ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography

Mark, Daniel B.; Berman, Daniel S.; Budoff, Matthew J.; Carr, J. Jeffrey; Gerber, Thomas C.; Hecht, Harvey S.; Hlatky, Mark A.; Hodgson, John McB.; Lauer, Michael S.; Miller, Julie M.; Morin, Richard L.; Mukherjee, Debabrata; Poon, Michael; Rubin, Geoffrey D.; Schwartz, Robert S.

doi:10.1002/ccd.22495

Cited by 51 publications

(11 citation statements)

References 209 publications

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“…Cardiac CTA is now commonly used to manage patients with suspected coronary artery disease (4), aortic stenosis in preparation for transcatheter aortic valve replacement (5), atrial fibrillation prior to ablation (6), and aortic dissection post surgical repair (7). Radiation exposure from these procedures can be significant because of the need for gating to compensate for cardiac motion.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Radiation Effects of Cardiac CT Angiography Using Protein and Genetic Biomarkers

Nguyen

Lee

et al. 2015

JACC: Cardiovascular Imaging

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Objectives To evaluate whether radiation exposure from cardiac computed tomographic angiography is associated with DNA damage and whether damage leads to programmed cell death and activation of genes involved in apoptosis and DNA repair. Background Exposure to radiation from medical imaging has become a public health concern, but whether it causes significant cell damage remains unclear. Methods We conducted a prospective cohort study in 67 patients undergoing cardiac computed tomographic angiography (CTA) between January 2012 and December 2013 in two US medical centers. Median blood radiation exposure was estimated using phantom dosimetry. Biomarkers of DNA damage and apoptosis were measured by flow cytometry, whole genome sequencing, and single cell polymerase chain reaction. Results The median DLP was 1535.3 mGy·cm (969.7 – 2674.0 mGy·cm). The median radiation dose to the blood was 29.8 milliSieverts (18.8 – 48.8 mSv). Median DNA damage increased 3.39% (1.29 – 8.04%, P<0.0001) post-radiation. Median apoptosis increased 3.1-fold (1.4 – 5.1-fold, P<0.0001) post-radiation. Whole genome sequencing revealed changes in the expression of 39 transcription factors involved in the regulation of apoptosis, cell cycle, and DNA repair. Genes involved in mediating apoptosis and DNA repair were significantly changed post-radiation, including DDB2 [1.9-fold (1.5 – 3.0-fold), P<0.001], XRCC4 [3.0-fold (1.1 – 5.4-fold), P=0.005], and BAX [1.6-fold (0.9 – 2.6-fold), P<0.001]. Exposure to radiation was associated with DNA damage [OR: 1.8 (1.2 – 2.6), P=0.003]. DNA damage was associated with apoptosis [OR: 1.9 (1.2 – 5.1), P<0.0001] and gene activation [OR: 2.8 (1.2 – 6.2), P=0.002]. Conclusions Patients exposed to radiation from cardiac CTA had evidence of DNA damage, which was associated with programmed cell death and activation of genes involved in apoptosis and DNA repair.

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Section: Introductionmentioning

confidence: 99%

Assessment of the Radiation Effects of Cardiac CT Angiography Using Protein and Genetic Biomarkers

Nguyen

Lee

et al. 2015

JACC: Cardiovascular Imaging

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“…1;2 The method is suitable to exclude coronary atherosclerosis, but has shown less diagnostic accuracy in the presence of severe coronary calcification or implanted stents. These appear larger on CT than they are due to blooming artifacts, which may cause low reader confidence and overestimation of coronary stenosis severity with false positive results.…”

Section: 1introductionmentioning

confidence: 99%

Feasibility of coronary calcium and stent image subtraction using 320-detector row CT angiography

