registry continues to grow, adding new centers and building the database to nearly 100,000 CMR cases. Any SCMR Member can propose a registry-based research project, and the Registry Committee has been busy developing the processes to manage database search requests and data access. The required
forms can be found online on the Registry web page
. Building on the momentum from the Scientific Sessions in Orlando, a number of projects have been proposed and are currently under review. The committee could use a few additional members to help with research proposal reviews, and to expand utilization of the Registry for education and quality control purposes. If you’re an SCMR member and have experience and/or expertise in registry-based research, please consider joining. To apply, submit your application below.
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Coming Soon! Recommendations and Guidelines to Help Resume CMR Activities
by Bradley Allen
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As the SARS-CoV-2 pandemic transitions out of the peak phase, it is appropriate for CMR units to begin performing many semi-urgent and elective CMR studies. The SCMR has developed and will soon publish a set of recommendations and guidelines to help CMR units safely and effectively resume clinical and research CMR activities. In general, adherence to updated local institutional guidelines, while balancing the benefits of imaging with COVID-19 related risks to patients and healthcare workers should guide re-activation timing and patient selection. Particular areas of focus for CMR providers include implementation of appropriate COVID-19 screening of patients and staff, scheduling and facility practices that promote physical distancing and effective cleaning and sanitation, availability of personal protective equipment with special considerations for risk of mask components related to CMR magnetic fields, and selection of appropriate imaging protocols and study interpretation practices that optimize patient CMR studies while keeping physicians, trainees, and staff safe. Finally, determining which research activities may be resumed at reasonable risk to participants and staff alike will enable academic endeavors to proceed.
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Safe Reintroduction of Cardiovascular Services during the COVID-19 Pandemic
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The leadership of fifteen major North American societies, including SCMR, have come together to outline a general guidance and framework to reinstate diagnostic services during COVID-19.
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Clinical Problem
The COVID-19 pandemic has led to marked global morbidity and mortality. There have been appropriate but significant restrictions on routine medical care to comply with public health guidance on physical distancing, and to help preserve or redirect limited resources. Most invasive cardiovascular (CV) procedures and diagnostic tests have been deferred with North American cardiovascular societies advocating for intensified triage and management of patients on waiting lists.
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Table 1:
Safe Reintroduction of Cardiovascular Procedures and Diagnostic Tests during the COVID-19 Pandemic: Guidance from North American Societies
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[Source: "Safe Reintroduction of Cardiovascular Services during the COVID-19 Pandemic: Guidance from North American Societies." (2020, May 20).
Canadian Journal of Cardiology
.]
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FDA Issues New Policy for Imaging Systems During COVID-19
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The Food and Drug Administration (FDA) plays a critical role in protecting the United States from threats such as emerging infectious diseases, including the Coronavirus Disease 2019 (COVID-19) pandemic. FDA is committed to providing timely guidance to support response efforts to this pandemic.
FDA is issuing
this guidance
to provide a policy to help expand the availability and capability of medical x-ray, ultrasound, and magnetic resonance imaging systems, and image analysis software that are used to diagnose and monitor medical conditions while mitigating circumstances that could lead to patient, healthcare provider, and healthcare technology management (HTM) exposure to COVID-19 for the duration of the public health emergency declared by the Secretary of Health and Human Services (HHS) on January 31, 2020, effective January 27, 2020, and renewed for 90 days on April 21, 2020, effective April 26, 2020.
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The Role of Cardiovascular Imaging for Myocardial Injury in Hospitalized COVID-19 Patients
Several societies have recently provided recommendations describing the importance of limiting cardiovascular imaging during the COVID-19 pandemic to reduce virus transmission and protect staff exposure. Nonetheless, elevated troponin and suspected myocardial injury appears to be a frequent feature in COVID-19 patients. Given the strengths of CMR in MINOCA and myocarditis assessment, it certainly has a role in this scenario, but this must be balanced against risks and the cases for CMR need to be selected accordingly. The recent paper by EACVI aims to provide guidance to clinicians regarding the appropriateness of cardiac imaging including CMR in the context of suspected myocardial injury, how best to decipher the mechanism, and how to guide patient management.
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Figure 3:
Stepwise approach in COVID-19 with myocardial injury and suspicion of CAD
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CMR News: Appropriate Use Criteria Program
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CMS Appropriate Use Criteria Program for Advanced Diagnostic Imaging Services
(updated May 2020)
by Carrie Kovar, Government Relations Consultant to SCMR
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What is AUC?
The Protecting Access to Medicare Act (PAMA) of 2014 established a program to mandate the use of appropriate use criteria (AUC) for advanced diagnostic imaging provided to Medicare beneficiaries.
How will I order a CMR?
