Coronary artery disease reporting and data system (CAD-RADS TM ): Inter-observer agreement for assessment categories and modifiers

Maroules, Christopher D.; Hamilton-Craig, C.; Branch, Kelley R.; Lee, James; Cury, Roberto Caldeira; Maurovich-Horvat, Pál; Rubinshtein, Ronen; Thomas, Dustin; Williams, Michelle C.; Yanshu, Guo; Cury, Ricardo C.

doi:10.1016/j.jcct.2017.11.014

Cited by 69 publications

(41 citation statements)

References 25 publications

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“…Our reporting of CAD-RADS categories and modifiers showed excellent IRA (ICC = 0.9862 and 0.8064, respectively). These results are very similar to that of the previous two studies [23,24], which assessed the interobserver agreement of CAD-RADS. However, as regards vulnerable plaque features (modifier "V"), the IRA was moderate (ICC = 0.5453).…”

Section: Discussionsupporting

confidence: 90%

The validity and applicability of CAD-RADS in the management of patients with coronary artery disease

et al. 2019

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Background: The coronary artery disease reporting and data system (CAD-RADS) is designed for a uniform standardization of coronary computed tomography angiography (CCTA) reporting and further management recommendations of coronary artery disease (CAD). This study aimed to assess clinical validity, applicability, and reproducibility of CAD-RADS in the management of patients with CAD. Methods and results:A single-center prospective study included 287 patients with clinically suspected or operated CAD who underwent CCTA. Four reviewers evaluated the CCTA images independently and assigned a CAD-RADS category to each patient. The invasive coronary angiography (ICA) was used as the reference standard for calculating diagnostic performance of CAD-RADS for categorizing the degree of coronary artery stenosis. The intra-class correlation (ICC) was used to test the inter-reviewer agreement (IRA). Reporting was provided to referring consultants according to the CAD-RADS. Based on ICA results, we have 156 patients with non-significant CAD and 131 patients with significant CAD. On a patient-based analysis, regarding those patients classified as CAD-RADS 4 and CAD-RADS 5 for predicting significant CAD, the CAD-RADS had a sensitivity, specificity, and an accuracy of 100%, 96.8 to 98.7%, and 98.3 to 99.3%, respectively, depending on the reviewer. There was an excellent IRA for CAD-RADS categories (ICC = 0.9862). The best cutoff value for predicting significant CAD was > CAD-RADS 3. Eightyseven percentage of referring consultants considered CAD-RADS reporting system to be "quite helpful" or "completely helpful" for clinical decision-making in CAD.Conclusion: CAD-RADS is valuable for improving CCTA structural reports and facilitating decision-making with high diagnostic accuracy and high reproducibility.

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Section: Discussionsupporting

confidence: 90%

The validity and applicability of CAD-RADS in the management of patients with coronary artery disease

et al. 2019

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“…22 An additional issue for the clinical use of the CAD-RADS V classification is the considerable observer variability in the classification of potentially "vulnerable" plaques. 34 Inter-observer reproducibility of the CAD-RADS system was found to be excellent, apart from the CAD-RADS V modifier which demonstrated only fair agreement. 34 Therefore, the CAD-RADS V modifier must be used with caution and that an alternative definition should be considered.…”

Section: Discussionmentioning

confidence: 81%

“…34 Inter-observer reproducibility of the CAD-RADS system was found to be excellent, apart from the CAD-RADS V modifier which demonstrated only fair agreement. 34 Therefore, the CAD-RADS V modifier must be used with caution and that an alternative definition should be considered. Further standardization with quantitative assessment may provide a more reliable definition.…”

Section: Discussionmentioning

confidence: 81%

Standardized reporting systems for computed tomography coronary angiography and calcium scoring: A real-world validation of CAD-RADS and CAC-DRS in patients with stable chest pain

