EACVI Certification in Cardiovascular Magnetic Resonance (CMR)

Exam

Eligibility

The EACVI CMR written examination is open to qualified physicians involved in cardiovascular magnetic resonance. 

Although EACVI CMR certification may be obtained during medical training, independent reporting will, in most instances, require the completion of postgraduate specialist medical training. 

The EACVI CMR Certification is not a compulsory or regulatory certificate of competence or excellence. Individuals' rights to report and sign clinical studies in individual countries remain to be defined by national laws and regulations.

Exam format

The EACVI CMR examination is a multiple-choice written examination in English.

The examination consists of 100 questions, administered over three hours, with no break.  

Questions are designed to assess the candidate's knowledge:

• Based on a clinical scenario
• Five options with only one single best answer
• No negative marking

Questions are drawn from the entire spectrum of cardiovascular magnetic resonance reflecting the EACVI CMR syllabus. 

• Topics distribution of the examination questions (examination blueprint)

Exam date and delivery

The EACVI CMR examination is usually delivered once a year, using an online proctoring platform (CYIM/ProctorU^®).

This provides candidates with the safety and convenience of an online platform while retaining the integrity and quality of an on-site supervised exam.

The online format of the EACVI CMR exam is:

• Accessible anywhere in the world.
• Taken on the candidate’s own device (computer only) and monitored by a human proctor online through ProctorU^®.

Please find more information here.  

Exam preparation

The EACVI CMR exam is designed to test a wide range of cardiovascular magnetic resonance knowledge aligned with the EACVI CMR syllabus.

There is no single source from which all questions are developed, so candidates are encouraged to read widely. 

You can also visit the EACVI educational area.

This section includes information about education-related matters such as:

• Cardiovascular Imaging Recommended Reading
• EACVI webinars (live, online seminars)
• Educational and preparatory courses organised by, or in collaboration with, the EACVI
• EACVI core syllabus
• EACVI textbooks and The ESC Textbook of Cardiovascular Imaging

Exam results

The passing score of the exam is established using referenced methodologies, that are widely used in certification. The passing score links the score required to pass the exam to the minimum level of knowledge required for cardiovascular magnetic resonance practice.

Following the exam, psychometric analysis of the questions is conducted and items that do not meet psychometric standards are removed from the exam. In addition, any items that have been flagged during the exam administration are reviewed and if these items are deemed to be defective for any reason they are removed from the exam.

Results are subjected to multiple levels of verification before being reported to candidates.

Examination results are communicated to candidates in the eight weeks after the examination.

Candidates will receive an email containing their results letter on the date of the result release. Successful candidates for the exam will also receive a certificate of completion of the written exam.

Candidate’s results are also made available through the candidate’s My ESC account.  

Appeal

ESC/EACVI aims to deliver examinations of the highest quality and provide the best level of service for all candidates. To ensure that all candidates are assessed fairly, there is a procedure to allow candidates to appeal against their exam results.

More information is available.

Policies for online proctoring examinations

For more information, please refer to the ESC online proctoring examination terms and conditions. 

Logbook

Once candidates have passed the exam, they can then apply for the logbook part of the programme to prove their practical experience in the CMR field. No late submissions will be accepted and, if the deadline is not respected, the candidate will have to repeat the exam to apply for certification.

Eligibility

The EACVI CMR logbook part of the programme is accessible to all successful candidates to the exam. 

Access to the logbook platform is granted to candidates only after having successfully passed the written exam.

Requirements

Candidates are required to provide evidence of their clinical experience. According to the level of certification the candidate would like to achieve, different routes of certification are detailed below. 

Application for EACVI CMR Level 2 Certification 

Level 2 certification is the expected level at which routine practitioners can undertake CMR scanning and reporting independently. It is not, however, generally considered to be an adequate level of certification to set up a new service or lead a CMR unit.

It is envisaged that the majority of practitioners in CMR would be certified at Level 2.