Ordering professionals will be required to consult with AUC through a clinical decision support mechanism (CDSM) prior to ordering an advanced diagnostic imaging service (CT, MR, nuclear and PET). CDSMs are the electronic tools through which a clinician consults AUC to determine the level of clinical appropriateness for a patient’s clinical scenario.
What if it is not “appropriate”?
The furnishing professional will not be paid by Medicare unless the furnishing professional documents the ordering professional consulted with AUC.
When will this start?
Full implementation begins on January 1, 2021. From this date AUC consultations with qualified CDSMs are required to occur along with reporting of the consultation.
How does COVID affect this ruling?
The American Medical Association (AMA) has requested that CMS postpone implementation in 2021. CMS has yet to give any indication that it will postpone implementation. SCMR will provide updates as developments occur.
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Don't miss the next
FSCMR Application
deadline June 1, 2020
Applications are collected quarterly.
March 1, June 1, September 1, December 1
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Case-Based Webinar Series Success!
In mid-April, Dr. Ibrahim Saeed of Saint Luke's Mid-America Heart Institute (Kansas City, MO) raised the question of how SCMR might better support CMR trainees who were in sheltering or experiencing a decrease in CMR volume in the midst of the COVID-19 pandemic. Young physicians were concerned that their learning opportunities were diminishing as non-urgent and elective CMR scans were postponed. Many of these physicians would be finishing imaging fellowships in June and starting new positions in July.
On April 22, a task force to address this concern convened, rapidly planning twice weekly webinars on core CMR topics to be held the entire month of May through the third week of June. The enthusiasm from the SCMR community to step up and participate as faculty was astounding—particularly given the short time-frame. In under two weeks after that first planning meeting, the inaugural SCMR Case-Based Educational Webinar took place on May 5, 2020. The response was overwhelming. In that first webinar, over 1,200 participants registered from across six continents. Participants have represented a diverse group including trainees from cardiology and radiology but also technologists, physicians in practice, and non-physician scientists. As an unintended benefit to the webinar series, the SCMR has observed new members joining the Society.
The program is ever evolving, as participants provide feedback. Because of the high number of questions received during the webinars, residual questions may now be answered on the SCMR blog, and topics for future sessions may also be suggested.
Despite these challenging times, the sense of community is stronger than ever. And perhaps, in this spontaneous but highly successful educational endeavor, the SCMR may have found a new forum in which to disseminate and share information globally.
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SCMR Case-Based Webinar Series Schedule
June 2 @ 11 am ET
Myocarditis
Presenters: Dr. Jeanette Schulz-Menger,
Dr. Maximilian Fenski, and Dr. Edyta Blaszczy
June 4 @ 11 am ET
HCM and Hypertophic Phenotypes
Presenters: Dr. John Baksi and
Dr. Daniel Sabo
June 9 @ 11 am ET
I
schemic Heart Disease (IHD)
Presenter: Dr. Mark Westwood
June 11 @ 11 am ET
Non-Ischemic Cardiomyopathy
Presenters: Dr. Subha Raman and Dr. Kate Tsarova
June 16 @ 11 am ET
Pulmonary Artery, Pulmonary Veins, Aorta
Presenters: Dr. Marco Francone, Dr. Iacopo Carbone, Dr. Nicola Galea and Dr. Viviana Maestrini
June 18 @ 11 am ET
Cardio-Oncology
Presenters: Dr. Charlotte Manisty, Dr. Lauren Baldassare, Dr. Ana Barac
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More Online Educational Opportunities
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Join us for the
Level I SCMR Workshop, as experts guide the participants through the fundamentals of CMR, reflecting on the added value of using CMR in clinical practice. This virtual experience will emphasize the clinical applications of CMR, with review of the appropriate use criteria and patients who might benefit most from the unique technology. Clinical cases will be used liberally throughout the course to emphasize key concepts. In addition to
Level I certification, participants will be eligible to claim CME, MOC, and ASRT credits for the time spent in the course.
In addition, attendees will have access to eight (8) hours of on-demand content for 60 days.
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Myocardial Perfusion Imaging Method: Principles and Methods
When: Wednesday, June 24 from 11:00 am - 12:00 pm ET
Peter Kellman, Senior Scientist in the National Heart, Lung, and Blood Institute at NIH, will discuss the basic principles of myocardial perfusion imaging including the mechanism of first pass contrast enhanced perfusion and description of saturation recovery imaging. The presentation will cover commonly used protocols for stress imaging, imaging protocol trade offs, and artifact mechanisms. The presentation will include advanced topics of myocardial perfusion quantification, dual sequence, and arterial input function estimation.
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Share Free Educational Content and Resources
with Colleagues
Limited Time Offer- Ends May 31, 2020
Members Only content that can now be accessed for free by non-members includes:
code
SCMR-Cares
at checkout.
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SCMR Journal Club Series Expands
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This month, the SCMR Journal Club Series has a new family member: The
CMR Journal Club
(
www.cmrjournalclub.com
).
