A brief summary and comments by Matthew J. Budoff, MD who chaired the writing committee for the statement

The overall training required for level 2 (to perform and interpret CCT) and 3 (to run a CT laboratory) is 2 months and 6 months respectively. However, for all level 2 and 3 requirements, the minimum time in a CCT laboratory is 50% of the time listed, with the other half garnered by exposure to CT in courses, case studies, CD/DVD training, time at major medical meetings devoted to performance of CCT, or other relevant educational training activities just as a few examples. The caseload recommendations may include studies from an established teaching file, previous CCT cases, electronic/on-line experience or courses.

More importantly, it is recognized that most physicians in practice cannot get away from practice for a one full month to train in a CT laboratory, and there are not enough CT laboratories available to train such physicians. The prior experience clause allows those physicians to obtain experience (or who have such experience) without the time requirement. This states that "Training completed before July 1, 2010 entails interpretation of at least 150 studies (in which 50 where the candidate is physically present, involved in the acquisition and interpretation of the case) and attendance in at least 20 hours of devoted CCT classes." Note, there is no TIME REQUIREMENT for this criteria.

Who can obtain training under this clause, "practitioners can qualify for completion of Level 2 or Level 3 training by having achieved the minimum criteria set forth below by July 1, 2010, as well as board certification and completion of an ACGME-approved radiology or nuclear medicine residency or cardiology fellowship, or at least two months of formal training in CCT."

Documentation and Maintenance of Clinical Competence in CCT

Documentation of Competence	Training Guidelines	Proof of Competence
Training completed after July 1, 2010	Level 2 or Level 3 training as outlined	Letter of certification from training supervisor OR letter attesting to competence from Level 2- or 3-trained physician
Training completed before July 1, 2010	Level 2 training OR interpretation of at least 150 studies (in which 50 where the candidate is physically present, involved in the acquisition and interpretation of the case) and attendance in at least 20 h of devoted CCT classes Level 3 training OR interpretation of at least 300 studies (in which 100 where the candidate is physically present, involved in the acquisition and interpretation of the case) and attendance in at least 40 h of classes devoted to CCT
Maintenance of competence	Contrast CCT examinations per year to be performed and interpreted: Level 2: 50 Level 3: 100