Any applicant for Level 2 certification in CMR is expected to fulfil the following requirements:

1. To be a qualified physician with current valid registration.
2. To have passed the EACVI CMR exam.
3. To have spent at least three months of full-time training** in CMR under a CMR Level 3 certified expert. Applicants are strongly advised to check the requirements for a Level 3 certified supervisor (see below) to ensure that their period of training will be recognised.
4. To submit a logbook of 150 cases with a maximum of 10% normal cases. Up to 75 cases can be from another centre (for instance if the candidate’s training centre does not have access to stress perfusion or patients with congenital heart disease). The logbook must be submitted no later than two years after passing the EACVI CMR examination with cases taken from a consecutive 24-month window (from a maximum of two years before up to two years after the date of sitting the exam).
5. To be ACLS certified (or provide documented evidence that advanced life support is part of their routine practice).
6. To have completed 25 hours of CME specifically in CMR (please see details regarding acceptable CME/CPD).
7. To submit the required supporting evidence and documentation including a supervisor’s declaration stating that the candidate was under his/her direct supervision, was responsible for supervising the CMR sessions, was primary operator/reporting physician for all of the cases provided in their logbook and is of the appropriate standard for Level 2 certification.

** This should be either three months of continuous full-time training in CMR or the equivalent length of time if split into separate periods of training (within a maximum 24-month window). For applicants who are training less than full-time (defined as at least 35 hours/week in CMR or CMR-related activities), the training period will need to be extended on a pro rata basis. For example, if the applicant only spends three days per week doing CMR (i.e. 3/5 full-time equivalent), three months of full-time equivalent will require a five-month period of training. 

Application for EACVI CMR Level 3 Certification

Level 3 certification is the expected level for senior practitioners in CMR who routinely supervise and teach CMR and lead a CMR service or CMR unit. It is recommended that this should be considered a requirement for those wishing to set up a new service or lead a CMR unit.

As mentioned above, it is envisaged that the majority of practitioners in CMR would be certified at Level 2 with experts in the field certified at Level 3. Level 3 certification should, therefore, represent mentors, educators and leaders in the field of cardiovascular magnetic resonance. Unless applying directly for Level 3 certification, all candidates must already hold Level 2 certification.

The two routes for application for Level 3 certification are as follows:

• Level 3 certification following previous Level 2 certification (i.e. 'via Level 2')
• Direct application for Level 3 certification

Application for EACVI CMR Level 3 Certification via Level 2

Any applicant for Level 3 certification in CMR via this route is expected to fulfill the following requirements:

1. To be a qualified physician with current registration.
2. To hold current EACVI CMR Level 2 certification, having passed the EACVI CMR exam and having met all requirements for Level 2 certification.
3. To have spent at least a further nine months** of full-time training in CMR under a CMR Level 3 certified expert. This means that the applicant must have completed a total of 12 months of full-time training in CMR. Applicants are strongly advised to check the requirements for a Level 3 certified supervisor to ensure that their period of training will be recognised.
4. To submit a further logbook of 150 cases with a maximum of 10% normal cases. This means that the candidate will have submitted 300 cases in total, 150 cases for their Level 2 certification with a further 150 cases as part of this Level 3 application. The cases submitted for the Level 3 application must be new cases (none of which was included in the previous Level 2 logbook) taken from a 24-month window immediately prior to the application for Level 3.
5. To be ACLS certified (or provide documented evidence that advanced life support is part of their routine practice).
6. To have completed 25 hours of CME specifically in CMR over and above the CME provided for a Level 2 application (please see details regarding acceptable CME/CPD). This means that the applicant must have completed 50 hours of CMR-related CME in total.
7. To provide evidence of peer recognition, with one of the following requirements:
   1. Faculty lecturer for two or more CME courses on CMR (local, national, international);
   2. Invited speaker/chair on CMR for two or more conferences or meetings (local, national, international);
   3. Three or more peer-reviewed publications in the area of CMR (any author), excluding abstracts ;
   4. Oral presentations of original data on CMR at two or more conferences or meetings (national or international) *

   *Please note that oral presentations will only be accepted if the candidate is the first author and presented the data themselves (moderated poster presentation is not accepted).

8. To submit the required supporting evidence and documentation including a supervisor’s declaration stating that the candidate was under his/her direct supervision, was responsible for supervising the CMR sessions, was primary operator/reporting physician for all of the cases provided in their logbook and is of the appropriate standard for Level 3 certification.

