STANDARDS & TARGETS

While there are no CTSS-specific national guidelines, recommendations from the British Societies of Cardiovascular Imaging (BSCI), Cardiac CT (BSCCT), and Thoracic Imaging (BSTI) offer advice on reporting/management of incidental CAC on non-gated thoracic CT.^[3] Our audits used the following standards derived from their consensus:

1. Reporting & Grading

If CAC is explicitly identified, it should be quantified using a simple visual scale (none, mild, moderate, severe) unless there is a   valid reason making this difficult or inappropriate (e.g. previous CABG, stent in situ).

→ target: 100%

2. Suggesting Recommendations in Report

If CAC is explicitly identified, simple recommendations for further assessment or management should be provided in the report text   itself.

→ target: 100%

3. Enacting Subsequent Clinical Management

If CAC is explicitly identified, some form of appropriate clinical management (e.g. patient discussion, lifestyle modification, statin   initiation, GP referral, etc.) should be enacted by the primary medical team responsible for the patient’s care.

→ target: 100%

METHODOLOGY

INTERVENTIONS

INTERVENTIONS TO IMPROVE REPORTING:

- educational presentation of findings: to specialty leads for oncological imaging to reinforce value of looking at coronary arteries on all CTSS

- guidance to radiologists: if a grade cannot be given where calcification is present, include an explicit reason in the report for why not (e.g. previous CABG, stent in situ)

INTERVENTIONS TO IMPROVE MANAGEMENT:

- educational presentation of findings: to both specialty leads for oncological imaging and haematology consultants specialising in myeloma to raise awareness

- guidance to radiologists: introduction of a standardised reporting template for CAC, which automatically includes simple recommendations for further management in the report text if CAC is explicitly identified

- guidance to clinicians: clinicians receiving a report definitively identifying CAC advised to…

> suggest lifestyle changes to minimise overall cardiovascular risk

> initiate/optimise statin therapy for primary prevention

> encourage patient to discuss long-term cardiovascular risk reduction with GP

- patient information sheet: co-developed with haematology consultants specialising in myeloma to empower patients with information needed to discuss strategies for cardiovascular risk reduction in primary care

RESULTS

1. In reports in which the coronary arteries were/CAC was explicitly commented on, what degree of calcification was noted?

2. What percentage of reports in which the coronary arteries were/CAC was explicitly commented on visually-qualified the   severity of calcification OR had an appropriate reason not to comment?

3. In reports where CAC was definitively identified, was there any simple recommendation re. further assessment/management   given in the report text?

4. In the most at-risk patients (i.e. those with risk factors for CVD) in whom CAC was definitively identified in the report and were   not already on/on sub-optimal primary prevention, was any subsequent clinical management enacted?

DISCUSSION & CONCLUSION