Fuchs

Kühl

Chen

et al. 2015

Journal of Cardiovascular Computed Tomography

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Background The reader confidence and diagnostic accuracy of coronary CT angiography (CCTA) can be compromised by the presence of calcified plaques and stents causing blooming artifacts. Compared to conventional invasive coronary angiography(ICA), this may cause an overestimation of stenosis severity leading to false positive results. In a pilot study we tested the feasibility of a new coronary calcium image subtraction algorithm in relation to reader confidence and diagnostic accuracy. Materials and Methods Forty-three patients underwent clinically indicated ICA and CCTA using a 320–detector row CT. Median Agatston score was 510. Two datasets were reconstructed: a conventional CCTA (CCTAconv) and a subtracted CCTA (CCTAsub), where calcifications detected on non-contrast images were subtracted from the CCTA. Reader confidence and concordance with ICA for identification of >50% stenosis were recorded. We defined target segments on CCTAconv as motion free coronary segments with calcification/stent and low reader confidence. The impact of CCTAsub was assessed. No approval from the ethics committee was required according to Danish law. Results A total of 76 target segments were identified. The use of coronary calcium image subtraction improved the reader confidence in 66% of these segments. In target segments specificity (86% vs. 65%, p<0.01) and positive predictive value (71% vs. 51%, p=0.03) were improved using CCTAsub compared to CCTAconv, without loss in negative predictive value. Conclusions Our initial experience with coronary calcium image subtraction suggests that it is feasible and could lead to an improvement in reader confidence and diagnostic accuracy for identification of significant coronary artery disease.

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“…The ability of coronary computed tomography angiography (CCTA) to noninvasively assess coronary arteries has generated widespread enthusiasm, as reflected by its rapid growth and dissemination. [2]…”

Section: Introductionmentioning

confidence: 99%

“…However, despite the proven value of CCTA in evaluating numerous medical conditions,[234] there have been growing concerns regarding its overuse in the clinical setting, which is not only associated with a significant financial strain on health services, but also the potential to expose patients to unnecessary radiation. The typical radiation dose for a CCTA study varies widely – from < 1 mSv in a FLASH mode CCTA,[5] through 2–3 mSv for “Step-and-Shoot” protocol[6] to a median dose of 12 mSv for a helical CCTA.…”

Section: Introductionmentioning

confidence: 99%

An audit on the appropriateness of coronary computed tomography angiography referrals in a tertiary cardiac center

Alderazi

Lynch

2017

Heart Views

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Background:In response to growing concerns regarding the overuse of coronary computed tomography angiography (CCTA) in the clinical setting, multiple societies, including the American College of Cardiology Foundation, have jointly published revised criteria regarding the appropriate use of this imaging modality. However, previous research indicates significant discrepancies in the rate of adherence to these guidelines.Aim:To assess the appropriateness of CCTA referrals in a tertiary cardiac center in Bahrain.Methods:This retrospective clinical audit examined the records of patients referred to CCTA between the April 1, 2015 and December 31, 2015 in Mohammed bin Khalifa Cardiac Center. Using information from medical records, each case was meticulously audited against guidelines to categorize it as appropriate, inappropriate, or uncertain.Results:Of the 234 records examined, 176 (75.2%) were appropriate, 47 (20.1%) were uncertain, and 11 (4.7%) were inappropriate. About 74.4% of all referrals were to investigate coronary artery disease (CAD). The most common indication that was deemed appropriate was the detection of CAD in the setting of suspected ischemic equivalent in patients with an intermediate pretest probability of CAD (65.9%). Most referrals deemed inappropriate were requested to detect CAD in asymptomatic patients at low or intermediate risk of CAD (63.6%).Conclusion:This audit demonstrates a relatively low rate of inappropriate CCTA referrals, indicating the appropriate and efficient use of this resource in the Mohammed bin Khalifa Cardiac Center. Agreement on and reclassification of “uncertain” cases by guideline authorities would facilitate a deeper understanding of referral appropriateness.

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ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography

Cited by 51 publications

References 209 publications

Assessment of the Radiation Effects of Cardiac CT Angiography Using Protein and Genetic Biomarkers

Assessment of the Radiation Effects of Cardiac CT Angiography Using Protein and Genetic Biomarkers

Feasibility of coronary calcium and stent image subtraction using 320-detector row CT angiography

An audit on the appropriateness of coronary computed tomography angiography referrals in a tertiary cardiac center

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