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Indications, imaging technique, and reading of cardiac computed tomography: survey of clinical practice

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Abstract

Objectives

To obtain an overview of the current clinical practice of cardiac computed tomography (CT).

Methods

A 32-item questionnaire was mailed to a total of 750 providers of cardiac CT in 57 countries.

Results

A total of 169 questionnaires from 38 countries were available for analysis (23%). Most CT systems used (94%, 207/221) were of the latest generation (64-row or dual-source CT). The most common indications for cardiac CT was exclusion of coronary artery disease (97%, 164/169). Most centres used beta blockade (91%, 151/166) and sublingual nitroglycerine (80%, 134/168). A median slice thickness of 0.625 mm with a 0.5-mm increment and an 18-cm reconstruction field of view was used. Interpretation was most often done using source images in orthogonal planes (92%, 155/169). Ninety percent of sites routinely evaluate extracardiac structures on a large (70%) or cardiac field of view (20%). Radiology sites were significantly more interested in jointly performing cardiac CT together with cardiology than cardiologists. The mean examination time was 18.6 ± 8.4 min, and reading took on average 28.7 ± 17.8 min.

Conclusions

Cardiac CT has rapidly become established in clinical practice, and there is emerging consensus regarding indications, conduct of the acquisition, and reading.

Key Points

• Cardiac CT has now become a routine clinical procedure

• Over 90% of cardiac CTs performed use at least 64 row or dual-source CT.

• Radiologists are significantly more interested in performing cardiac CT together with cardiologists than vice versa.

• Consensus has been reached on accepted indications for referral

• Agreed technical standards are used by most cardiac CT providers.

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References

  1. Hendel RC, Patel MR, Kramer CM et al (2006) ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 48:1475–1497

    Article  PubMed  Google Scholar 

  2. Murphy MK, Brady TJ, Nasir K et al (2010) Appropriateness and utilization of cardiac CT: implications for development of future criteria. J Nucl Cardiol 17:881–889

    Article  PubMed  Google Scholar 

  3. Chung SH, Kim YJ, Hur J et al (2010) Evaluation of coronary artery in-stent restenosis by 64-section computed tomography: factors affecting assessment and accurate diagnosis. J Thorac Imaging 25:57–63

    Article  PubMed  Google Scholar 

  4. Taylor AJ, Cerqueira M et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Circulation. J Am Coll Cardiol 56:1864–1894

    Article  PubMed  Google Scholar 

  5. Bastarrika G, Schoepf UJ (2010) Coming of age: coronary computed tomography angiography. J Thorac Imaging 25:221–230

    Article  PubMed  Google Scholar 

  6. Chheda SV, Srichai MB, Donnino R, Kim DC, Lim RP, Jacobs JE (2010) Evaluation of the mitral and aortic valves with cardiac CT angiography. J Thorac Imaging 25:76–85

    Article  PubMed  Google Scholar 

  7. Bamberg F, Klotz E, Flohr T et al (2010) Dynamic myocardial stress perfusion imaging using fast dual-source CT with alternating table positions: initial experience. Eur Radiol 20:1168–1173

    Article  PubMed  Google Scholar 

  8. Krombach GA, Niendorf T, Günther RW, Mahnken AH (2007) Characterization of myocardial viability using MR and CT imaging. Eur Radiol 17:1433–1444

    Article  PubMed  Google Scholar 

  9. Schoepf UJ, Zwerner PL, Savino G, Herzog C, Kerl JM, Costello P (2007) Coronary CT angiography. Radiology 244:46–63

    Article  Google Scholar 

  10. Kalra MK, Brady TJ (2008) Current status and future directions in technical developments of cardiac computed tomography. J Cardiovasc Comput Tomogr 2:71–80

    Article  PubMed  Google Scholar 

  11. Halon DA, Rubinshtein R, Gaspar T, Peled N, Lewis BS (2008) Current status and clinical applications of cardiac multidetector computed tomography. Cardiology 109:73–83

    PubMed  Google Scholar 

  12. Takakuwa KM, Halpern EJ (2008) Evaluation of a “triple rule-out” coronary CT angiography protocol: use of 64-Section CT in low-to-moderate risk emergency department patients suspected of having acute coronary syndrome. Radiology 248:438–446

    Article  PubMed  Google Scholar 

  13. Baumüller S, Leschka S, Desbiolles L et al (2009) Dual-source versus 64-section CT coronary angiography at lower heart rates: comparison of accuracy and radiation dose. Radiology 253:56–64

