Journal of Cardiovascular Computed Tomography
SCCT GuidelinesSCCT guidelines for the interpretation and reporting of coronary CT angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee
Section snippets
Preamble
Since the publication of the first guidelines for the interpretation and reporting of coronary CT angiography (coronary CTA) in 2009, there have been significant changes in the scope and utilization of this method. At that time it had only been 5 years since the introduction of 64 detector row scanners. Since then, multiple innovations in scanner design have occurred. Also there has been wide expansion of clinical applications of coronary CTA that are considered “appropriate use” (including,
Three-dimensional data sets and workstations
Coronary CT images should be acquired as isotropic submillimeter 3-dimensional electrocardiography (ECG)-gated data sets, which facilitate reconstruction and display in a variety of image formats.27, 28 Because of the complexity of coronary anatomy, the frequency of motion and calcium-related image artifacts, and the morphologic subtleties of lesions, interpreters must review coronary CTA interactively on cardiac-specific interpretation software platforms capable of 2- and 3-dimensional
Noncontrast coronary interpretation: coronary calcium scoring
A preliminary noncontrast examination for coronary artery and other cardiac structural calcification is routine in many centers but not in others where it is constrained to risk assessment in asymptomatic individuals. The use of prospective triggering and other factors reduce radiation with the calcium score, and the increase in radiation exposure (generally 0.5–1.5 mSv) must be weighed against the value of additional quantifiable information gained.42, 43, 44, 45, 46, 47, 48 The noncontrast
Examination of image quality
Because of the constant motion of the heart and the intrinsic limitations of CT, artifacts due to motion, calcification and metallic densities, image noise, and poor contrast enhancement all may degrade the quality of the study as well as simulate or obscure coronary stenoses.60, 61, 62 This is sufficiently common to require identification of artifacts before definitive image interpretation.
Noncoronary cardiac findings
Noncoronary cardiovascular structures within the field of view of routine CCTA include the pericardium, cardiac chambers, interatrial septum, interventricular septum, atrioventricular valves, ventriculoarterial valves, pulmonary arteries, pulmonary veins, thoracic aorta, imaged aortic branch arteries, and central systemic veins. Left ventricular and left atrial myocardial walls and chamber cavities are uniformly opacified in standard CCTA and should be examined for hypertrophy, dilation,
Extracardiac structures
By nature of the imaging technique and coverage, noncontrast calcium scoring and coronary CTA also display portions of noncardiovascular thoracic and upper abdominal anatomy, including the mediastinum, hilum, airway, lung parenchyma, pleura, chest wall, esophagus, stomach, liver, spleen, and colon. Review of all visible noncardiovascular structures is important for 2 principal reasons: (1) recognition of primary and secondary comorbid pathology, and (2) identification of findings that lead to
Preamble
This document is intended to identify critical factors involved in effective and thorough reporting of cardiac CTA studies so that it may serve as a standard for cardiac CT programs.
Timeline for report distribution
Documentation of the date of electronic or physical signature should be included in the report. It is recommended that all potentially life-threatening findings are reported to the referring physician on the same date of the study and that a record of a verbal communication be included in the report. Reports of emergency studies should be issued within 24 hours, and elective studies should be reported within 2 working days of the procedure.
Conclusions
In summary, the committee believes it is critical to generate comprehensive reports for cardiac CT. The report should always contain adequate information to support clinical necessity of the procedure and sufficient description of the findings to allow clear understanding of the clinical implications of the report. The committee also encourages definitive and clinically relevant descriptions and conclusions.
Acknowledgments
The authors thank the members of the Guidelines Committee:
Jonathon Leipsic, MD, FSCCT, Co-Chair
Leslee J. Shaw, PhD, Co-Chair
Stephan Achenbach, MD, FSCCT
B. Kelly Han, MD
Richard George, Jr., MD, FSCCT
Mahadevappa Mahesh, MD, FSCCT
GB John Mancini, MD
Paul Schoenhagen, MD
Michael Shen, MD, FSCCT
The authors also thank the members of the prior Writing Group:
Gilbert L. Raff, MD, FSCCT Chair
Aiden Abidov, MD, PhD
Stephan Achenbach, MD, FSCCT
Daniel S. Berman, MD, FSCCT
Lawrence Boxt, MD
Matthew J. Budoff, MD,
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Conflicts of interest: Jonathon Leipsic is a member of the speaker’s bureau of GE Healthcare and Edwards Lifesciences. He is a member of the advisory board at GE Healthcare, Edwards Lifesciences, Vital Images, and Circle CVI. He is also an equity stakeholder in TC3. He receives research grant support from Canadian Institute of Health Research, National Institutes of Health, GE Healthcare, and HeartFlow. Stephan Achenbach is a consultant for Circle, Guerbet, Siemens, and Servier. He receives research grant support from Bayer-Schering Pharma and Siemens USA. Ricardo Cury is a consultant for Astellas Pharma and receives research grant support from GE Healthcare and Astellas Pharma US. Koen Nieman is a member the speaker’s bureau of Siemens and Toshiba and receives research grant support from GE Healthcare and Bayer.