For more than 2 years, the monthly webinar hosted by Dr. Matthias Friedrich (McGill University Health Centre, Montreal, Canada) has been a huge success, with currently more 450 subscribers.
The setup is simple: Each paper is presented (typically by the author) for 10 minutes, followed by a 5-minute discussion. This lively format guarantees a fast paced focus on the key messages of the paper while still allowing for important questions. At each 30-minute webinar, two papers are discussed and often, more papers are mentioned as further reading.
For members, the PDFs are available online as part of the educational material.
Sign up is easy. No commercials, no spam, just entertaining, good education.
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CMR Journal Club
Wednesday, June 3 @ 11:00 am ET
Huang et al. Cardiac involvement in recovered COVID-19 patients identified by magnetic resonance imaging. JACC: Cardiovascular Imaging. May 2020.
Cosyns et al. The role of cardiovascular imaging for myocardial injury in hospitalized COVID-19 patients (on behalf of EACVI). Eur Heart J Cardiovasc Imaging. May 2020
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JCMR Journal Club
Wednesday, June 10 @ 11:00 am ET
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Did you miss the previous JCMR Journal Club?
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PhD Examination via Zoom
by Joao G. Ramos
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Recently I defended my PhD thesis at Karolinska Institutet, Sweden, on the CMR assessment of
pulmonary hypertension and diastolic dysfunction
. Due to the COVID-19 crisis, the whole examination process was conducted via Zoom across multiple timezones. The external evaluator, former SCMR president Professor Victor Ferrari, was in Philadelphia, USA (University of Pennsylvania), my main supervisor Martin Ugander was in Sydney, Australia (University of Sydney), and my colleagues and I were in Stockholm, Sweden (Karolinska Institutet). My supervisors, the evaluation committee, and I had video and microphone connections, and we shared our screens to show slides. The whole thesis defense was also open to the global public, and the audience could pose questions at the end of the session. Overall, it was a very positive experience. The recent advances in videoconferencing software allowed great video and audio quality, and the internet connection was stable throughout. I would have preferred to defend my PhD thesis as it's traditionally done, of course, since it feels more personal. However, under the current circumstances, I believe this solution worked out great and may be a feasible alternative for similar events in the future.
Dr. Ferrari commented, "The format worked very well and there were very few technical glitches. We left the main call and joined a second meeting for the evaluative portion of the defense proceedings, then rejoined the main call to congratulate Joao in person so that everyone joining the call could see him receive his well-deserved congratulations. I think it was the next best thing to being there, except for the lack of the wine and the customary party afterwards."
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by Sylvia Chen, Editor, Case of the Week
SCMR Case of the Week offers a great opportunity for showcasing interesting cases on the SCMR website, demonstrating the utility of cardiovascular magnetic resonance (CMR) in the assessment, diagnosis and management of cardiac disease, and therefore contribute to global CMR education.
It is peer reviewed by a panel of CMR experts. The five best cases for the year will have the opportunity to compete for ‘Best case of the year’ at SCMR’s annual scientific meeting the following year.
There is now emerging data describing the cardiac effects of COVID-19. We are interested to learn more about COVID-19's impact on the heart, and therefore will also be collecting cases for publication on
SCMR's COVID-19 Case Collection
.
We look forward to your cases!
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The Latest Case of the Week
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NUMBER 20-02: Rare Aortic Arch Anomaly Identified by CMR in patient with Klippel-Feil Syndrome
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A 28 year old asymptomatic male with a history of Klippel-Feil syndrome was referred for a transthoracic echocardiogram because of his history of a genetic condition. The echocardiogram revealed an enlarged right atrium and ventricle and possible left to right atrial level shunt.
The patient was diagnosed with Klippel-Feil syndrome at 16 years of age when he was found to have multiple vertebral anomalies (fusion of C2-3, C7-T1, T2-3) as part of an evaluation for scoliosis. He subsequently had an abdominal ultrasound which revealed an absent left kidney.
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May 1 to May 25
#WhyCMR Activity
by Purvi Parwani
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Each month our social media committee correspondents update us on the latest #WhyCMR activity stats, most popular tweets or threads. Join the conversation and use the #WhyCMR in your social media posts!
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Research
W. Patricia Bandettini, et al.
Published on: 18 May 2020
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Research
Viktoria Holtstiege, et al.
Published on: 18 May 2020
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Research
Kimberley Jacobs, et al.
Published on: 14 May 2020
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Review
G. J. H. Snel, et al.
Published on: 11 May 2020
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Research
Frank Lindemann, et al.
Published on: 11 May 2020
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Research
Gabriella Captur, et al.
Published on: 07 May 2020
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Please
use this link
for a filtered PubMed list of all CMR-related manuscripts for May 2020 – more than 200 in total!
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Manish Motwani
Newsletter Editor
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