Increasingly, cardiologists are taking an interest in vessels some distance from the heart. Maybe that’s why a quarter of the physicians who hold the Registered Physician in Vascular Interpretation (RPVI) credential are cardiologists (55% are vascular surgeons, 10% radiologists and 10% another specialty).
The credential was created about two years ago by the American Registry for Diagnostic Medical Sonography (ARDMS) and involves an exam that offers physicians a chance to prove their competence in analyzing images of the vasculature. The exam takes about four hours and involves 200 questions.
In the past, vascular specialists and cardiologists might have taken the Registered Vascular Technologist exam to document their expertise in reading images (1,490 physicians hold the RVT credential, ARDMS reports). Now they have their own test.
Given the significance of peripheral artery disease (PAD) in America (affecting an estimated 20 percent of Americans over 75), more physicians are seeking additional training in interpreting images throughout the body, and continuing on to get the credential.
Also, PAD’s association with heart disease is prompting more cardiologists to become familiar with patients’ disease in other vascular beds as they manage their risk for cardiac disease and/or stroke. In fact, the Mayo Clinic uses an integrated approach, bringing together endovascular specialists from vascular medicine, vascular radiology, vascular surgery, and interventional cardiology to individualize an optimal patient treatment plan for patients with global vascular disease.
“While there are differences in vascular beds, more physicians who treat vascular disease are thinking of the cardiovascular system as a whole verses individual parts,” says cardiologist Duane Stephens of Berkeley Cardiovascular Medical Group. Dr. Stephens notes that patients are becoming more knowledgeable about cardiovascular disease and the common risk factors, which is forcing doctors to “broaden their horizons” and expand their practice to provide better patient care. He began treating patients with vascular disease in the 1980’s after an existing cardiac patient asked him about venous disease in his extremities. Dr. Stephens says, “Vascular ultrasound is a good window to look into the vascular system.”
Dr. Arnold Levine, a retired vascular surgeon in northern California, is one of the instructors in Mint Medical Education’s new Vascular Interpretation Preceptorship, which prepares physicians for the RPVI exam. Over the years he’s watched ultrasound become increasingly useful in getting good vascular information, often obviating the need for a more expensive test. “I’ve been in the business since 1984, and it’s just grown and grown,” Dr. Levine says. “The indications for using it and the accuracy have gotten better and better. Ultrasound should be the first way to go.”
The review course offered by Mint at its San Francisco training center provides preparation for the exam, but also covers the fundamentals of ultrasound interpretation for vessels all over the body. Topics include the physics of ultrasound, how technologists conduct ultrasound studies and essentials of interpreting the images. “It’s a little bit of test prep but also broader issues in general,” Todd-Edwards says. “We want them to be OK with the test and also out in the real world.”
To sit for the exam, a physician must have fellowship training, 12 continuing medical education hours and have interpreted at least 500 vascular laboratory studies. Mint Medical is compiling a Case Study Review system that will offer providers more than 4,000 patient case studies, complete with images. It will soon be available for easy online review for preparation for the RPVI exam.
Cardiologists’ Input Critical to Integrated Management of PAD, Mayo Clinic website. http://www.mayoclinic.org/medicalprofs/peripheral-artery-disease.html. Accessed July 4, 2013.