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Quality and safety of coronary computed tomography angiography at academic and non-academic sites: insights from a large European registry (ESCR MR/CT Registry)

European Radiology Aims and scope Submit manuscript



To compare the use of coronary computed tomography angiography (CCTA) between academic and non-academic sites across Europe over the last decade.


We analyzed a large multicenter registry (ESCR MR/CT Registry) of stable symptomatic patients who received CCTA 01/2010–01/2020 at 47 (22%) academic and 165 (78%) non-academic sites across 19 European countries. We compared image quality, radiation dose, contrast-media-related adverse events, patient characteristics, CCTA findings, and downstream testing between academic and non-academic sites.


Among 64,317 included patients (41% female; 60 ± 13 years), academic sites accounted for most cases in 2010–2014 (52%), while non-academic sites dominated in 2015–2020 (71%). Despite less contemporary technology, non-academic sites maintained low radiation doses (4.76 [2.46–6.85] mSv) with a 30% decline of high-dose scans ( > 7 mSv) over time. Academic and non-academic sites both reported diagnostic image quality in 98% of cases and low rate of scan-related adverse events (0.4%). Academic and non-academic sites examined similar patient populations (41% females both; age: 61 ± 14 vs. 60 ± 12 years; pretest probability for obstructive CAD: low 21% vs. 23%, intermediate 73% vs. 72%, high 6% both, CAD prevalence on CCTA: 40% vs. 41%). Nevertheless, non-academic sites referred more patients to non-invasive ischemia testing (6.5% vs. 4.2%) and invasive coronary angiography/surgery (8.5% vs. 5.6%).


Non-academic and academic sites provide safe, high-quality CCTA across Europe, essential to successfully implement the recently updated guidelines for the diagnosis and management of chronic coronary syndromes. However, despite examining similar populations with comparable CAD prevalence, non-academic sites tend to refer more patients to downstream testing.

Key Points

Smaller non-academic providers increasingly use CCTA to rule out obstructive coronary artery disease.

Non-academic and academic sites provide comparably safe, high-quality CCTA across Europe.

Compared to academic sites, non-academic sites tend to refer more patients to downstream testing.

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Fig. 1
Fig. 2



Adverse events


Coronary artery calcium


Coronary artery disease


Coronary computed tomography angiography


Computed tomography


Dose length product


European Society of Cardiology


European Society of Cardiovascular Radiology


National Institute for Health and Care Excellence


Pretest probability


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We thank the clinical and research personnel for the continuous hard work on extending the ESCR MR/CT registry. The authors acknowledge the help of the ESCR office Vienna, Austria and LoeScap Technology GmbH, Berlin, Germany.


The ESCR MRCT Registry received unrestricted educational funding from Siemens Healthineers, Erlangen, Germany; Bayer Healthcare, Leverkusen, Germany; Philips, Amsterdam, the Netherlands; and Bracco, Milan, Italy.

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Correspondence to Borek Foldyna.

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The scientific guarantor of this publication is Dr. Matthias Gutberlet.

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No complex statistical methods were necessary for this paper.

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• Retrospective

• Observational

• Multicenter observational cohort study

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Borek Foldyna and Johannes Uhlig share first authorship.

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Foldyna, B., Uhlig, J., Gohmann, R. et al. Quality and safety of coronary computed tomography angiography at academic and non-academic sites: insights from a large European registry (ESCR MR/CT Registry). Eur Radiol 32, 5246–5255 (2022).

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