It should be noted that Level 3 certification via this route will only be considered with current Level 2 certification. No application will be considered if the applicant’s Level 2 certification has expired.

** As for Level 2 certification, this should be either nine months of continuous full-time training in CMR or the equivalent length of time if split into separate periods of training (within a maximum 24-month window). For applicants who are training less than full-time (defined as at least 35 hours/week in CMR or CMR-related activities), the training period will need to be extended on a pro rata basis. For example, if the applicant only spends three days per week doing CMR (i.e. 3/5 full-time equivalent), nine months of full-time equivalent will require a 15-month period of training.

Direct application for EACVI CMR Level 3 Certification 

Direct application for Level 3 certification will also be considered. Any applicant for Level 3 certification in CMR via this route is expected to fulfill the following requirements:

1. To be a qualified physician with current registration.
2. To have passed the EACVI CMR exam.
3. To have spent at least 12 months** of full-time training in CMR under a CMR Level 3 certified expert. Applicants are strongly advised to check the requirements for a Level 3 certified supervisor to ensure that their period of training will be recognised.
4. To submit a logbook of 300 cases with a maximum of 10% normal cases. Up to 75 cases can be from another centre (for instance if the candidate’s training centre does not have access to stress perfusion or patients with congenital heart disease). The logbook must be submitted no later than two years after passing the EACVI CMR examination with cases taken from a consecutive 24-month window (from a maximum of two years before up to two years after the date of sitting the exam).
5. To be ACLS certified (or provide documented evidence that advanced life support is part of their routine practice).
6. To have completed 50 hours of CME specifically in CMR (please see details regarding acceptable CME/CPD).
7. To provide evidence of peer recognition, with one of the following requirements:
   1. Faculty lecturer for two or more CME courses on CMR (local, national, international);
   2. Invited speaker/chair on CMR for two or more conferences or meetings (local, national, international);
   3. Three or more peer-reviewed publications in the area of CMR (any author), excluding abstracts ;
   4. Oral presentations of original data on CMR at two or more conferences or meetings (national or international) *                                                                                                                                               *Please note that oral presentations will only be accepted if the candidate is the first author and presented the data themselves (moderated poster presentation is not accepted)
8. To submit the required supporting evidence and documentation including a supervisor’s declaration stating that the candidate was under his/her direct supervision, was responsible for supervising the CMR sessions, was primary operator/reporting physician for all of the cases provided in their logbook and is of the appropriate standard for Level 3 certification.

** This should be either 12 months of continuous full-time training in CMR or the equivalent length of time if split into separate periods of training (within a maximum 24-month window). For applicants who are training less than full-time (defined as at least 35 hours/week in CMR or CMR-related activities), the training period will need to be extended on a pro rata basis.

Requirements for Continuing Medical Education (CME)/Continued Professional Development (CPD)

Evidence of CME is required for all applications for Level 2 and Level 3 certification.

Required CME credits should not be claimed from a single online source, congress or event. 

Courses/conferences attended more than two years before the exam are not appropriate.

General cardiology or radiology conferences/general webinars are not accepted and only the CMR component of relevant meetings will count for certification. 

The learning hours must be collected as follows:

• 1 CME/CPD Credit = 1 hour of CMR learning
• CME/CPD Credits are obtained by participating in:
  • Recognised national, European and international CMR meetings; and
  • Educational courses with relevant endorsement and CPD credits
  • ECTS points (European Credit Transfer System) are accepted

For multimodality imaging courses, conferences or meetings with CMR content, the number of total CME/CPD Credits should be divided by number of modalities in question. For example, if the meeting is on cardiac CT, nuclear cardiology and CMR, the total CME/CPD Credits must be divided by 3. If the meeting is on cardiac CT and CMR, the total number is divided by 2.

Examples of specific meetings are given in Table 1 (below), this list is not exhaustive. It should be noted that CME Credits will vary between meetings and should be confirmed for each meeting attended.