    Article  PubMed  Google Scholar 

  14. Lehmkuhl L, Gosch D, Nagel HD, Stumpp P, Kahn T, Gutberlet M (2010) Quantification of radiation dose savings in cardiac computed tomography using prospectively triggered mode and ECG pulsing: a phantom study. Eur Radiol 20:2116–2125

    Article  PubMed  Google Scholar 

  15. Hein PA, May J, Rogalla P, Butler C, Hamm B, Lembcke A (2010) Feasibility of contrast material volume reduction in coronary artery imaging using 320-slice volume CT. Eur Radiol 20:1337–1343

    Article  PubMed  Google Scholar 

  16. Schuetz GM, Zacharopoulou NM, Schlattmann P, Dewey M (2010) Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging. Ann Intern Med 152:167–177

    PubMed  Google Scholar 

  17. Friedrich G (2007) Clinical development of cardiac CT diagnostics: clinical and scientific applications from the cardiologist’s point of view. Wien Med Wochenschr 157:61–64

    Article  PubMed  Google Scholar 

  18. Maurer MH, Hamm B, Dewey M (2009) Survey regarding the clinical practice of cardiac CT in Germany: indications, scanning technique and reporting. Rofo 181:1135–1143

    Article  PubMed  CAS  Google Scholar 

  19. Schnapauff D, Dübel HP, Scholze J, Baumann G, Hamm B, Dewey M (2007) Multislice computed tomography: angiographic emulation versus standard assessment for detection of coronary stenoses. Eur Radiol 17:1858–1864

    Article  PubMed  Google Scholar 

  20. Marwan M, Pflederer T, Schepis T et al (2010) Accuracy of dual-source computed tomography to identify significant coronary artery disease in patients with atrial fibrillation: comparison with coronary angiography. Eur Heart J 31:2230–2237

    Article  PubMed  Google Scholar 

  21. Rist C, Johnson TR, Müller-Starck J et al (2009) Noninvasive coronary angiography using dual-source computed tomography in patients with atrial fibrillation. Invest Radiol 44:159–167

    Article  PubMed  Google Scholar 

  22. Wang Y, Zhang Z, Kong L et al (2008) Dual-source CT coronary angiography in patients with atrial fibrillation: comparison with single-source CT. Eur J Radiol 68:434–441

    Article  PubMed  Google Scholar 

  23. Bastarrika G, Lee YS, Huda W, Ruzsics B, Costello P, Schoepf UJ (2009) CT of coronary artery disease. Radiology 253:317–338

    Article  PubMed  Google Scholar 

  24. Johnson PT, Eng J, Pannu HK, Fishman EK (2008) 64-MDCT angiography of the coronary arteries: nationwide survey of patient preparation practice. AJR Am J Roentgenol 190:743–747

    Article  PubMed  Google Scholar 

  25. Dewey M, Hoffmann H, Hamm B (2006) Multislice CT coronary angiography: effect of sublingual nitroglycerine on the diameter of coronary arteries. Rofo 178:600–604

    Article  PubMed  CAS  Google Scholar 

  26. Hamon M, Hamon M (2006) Images in clinical medicine. Asymptomatic coronary-artery spasm. N Engl J Med 355:2236

    Article  PubMed  CAS  Google Scholar 

  27. Engelken FJ, Lembcke A, Hamm B, Dewey M (2009) Determining optimal acquisition parameters for computed tomography coronary angiography: evaluation of a software-assisted, breathhold exam simulation. Acad Radiol 16:239–243

    Article  PubMed  Google Scholar 

  28. Cademartiri F, de Monye C, Pugliese F et al (2006) High iodine concentration contrast material for noninvasive multislice computed tomography coronary angiography: iopromide 370 versus iomeprol 400. Invest Radiol 41:349–353

    Article  PubMed  Google Scholar 

  29. Kim DJ, Kim TH, Kim SJ et al (2008) Saline flush effect for enhancement of aorta and coronary arteries at multidetector CT coronary angiography. Radiology 246:110–115

    PubMed  Google Scholar 

  30. Fleischmann D, Hittmair K (1999) Mathematical analysis of arterial enhancement and optimization of bolus geometry for CT angiography using the discrete fourier transform. J Comput Assist Tomogr 23:474–484

    Article  PubMed  CAS  Google Scholar 

  31. Cademartiri F, Nieman K, van der Lugt A et al (2004) Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology 233:817–823