Williams

Moss

Dweck

et al. 2020

Journal of Cardiovascular Computed Tomography

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A B S T R A C TObjectives: To assess the prognostic implications of standardized reporting systems for coronary computed tomography angiography (CCTA) and coronary artery calcium scores (CACS) in patients with stable chest pain. Background: The Coronary Artery Disease Reporting And Data System (CAD-RADS) and Coronary Artery Calcium -Data and Reporting System (CAC-DRS) aim to improve communication of CACS and CCTA results, but its influence on prognostication is unknown. Methods: Images from 1769 patients who underwent CCTA as part of the Scottish Computed Tomography of the HEART (SCOT-HEART) multi-center randomized controlled trial were assessed. CACS were classified as CAC-DRS 0 to 3 based on Agatston scores. CCTA were classified as CAD-RADS 0 to 5 based on the most clinically relevant finding per patient. The primary outcome was the five-year events of fatal and non-fatal myocardial infarction. Results: Patients had a mean age of 58 ± 10 years and 56% were male. CAC-DRS 0, 1, 2 and 3 occurred in 642 (36%), 510 (29%), 239 (14%) and 379 (21%) patients respectively. CAD-RADS 0, 1, 2, 3, 4A, 4B and 5 occurred in 622 (35%), 327 (18%), 211 (12%), 165 (9%), 221 (12%), 42 (2%) and 181 (10%) patients respectively. Patients classified as CAC-DRS 3 were at an increased risk of fatal or non-fatal myocardial infarction compared to CAC-DRS 0 patients (hazard ratio (HR) 9.41; 95% confidence interval (CI) 3.24, 27.31; p < 0.001). Patients with higher CAD-RADS categories were at an increased risk of fatal or non-fatal myocardial infarction, with patients classified as CAD-RADS 4B at the highest risk compared to CAD-RADS 0 patients (HR 19.14; 95% CI 4.28, 85.53; p < 0.001). Conclusion: Patients with higher CAC-DRS and CAD-RADS scores were at increased risk of subsequent fatal and non-fatal myocardial infarction. This confirms that the classification provides additional prognostic discrimination for future coronary heart disease events.

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“…A second limitation is that data on beta‐blocker or ivabradine dosing were not captured, but mean heart rate fell significantly during the study period, with no adverse events. Thirdly, objective data on CCTA image quality are lacking as we did not have the resources to retrospectively evaluate image quality such as Likert scores in 3333 scans . Sensitivity could not be directly measured as patients with negative CCTA did not progress to catheterisation (appropriately).…”

Section: Discussionmentioning

confidence: 99%

“…Thirdly, objective data on CCTA image quality are lacking as we did not have the resources to retrospectively evaluate image quality such as Likert scores in 3333 scans. 24 Sensitivity could not be directly measured as patients with negative CCTA did not progress to catheterisation (appropriately). However, the specificity of CCTA remained very high compared with invasive coronary angiography and did not change over the study period 25 and, in fact, was slightly higher than the pooled specificity (0.70) from the 3 major international diagnostic accuracy trials of 64-slice CCTA.…”

Section: Limitationsmentioning

confidence: 99%

Coronary CT radiation dose reduction strategies at an Australian Tertiary Care Center – improvements in radiation exposure through an evidence‐based approach

Hamilton-Craig

Tandon

Kwan

et al. 2019

J of Medical Radiation Sci

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Introduction Coronary CT Angiography (CCTA) is a rapidly increasing technique for coronary imaging; however, it exposes patients to ionising radiation. We examined the impact of dose reduction techniques using ECG‐triggering, kVp/mAs reduction and high‐pitch modes on radiation exposure in a large Australian tertiary CCTA service. Methods Data on acquisition modes and dose exposure were prospectively collected on all CCTA scans from November 2009 to March 2014 at an Australian tertiary care centre. A dose reduction algorithm was developed using published techniques and implemented with education of medical staff, radiographers and referrers. Associations of CCTA acquisition to radiation over time were analysed with multivariate regression. Specificity in positive CCTA was assessed by correlation with invasive coronary angiography. Results 3333 CCTAs were analysed. Mean radiation dose decreased from 8.4 mSv to 5.3, 4.4, 3.7, 2.9 and 2.8 mSv (P < 0.001) per year. Patient characteristics were unchanged. Dose reduction strategies using ECG‐triggering, kVp/mAs reduction accounted for 91% of the decrease. High‐pitch scanning reduced dose by an additional 9%. Lower dose was independently related to lower kVp, heart rate, tube current modulation, BMI, prospective triggering and high‐pitch mode (P < 0.01). CCTA specificity remained unchanged despite dose reduction. Conclusion Implementation of evidence‐based CCTA dose reduction algorithm and staff education programme resulted in a 67% reduction in radiation exposure, while maintaining diagnostic specificity. This approach is widely applicable to clinical practice for the performance of CCTA.

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Coronary artery disease reporting and data system (CAD-RADS TM ): Inter-observer agreement for assessment categories and modifiers

Cited by 69 publications

References 25 publications

The validity and applicability of CAD-RADS in the management of patients with coronary artery disease

The validity and applicability of CAD-RADS in the management of patients with coronary artery disease

Standardized reporting systems for computed tomography coronary angiography and calcium scoring: A real-world validation of CAD-RADS and CAC-DRS in patients with stable chest pain

Coronary CT radiation dose reduction strategies at an Australian Tertiary Care Center – improvements in radiation exposure through an evidence‐based approach

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