Table 1. Examples of CME Points for Specific Meetings

Candidates will be required to upload the relevant attendance certificates detailing the number of CME points/ hours accrued. We no longer allow self-directed learning for CME submission.

The CMR certification committee reserves the right to check the details of the course and evidence of attendance. The decision of the EACVI certification committee is final regarding award of CME hours.

Special circumstances

In exceptional circumstances, an application for certification which falls outside the above routes for Level 2 and Level 3 may be considered. If you consider yourself to be in this category, special circumstances can be discussed with the EACVI CMR Exam board by contacting the ESC certification team stating why your application should be considered.

Overview of requirements for ESC/EACVI Certification in CMR at Level 2 and Level 3

Table 2.

Logbook regulations

Not complying with the below regulations will result in the logbook being returned to the candidate for modification and as such, delay the grading process.

• The application must be submitted in English. Any document in the local language must be accompanied by an English translation. 
• The application must not include any patient data, in order to comply with GDPR regulations. 
• The application must be submitted no later than 2 years after having received the exam results. 
• Cases included in the logbook must have been collected from two years before to two years after the written exam and must cover only 24 consecutive months.
• Each patient may be present only once in the logbook. It is not allowed to add multiple studies of the same patient. 
• Candidates should only include cases in the logbook where they have been the primary operator or reporting physician (i.e. the candidate must have performed their own analysis and provided a full written report independently). Cases which have only been observed cannot be included.
• The candidate must have been present in the scanner control room during the acquisition of at least 50 (Level 2) cases and 100 (Level 3) cases.
• Candidates must ensure that the maximum number of 'normal' cases (10%) is not exceeded.
• There must be the required minimum number of cases in each diagnostic/study category, and each of the categories must be fully respected. For example, the adult congenital cases must include assessment of true congenital pathology, such as shunts, anomalous pulmonary venous drainage, Fontan circulation, etc. Cases such as hypertrophic cardiomyopathy and bicuspid aortic valve will not be accepted in this category.
• Cases submitted from courses are allowed, but must not exceed 20% of the total required cases. Any cases included from courses must have included a full review of the case submitted by the candidate. Cases from the same course cannot be counted more than once.
• No duplicate cases are allowed. Each patient may be present only once in the logbook unless there is a significant change in clinical status – we will not allow follow-up studies of the same patient if the findings have not changed.

Candidates are not asked to submit the full reports, although they may be requested by the EACVI CMR graders and EACVI CMR certification committee. Thus, candidates are asked to keep this information available. 

The EACVI CMR Exam Board reserves the right to perform random checks to cross-reference the above information with the Level 3 supervisors and training centres.

Both the Level 3 trainer (supervisor) and the candidate are fully responsible for providing the correct information. Misconduct may result in both the trainer and candidate losing their EACVI CMR Certification (see section Professional Standards of Conduct).

Professional standards of conduct

It should be noted that if any impropriety, falsification or fraudulent application is discovered, either at the time of the application or at a later stage, this may result in the revocation of both the applicant’s and the supervisor’s own Level 3 EACVI certification. This could be deemed to be serious professional misconduct and any further action would be decided by the EACVI CMR Exam Board in conjunction with the EACVI Board and the ESC. In extreme cases, this might also mandate reporting to the appropriate national society or national body for professional registration.

Supervisor

Any current practitioner in CMR who holds active Level 3 CMR certification (from either EACVI or SCMR) can act as a supervisor for a candidate’s application for Level 2 and Level 3 certification. The following mandatory stipulations, however, apply:

1. All supervisors must have current Level 3 certification (either EACVI or SCMR).
2. No person can act as a supervisor until the date they have been awarded Level 3 certification.
3. No logbook can contain cases supervised by them before this date.
4. The supervisor must ensure that the logbook submission is accurate.
5. The supervisor must ensure that the applicant is of the appropriate standard for Level 2 or Level 3 certification in CMR, as appropriate.

Applicants are strongly advised to check the requirements for a Level 3 certified supervisor before starting any period of training to ensure that their training will be recognised.

Remote training policy

If a candidate’s own training centre cannot provide all of the required indications, the candidate should seek to receive on-site training in another centre. If this cannot be achieved, cases from other centres can be submitted, provided the candidate has reviewed and reported the scans independently. The number of cases must not exceed 75 (Level 2) or 150 (Level 3).

