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Submitted on 17 Sep 2019
Author(s): Dr Rida Fatima, Dr Evlyn James, Dr Rajesh Annamalaisamy
Poster Views: 107
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Poster Information
Abstract: Abstract:

Coronary artery disease (CAD) is one of the main causes of morbidity and mortality in the UK.1 Coronary artery calcification (CAC) is a significant independent risk factor for CAD.2 ECG triggered cardiac CT was traditionally used to calculate the level of CAC using Agatston scoring.3 However, multiple studies have shown that a simple visual assessment of CAC on non-gated CT chest is comparable to the Agatston score and have demonstrated it to be a valuable tool for assessing risk of CAD.3
American society of Thoracic Radiology study states that coronary artery Calcium (CAC) should be evaluated and reported on all chest CT examinations.4 American College of Radiology adapted this to say that all final reports for male patients aged 18 years through 50 and female patients aged 18 through 65 years undergoing chest CT exams.5

Whether coronary artery calcification was commented on in CT thorax report
Whether CAC score was reported on CT thorax report
Whether appropriate advice was given by the radiologist regarding further management/investigations if calcification was identified
Extra Interest
Is there a demonstrable association between CAC and IHD within our population?

Patients were identified retrospectively by the radiology department at Royal Oldham hospital.
Patients who underwent a non-gated CT thorax between 2012 and 2013 were randomly selected. Radiology data was collected using PACS programming.
Further data such as cardiology history and other risk factors were collected using HealthViews.
A visual assessment of the 4 main coronary arteries of each CT scan was done by a consultant radiologist to give a CAC score between 0-12 (known as ordinal scoring).
Whether the CAC was reported and any previous history of an MI was recorded for each patient
Additional data was also collected for each scan such as age, gender, smoking history, history of diabetes and hypertension, event date, patient type (Outpatient/Inpatient) and the indication for the scan

5/257 patients were noted to have coronary artery calcification
No CAC scores were reported
No suggestions or recommendations given
54 patients with history of IHD was identified and the mean CAC scores were calculated as 7.58. 52 patients with no history of IHD was identified and their mean CAC scores were calculated as 2.48. As the distribution of data is non parametric, a Mann Whitney test was used to compare medians in the independent t-test. This demonstrated a statistical significance of 0.000 ( < 0.05 = statistically significant). Therefore it can be concluded that there is a notable association between the CAC score and the likelihood of the patient to have had an MI.

Presence of coronary calcium is predictive of future coronary events in both asymptomatic and symptomatic populations and can prompt consideration of primary prevention.2 It can also lead to better patient adherence to therapy.6 CAC assessment on CT thorax are comparable to cardiac CT and majority of radiologists preferred visual assessment over Agatston. The lack of CAC reporting could be due to the following:
Lack of awareness of the significance of CAC as an important risk factor.
Lack of knowledge in how to calculate a CAC score.
Time pressures on reporting scans
Belief that non-gated CT channels to be too inaccurate for CAC scoring

Change exclusion criteria to only include the population as recommended by the American College of Radiology
To only record MI’s that occurred post scan

Moderate and severe CAC score should be reported

Moderate CAC: Lifestyle + In patients with QRISK3 10% in 10 years) statin should be c
Summary: A poster on the reporting of coronary artery calcification on CT thorax by radiologists.References: References
1 Neves PO, Andrade J, Monção H. Coronary artery calcium score: current status. Radiologia Brasileira. 2017;50(3):182-189. doi:10.1590/0100-3984.2015.0235
2 Budoff MJ, Gul KM. Expert review on coronary calcium. Vasc Health Risk Manag. 2008;4(2):315–324.
3Shemesh  J, Henschke  CI, Shaham  D,  et al.  Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease.  Radiology. 2010;257(2):541-548.
4 Hecht HS, Cronin P, Blaha MJ, et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of
noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography
and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr. 2017 Jan - Feb;11(1):74-84. doi:
5American College of Radiology (ACR) (2017). Diagnostic Imaging 2017 - Quality Measures. p.16.
6 Kalia NK, Miller LG, Nasir K, Blumenthal RS, Agrawal N, Bu
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