Improving the quality of the CT Coronary Angiography (CTCA) service
Aims:
•To review the current CTCA service and to establish the current rate for non-diagnostic CTCA scans
•To identify modifiable factors that led to non-diagnostic scans
•To look at the quality and turn around for reporting of CTCAs
Method:
First cycle audit: CTCA data from November 2022 - 50 consecutive patients
Intervention
•present data at clinical governance
•circulate data and beta blocker Standard Operating Procedure (SOP) amongst relevant clinicians/reporters
•amend electronic CTCA request form (in progress)
Second cycle audit: CTCA data from April 2024 - 50 consecutive patients
Results:
Indications for CTCA
•Atypical chest pain – 44%
•Angina – 40%
•Pre-op valve disease (assessment of CAD) – 6%
•Other – 10%
Quality of scan
% diagnostic: 74%
Of those that were non-diagnostic (N=13)
•100% reports mentioned HRtoo high/step artefact
•46% had HR>80 at time of request
•1/3 of these were not startedon oral beta blocker therapy at time of request
•15% reports additionally mentioned impaired quality due to extensive calcification
Report features
•Mean scan-report time: 4.82days
•Reports mentioning radiation dose: 68%
•Reports mentioning calcium score: 90%
•Highly variable IV metoprololdose during CTCA – no clearrationale behind dosing (hence our SOP)
•(pie chart)
RE-audit data:
After intervention:
•% diagnostic scans increased from 74% to 92%
•% started on beta blockertherapy if HR>80 at time of request increased from 50% to 64%
Improving diagnostic rate:
1)Improved HR control before CTCA (initiation of oral beta blockers if HR>80 at time of scan request)
2)Introduction of beta blocker Standard Operating Procedure (SOP) to enable higher IV doses to be given with confidence during CTCA
3)Amend electronic CTCArequest form – add mandatory field ‘is this patient suitable for IV betablockers up to 60mg?’ – requesters to specifically consider beta blocker administration (this intervention is still in progress)
Conclusions:
Strict heart rate control prior toCTCA is critical for goodquality, diagnostic images.
Beta blocker therapy (both before and during the scan) is essential, assuming the patient does not have any contraindications.
