Radiologists utilize novel CAD-RADS in 95% of coronary CTA reports
In 2016, radiology and cardiology societies introduced a data system to help classify arterial plaque buildup on coronary CT angiography exams. And a new special report suggests providers were quick to adopt the technique.
The Coronary Artery Disease Reporting and Data System or CAD-RADS standardizes coronary artery stenosis reporting for CCTA exams. It’s been proven to accurately predict adverse events such as heart attack or death, but adoption and opt-out rates have been understudied, experts explained in Radiology: Cardiothoracic Imaging.
Massachusetts General Hospital doctors looked within their high-volume cardiac CT service center for answers. They found CAD-RADS scores were used in 95% of CCTA reports performed at their institution over a three-year period.
Furthermore, readers most often opted out of using the system in complex cases, such as advanced CAD and those with prior percutaneous coronary interventions.
This information can help guide future versions of CAD-RADS, Angelo K. Takigami, MD, and colleagues with the Boston institution’s Cardiovascular Imaging Section wrote on June 24.
“While this is in keeping with CAD-RADS guidelines emphasizing the sensitivity and negative predictive value of coronary CTA (maximizing clinical value in patients with acute or stable chest pain and no prior diagnosis of CAD), it suggests a potential need to educate new users of CAD-RADS, and perhaps an avenue to improve future versions of CAD-RADS to account more readily for more complex disease,” the authors added.
The team retrospectively reviewed some 6,500 CCTA reports, keying in on CAD-RADS usage rates, opt-outs, and exceptions (cases not designed to fall under the system). Among the 5% without data system scores, providers opted out in 58% with the remaining 42% reflecting exceptions.
Exams with higher degrees of stenosis, stents, and coronary artery bypass grafts occurred more often in opt-out reports.
Given their findings, Takigami et al. suggested a system tweak so CAD-RADS can be utilized in a wider variety of cases.
“This modifier would have three purposes: it would make possible the evaluation of CAD in cases of CAD-RADS exceptions, it would provide a framework for research into those etiologies, and it would indicate to the provider that CAD-RADS recommendations pertinent to CAD would not apply,” the group wrote. “Management decisions would still be made on an individual basis, using clinical data and other detailed information in the report.”
Read the full study here.
Related CAD-RADS Content:
New CAD-RADS 2.0 reporting for coronary CTA offers patient management recommendations
CAD-RADS a ‘big step in the right direction’ toward improving outcomes for acute chest pain
Plaque characteristics boost predictive power of CTA risk scoring
Continued variation in radiology tech reports poses threat to readability
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.