Survey regarding the Clinical Practice of Cardiac CT in Germany: Indications, Scanning Technique and Reporting

 

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Zusammenfassung

Ziel: Ziel dieser Studie war es, die aktuelle Praxis der CT des Herzens in Deutschland zu evaluieren. Material und Methoden: Ein 30 Fragen umfassender Bogen wurde insgesamt 149 Anbietern von Herz-CT zugeschickt. Gefragt wurde nach der Indikationsstellung, der Untersuchungs- und Befundungstechnik und der Datenspeicherung. Ergebnisse: 45 Fragebogen konnten insgesamt ausgewertet werden (30 %). Es kamen in 76 % der Zentren (34 von 45) CT der neuesten Generation zum Einsatz (mind. 64 Zeilen). Die häufigsten akzeptierten Indikationen waren der Ausschluss einer koronaren Herzerkrankung (91 %, 41 / 45) oder Koronaranomalien (80 %, 36 / 45) sowie Bypassuntersuchungen (53 %, 24 / 45). Im Jahr 2007 wurden je Anbieter durchschnittlich 243 ± 310 Patienten untersucht und die Zahl der Anbieter stieg signifikant (p = 0,035) gegenüber dem Vorjahr. Die Mehrzahl verabreichte Nitroglycerin (84 %, 38 / 45) und/oder einen Betablocker (86 %, 39 / 44). Zahlreiche Anwender nutzten eine EKG-getriggerte Röhrenstrommodulation (65 %, 29 / 44) und/oder adaptierten den Röhrenstrom an den Body-Mass-Index oder das Körpergewicht (63 %, 28 / 44). Im Median kam eine Schichtdicke von 0,75 mm und ein Schichtinkrement von 0,5 mm zur Anwendung, das Field-of-View betrug im Median 20 cm. Die Befundung erfolgte überwiegend mit Quellbildern (96 %, 43 / 45), gekrümmten MPRs (93 %, 42 / 45) und dünnschichtigen MIPs (69 %, 31 / 45). Extrakardiale Strukturen wurden in 84 % der Zentren (38 / 45) mitbefundet. Die Untersuchung dauerte durchschnittlich 16,2 min, die Befundung 28,8 min. Schlussfolgerung: Bereits nach wenigen Jahren haben sich Standards bei Indikation, Durchführung und Befundung der CT des Herzens etabliert.

Abstract

Purpose: To obtain an overview of the current clinical practice of cardiac computed tomography (CT) in Germany. Materials and Methods: A 30-item questionnaire was mailed to 149 providers of cardiac CT in Germany. The items asked about indications, scanning technique and reporting, data storage, and cost of the examination. Results: Overall 45 questionnaires could be analyzed (30 %). The majority of centers (76 %, 34 of 45 centers) used CT scanners of the latest generation (at least 64 rows). The most common appropriate indications were exclusion of coronary artery disease (91 %, 41 / 45), coronary anomalies (80 %, 36 / 45), and follow-up after coronary artery bypass grafting (53 %, 24 / 45). Each center examined on average 243 ± 310 patients in 2007 and the number of centers performing cardiac CT increased significantly in 2007 (p = 0.035) compared with the preceding year. Most used sublingual nitroglycerin (84 %, 38 / 45; median of 2 sprays = 0.8 mg) and/or a beta blocker (86 %, 39 / 44; median of 5 mg IV, median heart rate threshold: 70 beats/min). Many providers used ECG-triggered tube current modulation (65 %, 29 / 44) and/or adjusted the tube current to the body mass index or body weight (63 %, 28 / 44). A median slice thickness of 0.75 mm with a 0.5 mm increment and a 20 cm field-of-view was most commonly used. Source images in orthogonal planes (96 %, 43 / 45), curved MPRs (93 %, 42 / 45), and thin-slice MIPs (69 %, 31 / 45) were used most frequently for interpretation. Extracardiac structures were also evaluated by 84 % of the centers (38 / 45). The mean examination time was 16.2 min and reporting took an average of 28.8 min. Conclusion: Cardiac CT has rapidly become an established procedure with standards regarding indications, scanning technique, and reporting.

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Priv. Doz. Dr. Marc Dewey

Radiology, Charité

Charitéplatz 1

10117 Berlin

Phone: ++ 49/30/4 05 52 72 96

Fax: ++ 49/30/4 05 52 79 96

Email: dewey@charite.de