    Article  PubMed  Google Scholar 

  32. Cademartiri F, Luccichenti G, Marano R, Runza G, Midiri M (2004) Use of saline chaser in the intravenous administration of contrast material in non-invasive coronary angiography with 16-row multislice Computed Tomography. Radiol Med 107:497–505

    PubMed  Google Scholar 

  33. Seifarth H, Puesken M, Kalafut JF et al (2009) Introduction of an individually optimized protocol for the injection of contrast medium for coronary CT angiography. Eur Radiol 19:2373–2382

    Article  PubMed  Google Scholar 

  34. Dewey M, Schnapauff D, Laule M et al (2004) Multislice CT coronary angiography: evaluation of an automatic vessel detection tool. Rofo 176:478–483

    Article  PubMed  CAS  Google Scholar 

  35. Ferencik M, Ropers D, Abbara S et al (2007) Diagnostic accuracy of image postprocessing methods for the detection of coronary artery stenoses by using multidetector CT. Radiology 243:696–702

    Article  PubMed  Google Scholar 

  36. Wann S, Rao P, Des Prez R (2009) Cardiac computed tomographic angiography: evaluation of non-cardiac structures. J Nucl Cardiol 16:139–150

    Article  PubMed  Google Scholar 

  37. Budoff MJ, Fischer H, Gopal A (2006) Incidental findings with cardiac CT evaluation: should we read beyond the heart? Catheter Cardiovasc Interv 68:965–973

    Article  PubMed  Google Scholar 

  38. Kalra MK, Abbara S, Cury RC, Brady TJ (2007) Interpretation of incidental findings on cardiac CT angiography. Catheter Cardiovasc Interv 70:324–325

    Article  PubMed  Google Scholar 

  39. Koonce J, Schoepf JU, Nguyen SA, Northam MC, Ravenel JG (2009) Extra-cardiac findings at cardiac CT: experience with 1,764 patients. Eur Radiol 19:570–576

    Article  PubMed  Google Scholar 

  40. Boochever SS (2004) HIS/RIS/PACS integration: getting to the gold standard. Radiol Manage 26:16–24

    PubMed  Google Scholar 

  41. Jepson C, Asch DA, Hershey JC, Ubel PA (2005) In a mailed physician survey, questionnaire length had a threshold effect on response rate. J Clin Epidemiol 58:103–105

    Article  PubMed  Google Scholar 

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Acknowledgement

We cordially thank G. Förster and G. Schütt for their help in conducting the survey and B. Herwig for editorial assistance. Finally, we thank all colleagues who completed and returned the questionnaires, in particular those who provided very detailed comments regarding cardiac CT and the main results of the survey.

Dr. Dewey has received grant support from GE Healthcare, Bracco, Guerbet, the European Funds for Regional Development (EFRE), the German Heart Foundation/German Foundation of Heart Research, Joint program from the German Science Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF) for meta-analyses, and Toshiba Medical Systems and lecture fees from Toshiba Medical Systems, Cardiac MR Academy Berlin, Guerbet, and Bayer-Schering; he is also a consultant for Guerbet. He is also the author of “Coronary CT Angiography” and “Cardiac CT” published by Springer and offers hands-on workshops on cardiovascular imaging (www.ct-kurs.de). Dr. Hamm has received grant support from GE Healthcare, Schering, Siemens Medical Solutions, and Toshiba Medical Systems, and lecture fees from Siemens Medical Solutions and Bayer-Schering. Furthermore, there are institutional master research agreements with Philips Medical Systems, Siemens Medical Solutions, and Toshiba Medical Systems. These funding sources had no role in the collection, analysis, and interpretation of the data and in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Radiology, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    M. H. Maurer, E. Zimmermann, C. Germershausen, B. Hamm & Marc Dewey

  2. Department of Medical Statistics, Computer Sciences and Documentation, University Hospital of Friedrich-Schiller University Jena, Jena, Germany

    P. Schlattmann

  3. Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, PO Box 10098, Germany

    Marc Dewey

Authors
  1. M. H. Maurer
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  4. C. Germershausen
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Correspondence to Marc Dewey.

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Maurer, M.H., Zimmermann, E., Schlattmann, P. et al. Indications, imaging technique, and reading of cardiac computed tomography: survey of clinical practice. Eur Radiol 22, 59–72 (2012). https://doi.org/10.1007/s00330-011-2239-7

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  • DOI: https://doi.org/10.1007/s00330-011-2239-7

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