Clinical practice management
Case studies in clinical practice management
Coronary Artery Calcification Reporting Compliance

https://doi.org/10.1016/j.jacr.2016.08.022Get rights and content

Introduction

Until recently, coronary artery calcification (CAC) scoring has not been a standard component of chest CT reporting. Using data from the National Lung Cancer Screening Trial cohort, Chiles et al [1] showed that there is strong correlation between visual assessment of CAC on nongated chest CT scans and Agatston scores on electrocardiographic-gated CT scans. CAC on CT (whether nongated or electrocardiographic-gated) is a useful risk stratification tool, as it has been associated with patient mortality 1, 2. Heart disease is the leading cause of death in the United States, above cancer. Nearly half of these deaths are the result of coronary artery disease [3]. According to the American College of Cardiology, reporting of the presence of coronary artery calcium on nongated chest CTs provides an opportunity for risk assessment and management for referring providers [4].

The importance of CAC reporting on chest CT has recently been emphasized. Documentation of the presence of CAC in routine thoracic CT has been defined as a quality indicator by the ABR [5] and is one of their suggested Practice Quality Improvement projects.

At the University of Chicago, our cardiologists proposed a project to determine how physicians use information about CAC described in routine nongated chest CT reports. In the course of auditing our nongated chest CT reports, it became apparent that the compliance rate was less than optimal. We formally assessed compliance with coronary calcium reporting on nongated chest CT scans in the chest section and among non–chest specialty radiologists before and after a two-part intervention consisting of a formal meeting to establish coronary calcium reporting as mandatory across both sections and creation of appropriate reporting template modifications.

The purpose of this study was to (1) assess compliance with reporting coronary calcium on nongated chest CTs, and (2) introduce and assess the effect of the aforementioned intervention to increase the rate of coronary calcium reporting on nongated chest CTs.

Section snippets

CAC Reporting Rate Assessment, Reporting Consensus, and Structured Reporting Templates

A consensus was reached in the chest section to consistently report coronary calcium using a scale of none, mild, moderate, severe, and indeterminate. The non–chest specialty radiologists, who frequently read chest CTs when combined with abdomen and pelvis examinations, also agreed to use the scoring system. A set of reference images were created showing examples of mild to severe calcification and corresponding Agatston scores.

Structured reporting is used in our institution, with standardized

Results After Intervention

Baseline compliance with coronary artery calcium reporting was 70% in the chest section and 36% among non–chest specialty radiologists (Table 1). After the intervention of reaching a consensus to report coronary calcium and modification of the reporting templates, the chest section was 99% compliant and the non–chest specialty radiology group was 78% compliant. Both groups had markedly improved, but it still was not adequate for our purposes.

The data were further analyzed by a radiologist and

Conclusion

Near 100% compliance with coronary calcium reporting can be achieved through consensus, education, and structured reporting. Initially, there was a substantial difference in adherence to coronary calcium reporting between the chest and non–chest specialty radiologists, which was likely owing to inappropriate use of individual nonstandard report templates. Revisiting the issue with the non–chest specialty radiologists ultimately resulted in 93% compliance.

In summary, CAC reporting is becoming

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The authors have no conflicts of interest related to the material discussed in this article.

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