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Abstract
ObjectivesThe aim of this study was to identify factors and quality improvement strategies to improve coronary computed tomography angiography (CCTA) studies referred for fractional flow reserve derived from CT angiography (FFRCT) analysis.MethodsThirty randomly selected CCTAs were analyzed for quality control. A uniform CCTA protocol was implemented by an in-house steering committee, emphasizing the importance of adequate heart rate control and nitroglycerine usage. Sixty additional randomly selected CCTAs were evaluated for quality at multiple time points during intervention, and FFRCT acceptance rate was analyzed at the conclusion.ResultsPrior to the implementation of this quality improvement program, our overall institution-specific percent acceptance rate was 76.1% for FFRCT compared to the national average of >95%. Post-intervention, this was improved to an average acceptance rate of 90% for FFRCT analysis.ConclusionsEstablishment and strict adherence to CCTA imaging protocols with appropriate training and adequate buy-in of CT technologists and nurses is a viable way of improving the quality of imaging and subsequent patient care.
Highlights
Current guidelines recommend the use of non-invasive anatomic imaging, including coronary computed tomography angiography (CCTA), for first-line testing in patients with suspected intermediate-risk stable coronary artery disease (CAD) [1,2]
Prior to the implementation of this quality improvement program, our overall institution-specific percent acceptance rate was 76.1% for flow reserve derived from CT angiography (FFRCT) compared to the national average of >95%
Post-intervention, this was improved to an average acceptance rate of 90% for FFRCT analysis
Summary
Current guidelines recommend the use of non-invasive anatomic imaging, including coronary computed tomography angiography (CCTA), for first-line testing in patients with suspected intermediate-risk stable coronary artery disease (CAD) [1,2]. CCTA and invasive coronary angiography have high accuracy for the detection of coronary artery stenoses based on anatomy evaluation, but they are less helpful for the identification of functionally significant, flow-limiting stenoses of approximately 50-90% [1,3]. FFRCT has been shown to be a valuable tool in the evaluation of intermediate-range stenosis on CCTA, the analysis is highly sensitive to scanning protocol and artifacts [4]. The rejection rate of FFRCT in the literature ranges from 2% to 33% mainly due to differences in imaging acquisition, study incompletion such as missing best diastolic or systolic reconstructions for myocardial segmentation, patient-specific factors including body habitus and motion, and artifacts including calcium blooming, motion, and low contrast [4,6]. The rejection rate at our facility of radiologist-referred FFRCT was discovered to be as high as 50%, limiting comprehensive evaluation of coronary artery stenoses and further patient management
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