Cardio-Oncology

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 27, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 0.50
Procedures: 0.50
Cardiac Procedures: 0.50

Registered Radiologist Assistant: 2.00
Safety: 2.00
Patient Safety, Radiation Protection, and Equipment Operation: 2.00

Radiation Therapy: 0.50
Patient Care: 0.50
Patient and Medical Record Management: 0.50

Outline

1. Introduction
2. Background
3. Panomics: Biomarker Identification
   1. Genomics
   2. Proteomics
4. Phenomapping with Imaging
   1. LVEF
   2. Myocardial Deformation and Mechanics
   3. CMR Imaging Metrics
   4. Myocardial Perfusion Imaging
   5. Cardiovascular Molecular Imaging Techniques
5. Radiation-Induced Cardiotoxicity
   1. Radiation-Induced Atherosclerosis
6. Conclusion

Objectives

Upon completion of this course, students will:

1. know the name of the process of computational integration of clinical data with advanced genetic, biomolecular, and demographic profiling to better risk-stratify patients
2. know the assumption that remains the current therapeutic standard in cancer therapy related CVD
3. know the various categories of cardiovascular complications of cancer therapy listed in the article
4. be familiar with the types of various traditional and targeted cancer therapies
5. know the current recommendations for managing potential cardiac dysfunction in patients receiving cardiotoxic therapies
6. know the signs and symptoms of the heart failure staging system
7. identify what can currently be adjusted in the clinical management of cancer therapy cardiotoxicity, without the benefits of cardio-oncology precision medicine
8. know where recent research has focused to complement sensitive imaging metrics
9. understand why brain natriuretic peptide and troponin have not been more commonly used in cardio-oncology assessments
10. be familiar with some potentially useful biomarkers that play critical roles in oxidative stress or nitric oxide metabolism which are potential mechanisms of anthracycline-induced cardiotoxicity
11. know what can illuminate novel disease metrics in therapy-induced cardiotoxicity that can, in turn, inform cardio-oncology personalization
12. know how precision phenotyping improves current cardio-oncology approaches
13. be familiar with the cardiomyopathy risk and cardiotoxicity findings of various child and adult cancer survivor studies
14. understand the significance and usefulness of circulating micro-RNA in CVD research
15. understand the importance of energy metabolism in relation to daunorubicin-induced cardiotoxicity
16. be familiar with the uses and insights into CVD that can be gleaned from metabolomics
17. recognize the future potential of metabolomics studies and resulting data
18. know the reasons that limit LVEF as a gold standard for the surveillance and diagnosis of treatment-related CVD
19. know the reasons why 2D echocardiography is typically the modality of choice for LVEF measurement
20. know why routine clinical use of 3D echocardiography has been challenging
21. identify the factors that have limited the use of multi-gated acquisition for surveillance and diagnosis of treatment-related CVD
22. know the major appeal of using imaging to measure myocardial deformation
23. be familiar with the advantages of 3D STE imaging
24. know how CMR T1-weighted images and T1 mapping can characterize cardiac tissue
25. be familiar with CMR’s role in assessing cardiac function and blood flow
26. be familiar with the SPECT-based study results in patients receiving left breast/chest wall RT compared with pre-RT SPECT scans
27. know the features of PET myocardial perfusion imaging that make it the gold standard for myocardial perfusion assessment when compared with SPECT
28. understand the challenges that have limited the use of PET imaging techniques in cardio-oncology patients
29. be familiar with the various molecular imaging radiotracers, their molecular target or mechanism of uptake, and cardiovascular application
30. be familiar with the canine model of radiation-induced cardiotoxicity, as cited in the article
31. recognize the early markers of cardiotoxicity being utilized by new molecular imaging agents
32. know the factor to which radiation therapy toxicity can be directly linked
33. know a proposed therapeutic approach for radiation-induced cardiotoxicity that uses gene-expression assays to identify potential single-nucleotide polymorphisms that may predict adverse reactions to radiation therapy
34. know how molecular imaging could be used as an early diagnosis and surveillance approach for radiation-induced atherosclerosis
35. be familiar with the various imaging techniques associated with radiation-induced atherosclerosis