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Pediatric Cross-Sectional Cardiac Imaging in Europe: Current Status, Disparities, and Potential Solutions: A Survey
Tristan Ramcharan1,2, Arno Roest3, Inga Voges4,5
1Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK. tristanramcharan@doctors.org.uk.
Insights
European pediatric cardiology centers show varied practices in cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMR) and in training cardiologists. Standardization of these advanced imaging techniques is needed.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatrics
Background:
- Cross-sectional cardiac imaging, including cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMR), provides essential 3D visualization of cardiac structures.
- Current European practices and training in pediatric cardiology cross-sectional imaging are not well-defined.
Purpose of the Study:
- To assess the current landscape of pediatric CCT and CMR utilization in Europe.
- To understand the training pathways for pediatric cardiologists in cross-sectional imaging techniques.
- To identify variations and challenges in current European practice.
Main Methods:
- A comprehensive 64-question survey was distributed to members of the Imaging Working Group across 95 AEPC-affiliated centers.
- Responses were collected from consultants in 42 centers across 25 European countries between July and October 2024.
- Data analysis focused on imaging performance, personnel involved, training, and guideline adherence.
Main Results:
- Most centers have over 10 years of experience with CCT (median 135 scans/year) and CMR (median 200 scans/year).
- CCT is primarily performed by pediatric radiologists, while CMR involves pediatric cardiologists more frequently, often in combination with radiologists.
- Less than two-thirds of centers train fellows in CCT/CMR, with many fellows seeking international training; over half have institutional guidelines, and most desire European guidelines.
Conclusions:
- Significant variability exists in pediatric CCT/CMR performance and training across Europe.
- There is a clear need for standardized European guidelines to improve consistency and quality of pediatric cardiac imaging.
- Addressing these variations is crucial for advancing pediatric cardiology care through advanced imaging.
Abstract:
Cross-sectional cardiac imaging including cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMR) allows three-dimensional imaging of intracardiac and extracardiac structures. This study was undertaken to better understand current European practice of pediatric cardiology cross-sectional imaging, in addition to how training is undertaken in different centers. A structured detailed 64-question survey focusing on cross-sectional imaging was circulated to all Imaging Working Group members of the 95 AEPC affiliated centers. Consultants from 42 centers (44%) from 25 different European countries completed the survey, between 7th July 2024 and 28th October 2024. Ninety percent of centers have been performing pediatric CCT for > 10 years, with median 135 scans/year. Comparatively, 84% of centers have been performing CMR for > 10 years, with a median 200 scans/year. CCT was performed by a pediatric radiologist, whereas CMR was more often performed by a pediatric cardiologist, but frequently both modalities were undertaken by a combination of pediatric cardiologists and radiologists. Less than two-third of centers surveyed train fellows in CMR or CCT. Many fellows travel abroad to obtain specialist training. Just over half of the centers surveyed have institutional guidelines for pediatric CCT/CMR, with the majority agreeing that provision of European (AEPC-led) guidelines for pediatric CCT/CMR would be helpful. Across Europe there is significant variation in how CCT/CMR is performed and how pediatric cardiologists are trained in cross-sectional imaging. This survey highlights the current state of cross-sectional imaging in Europe, challenges faced, but also explores potential solutions to standardize European cross-sectional imaging.
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