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. 2023 Jun;10(1):e002263.
doi: 10.1136/openhrt-2023-002263.

Drugless and radiographer led: the start of a new era for CT coronary angiography

Gareth Morgan-Hughes  1 , Rebecca McNally  2 , Christopher Gibbs Gibbs  3 , Stelios Iacovides  2 , Prabesh Kirat-Rai  2 , Nang Thiriphoo  2 , Alison Powell  2 , Colin Stuckey  2 , Ross Thorpe  2 , Louisa Mayo  2 , Carl Roobottom  2
Affiliations

Drugless and radiographer led: the start of a new era for CT coronary angiography

Gareth Morgan-Hughes et al. Open Heart. 2023 Jun.

Abstract

Objective: Since inception CT coronary angiography (CTCA) has required facilitating beta blockers (BB). However, CT technology has improved rapidly as has radiographer and reporter expertise. Using these factors, we instituted a radiographer led cardiac CT service (RLCCTS), without routine BB, which we studied for quality control (QC).

Methods: RLCCTS started October 2021 using a wide detector array CT system, with 20 min slots. QC study was registered with the clinical audit team, University Hospitals Plymouth, CA_2020-21-118. Uniform reporting was agreed including indication, BB administration, demographics, dose length product (DLP) and the coronary artery disease-reporting and data system (CAD-RADS) score. Uncertain CAD-RADS meant a non-diagnostic scan (NDS). Six months of data were collected; stable chest pain (SCP) patients, who have national CTCA QC comparators, were analysed using descriptive statistics.

Results: Of 1475 patients, 447 were not SCP patients-known CAD (157); valves (286); removed (4, data incomplete) leaving 1028 SCP patients CTCA for analysis. Demographics-mean age 63 years, body mass index 29, 50.4% women. BB therapy-four patients (two recalls). Overall, 36/1024 or 3.5% were NDS; median DLP 173mGy×cm; mean heart rate (HR) 70 bpm, 99/1024 or 9.7% HR >90 bpm (45% not sinus rhythm).

Conclusions: Quality for RLCCTS was judged by NDS rate and DLP. National QC comparators suggest 4% NDS rate; median DLP for SCPP CTCA 209 mGy×cm. RLCCTS compares favourably. With modern cardiac CT, experienced radiographers and reporters, 'drugless' RLCCTS can deliver 20 min slot CTCA with satisfactory QC indicators.

Keywords: Chest Pain; Computed Tomography Angiography; Diagnostic Imaging; Quality of Health Care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Drugless radiographer led CTCA for chest pain assessment following NICE CG 95 (2016), CAD-RADS distribution 1024 cases (%). CR, CAD-RADS, Coronary Artery Disease—Reporting and Data System; CTCA, CT coronary angiography; NICE-CG95, National Institute for Health and Care Excellence—Clinical Guidance 95.
Figure 2
Figure 2
Drugless radiographer led CTCA for chest pain assessment following NICE CG 95 (2016), diagnostic scan rate by HR (%). CTCA, CT coronary angiography; HR, heart rate in beats per minute; NICE-CG95, National Institute for Health and Care Excellence—Clinical Guidance 95.
Figure 3
Figure 3
Drugless radiographer led CTCA for chest pain assessment following NICE CG 95 (2016), distribution of median DLP by patient’s HR. CTCA, CT coronary angiography; DLP, dose length product; HR, heart rate in beats per minute; NICE-CG95, National Institute for health and Care Excellence—Clinical Guidance 95.
See this image and copyright information in PMC

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