Getting Started in Practice as a Heart and Vascular Imaging Clinician

Naomi M. Hamburg, MD, MS

Rene Quiroz, MD, MPH
Rene Quiroz is currently completing his first year as the medical director of the South Texas Vascular Health Center and the Methodist Hospital Vascular Diagnostic Laboratory in San Antonio, Texas. He is member of the board of the Council on Vascular Ultrasound of the ASE. Dr. Quiroz spoke with Naomi Hamburg, MD, FASE, chair of the council, about his training in vascular medicine and imaging, starting out in practice with an expertise in cardiovascular imaging, and his involvement in ASE and opportunities for members to participate.

Dr. Hamburg: Tell us about your training and how you became interested in vascular medicine.

Dr. Quiroz: I was first exposed to vascular medicine and biology during a two year research fellowship in the venous thromboembolism group at Brigham and Women’s Hospital with Dr. Samuel Goldhaber. When I was training in cardiology at Boston University Medical Center, I was struck by the needs of patients with vascular disease. They are often the most complex and fragile patients who require the coordinated services of surgeons, primary care physicians, and cardiovascular specialists. Exposure to vascular diseases in cardiology fellowship was important. As you know, there is a NIH-funded K12 program training fellows in vascular medicine at Boston University. I remember talking with you, Robert Eberhardt, MD, FASE and Joseph Vita, MD about my interest in academic vascular medicine. Based on my interest and our conversations, I committed to spending a three-year period training in vascular medicine and epidemiology research with Dr. Vasan Ramachandran at the Framingham Heart Study.

Dr. Hamburg: Tell us about your vascular laboratory.

Dr. Quiroz: I am currently the director for two labs. One is within our practice’s clinic and the other is at Methodist Hospital. The clinic’s vascular lab is fairly busy, with one sonographer doing 40-45 ultrasounds a week and an additional 20 ABIs. We are currently expanding and adding another sonographer and ultrasound machine. In the hospital lab, we are in the process of incorporating standardized reading and interpretations for all reports. While we are currently dictating, soon we will have a structured, electronic reporting.

Dr. Hamburg: Is your vascular lab connected to your echocardiography lab?

Dr. Quiroz: In the clinic, the vascular and echo labs are independent. Our vascular sonographer only does vascular studies. In the hospital, we have three sonographers who are dual certified. This makes workflow a bit easier, as both studies can be done on the same patient in one visit and by the same sonographer.

Dr. Hamburg: What were the challenges in starting up your vascular lab? Any surprises?

Dr. Quiroz: There have been numerous challenges and surprises in becoming the director of a lab. First off, it’s been a significant transition from an academic setting in the Northeast to a practice setting in Texas (I’m also the newest, youngest member of the practice). I will say that the practice setting tends to be more efficient – there are always sonographers on call and studies are frequently done on weekends and in the evenings. Another challenge has been working to standardize reporting in a practice with 35 cardiologists. Other aspects that have been new are refining imaging protocols, giving feedback and dealing with ‘real world’ problems. For example, we recently adopted the SRU criteria for grading internal carotid artery stenosis based on the recommendations in a white paper from the IAC: ( ). We are working toward accreditation for our laboratories.

Dr. Hamburg: What parts of your training in ultrasound imaging were most helpful?

Dr. Quiroz: The most helpful aspect was reading a sufficient number of studies with good and varied mentorship. I had three different people with whom I read studies, and each approached vascular imaging differently. Getting in the habit of reviewing the images myself, spending time with sonographers to see how studies are performed, and seeing a few zebras all helped consolidate my skills.

Dr. Hamburg: How did you first get involved in the ASE?

Dr. Quiroz: I knew about ASE throughout fellowship, especially from guidelines that we used in both the echo and vascular labs. As a fellow, I was awarded the council’s travel grant to attend the Scientific Sessions in 2012. Attending sessions was an excellent way to meet people with similar research and clinical interests. There were multiple opportunities to network with members of the Vascular Council. Last year, I was appointed to the council board, and I am faculty member at this year’s scientific sessions in Portland. I am impressed by the commitment of ASE to comprehensive cardiovascular imaging. As a clinician who integrates both cardiac and vascular imaging in the care of my patients, it is so important to have an organization that offers education in both areas.

Dr. Hamburg: What are some of the activities of the Council on Vascular Ultrasound? How can members get involved? I am often asked by fellows and junior faculty who are interested in being more active in ASE.

Dr. Quiroz: We have many activities, but I would highlight the vascular imaging programming at the scientific sessions each year. We have dedicated vascular imaging talks that have largely focused on carotid duplex studies and management. We are offering a hands-on session at the 2014 meeting. We also have representatives from the council who serve on ASE committees. Serving on a committee is a great way to get involved in ASE for early career members. We are always excited to have energetic individuals who want to work with ASE. They can contact one of us through the council staff liaison, Cathy Kerr, at .

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May 31, 2018 | Posted by in CARDIOLOGY | Comments Off on Getting Started in Practice as a Heart and Vascular Imaging Clinician

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