When there is no Level 3 certified individual at the candidate's institution, remote supervision can be considered. Please note that this is not a substitute for mentoring in the home institution, and applications will only be considered where on-site mentoring is not possible. Remote mentoring requires prior approval by the EACI CMR Exam Board. The remote mentor must be CMR Level 3 certified as defined above.

Candidates considering remote supervision should contact the ESC Certification Team with the following information: 

• The reason for seeking remote supervision.
• The annual caseload in the candidate's own institution.
• The level of supervision in the candidate's own institution – e.g. 'cardiologist with five years CMR experience, but no formal certification in CMR'.
• The name of the remote supervisor.
• Proposed arrangements for remote supervision – e.g. regular attendance at the supervisor's institution, teleconferences, etc.
• Anticipated contact time between supervisor and candidate.
• Methods of assessment to be used by the supervisor to assess the candidate's progress.

The EACVI CMR Exam Board will consider each application for remote supervision and reply to the candidates within four weeks. The EACVI CMR Exam Board may ask for changes to the proposed remote supervision plan and may contact the remote supervisor directly.

Logbook results

As soon as the logbook is compliant with the requirements, the application is sent for grading to members of the EACVI CMR Certification Committee. Graders may require additional information from the candidate to provide their grading. 

Results are sent by email within 3 months of submitting the e-Logbook. Please note that some delays in the grading can occur due to the high volume of applications received throughout the year. 

Appealing the logbook

Candidates who fail to the logbook part may raise an appeal.

Please find more information here. 

Extension requests

There is a one-year window to complete the logbook part of the programme. In exceptional circumstances, candidates may request an extension to submit their application.

To ensure the process remains fair and robust, extensions will generally only be given in the following circumstances: parental leave, less than full-time work or illness of the candidate.

Extension requests must be accompanied by a signed letter from your supervisor briefly explaining the situation and stating the duration of the extension required. Requests cannot be considered without this letter. The request must be submitted before the deadline.

Please note that extension requests are not guaranteed and are reviewed on a case-by-case basis by the certification committee.    

Use the “Contact Us” to submit such requests and further information.

Recertification

Candidates will be granted certification in CMR once they have completed the two parts of the programme (exam and logbook). The certification is valid for 5 years after which the candidate must apply for recertification to keep the certification valid. 

Requirements

For more detailed information, please refer to the recertification requirements webpage.

Recertification fee

• Non-members and EACVI Associates: €200 (excluding VAT)
• EACVI Silver Members: €75 (excluding VAT)

How to apply?

Candidates must apply for recertification from six months before to six months after the current certification expiration date.

During this time, candidates who are eligible for the recertification will receive automatic reminders to apply for recertification. These reminders are sent to their My ESC email address.

All candidates will be reminded as the deadline approaches, but it is the candidate's responsibility to ensure that the recertification is submitted on time. No late submissions will be accepted and, if the deadline is not respected, the candidate will have to repeat the certification process (exam + logbook) to recertify.

If all requirements of recertification are met, a certificate will be issued which will be valid for a further 5-year period.

Extension requests

There is a one-year window to apply for recertification (from six months before to six months after the current certification expiration date). In exceptional circumstances, candidates may request an extension to submit their application.

To ensure the process remains fair and robust, extensions will generally only be given in the following circumstances: parental leave, less than full-time work or illness of the candidate.

Extension requests must be accompanied by a signed letter from the candidate's supervisor briefly explaining the situation and stating the duration of the extension required. Requests cannot be considered without this letter. The request must be submitted before the deadline.

Please note that extension requests are not guaranteed and are reviewed on a case-by-case basis by the certification committee.    

Use the “Contact Us” to submit such requests and further information.

Certification result and list of certified candidates

Candidates will be granted certification in CMR once they have completed the two parts of the programme (exam and logbook). The certification is valid for 5 years after which the candidate must apply for recertification to keep the certification valid. 

EACVI is pleased to list all their CMR certified candidates (Level 2 or Level 3).