Society Of Cardiovascular Computed Tomography Research Articles

Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits and Bioprosthetic Valves: A White Paper of the Society of Cardiovascular Computed Tomography (SCCT), Congenital Heart Surgeons’ Society (CHSS), and Society for Cardiovascular Angiography & Interventions (SCAI)

Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits and Bioprosthetic Valves: A White Paper of the Society of Cardiovascular Computed Tomography (SCCT), Congenital Heart Surgeons’ Society (CHSS), and Society for Cardiovascular Angiography & Interventions (SCAI)

Standardized Medical Terminology for Cardiac Computed Tomography 2023 Update: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), American Association of Physicists in Medicine (AAPM), American College of Radiology (ACR), North American Society for Cardiovascular Imaging (NASCI), and Radiological Society of North America (RSNA) with endorsement by the Asian Society of Cardiovascular Imaging (ASCI), the European Association

Since the emergence of cardiac computed tomography (Cardiac CT) at the turn of the 21st century, there has been an exponential growth in research and clinical development of the technique, with contributions from investigators and clinicians from varied backgrounds: physics and engineering, informatics, cardiology, and radiology. However, terminology for the field is not unified. As a consequence, there are multiple abbreviations for some terms, multiple terms for some concepts, and some concepts that lack clear definitions and/or usage. In an effort to aid the work of all those who seek to contribute to the literature, clinical practice, and investigation of the field, the Society of Cardiovascular Computed Tomography updates a standard set of medical terms commonly used in clinical and research activities related to cardiac CT. Keywords: Cardiac, CT, Medical Terminology Supplemental material is available for this article. This article is published synchronously in Radiology: Cardiothoracic Imaging and Journal of Cardiovascular Computed Tomography. ©2023 Society of Cardiovascular Computed Tomography. Published by RSNA with permission.

How will artificial intelligence transform cardiovascular computed tomography? A conversation with an AI model

Artificial intelligence (AI) has the potential to transform healthcare, but its clinical use also has important challenges and limitations. Recently natural language processing and generative pre-training transformer (GPT) models have gained particular interest due to their ability to simulate human conversation. We aimed to explore output of the ChatGPT model (OpenAI, https://openai.com/blog/chatgpt) regarding current debates in cardiovascular CT. Prompts included debate questions from the Society of Cardiovascular Computed Tomography 2023 programme as well as questions about high risk plaque (HRP), quantitative plaque analysis, and how AI will transform cardiovascular CT. The AI model rapidly provided plausible responses including both pro and con sides of the argument. Advantages of AI for cardiovascular CT that were described by the AI model included improving image quality, speed of reporting, accuracy, and consistency. The AI model also acknowledged the importance for continued involvement of clinicians in patient care.

Contemporary cardiovascular computed tomography (CCT) training: Serial surveys of the international CCT community by the Fellow and Resident Leaders of the Society of Cardiovascular Computed Tomography (SCCT) Committee (FiRST) and SCCT Future Leaders Program (FLP)

BackgroundAs cardiovascular computed tomography (CCT) practice evolves, the demand for specialists continues to increase. However, CCT training remains variable globally with limited contemporaneous data to understand this heterogeneity. We sought to understand the role of CCT globally and the training available to underpin its use. MethodsWe performed two consecutive surveys of cardiology and radiology physicians, two years apart, utilizing the Society of Cardiovascular Computed Tomography (SCCT) website, weblinks, social media platforms, and meeting handouts to maximize our response rate. We compared United States (US)-based vs. international responses to understand global similarities and differences in practice and training in the surveys. Results235 respondents (37% trainees and 63% educators/non-trainees) initiated the first survey with 174 (74%) completing the core survey, with 205 providing their work location (114 US and 91 international). Eighty-four percent (92/110) of educator respondents stated a need for increased training opportunities to meet growing demand. Dedicated training fellowships are heterogenous, with limited access to structural heart imaging training, despite structural scanning being performed within institutions. The lack of a standardized curriculum was identified as the main obstacle to effective CCT learning, particularly in the US, with web-based learning platforms being the most popular option for improving access to CCT training. 148 trainees initiated the second survey with 107 (72%) completing the core components (51% North America, 49% international). Only 68% said they would be able to meet their required CCT education needs via their training program. Obstacles in obtaining CCT training again included a lack of a developed curriculum (51%), a lack of dedicated training time (35%), and a lack of local faculty expertise (31%). There was regional variability in access to CCT training, and, in contrast to the first survey, most (89%) felt 1:1 live review of cases with trained/expert reader was most useful for improving CCT training alongside formal curriculum/live lectures (72%). ConclusionsThere is a need to expand dedicated CCT training globally to meet the demand for complex CCT practice. Access to CCT education (didactic and 1:1 case-based teaching from expert faculty), implementation of recently published global training curricula, and increased teaching resources (web-based) as an adjunct to existing experiential learning opportunities, are all deemed necessary to address current educational shortfalls.

Peritoneal Carcinomatosis of Prostate Cancer with PSMA-targeted 18F-DCFPyL PET/CT

HomeRadiology: Imaging CancerVol. 5, No. 2 PreviousNext Images in CancerFree AccessPeritoneal Carcinomatosis of Prostate Cancer with PSMA-targeted 18F-DCFPyL PET/CTRonald Woodruff , Cameron Henry, Phillip SchererRonald Woodruff , Cameron Henry, Phillip SchererAuthor AffiliationsFrom the Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131 (R.W.); and Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H., P.S.).Address correspondence to R.W. (email: [email protected]).Ronald Woodruff Cameron HenryPhillip SchererPublished Online:Mar 17 2023https://doi.org/10.1148/rycan.220174MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Prostate cancer is the second most common cause of cancer-related death in men. Metastatic spread of prostate cancer frequently involves the bones (84%) and, less commonly, distant lymph nodes (10.6%) and the liver (10.2%) (1). Peritoneal spread of prostate adenocarcinoma is rarely described in the literature, especially without evidence of bony spread or other distant metastatic involvement (2,3). The cause of peritoneal involvement of prostate cancer is poorly understood. While treatment options such as surgical intervention combined with medical therapy have proven effective in preventing local disease recurrence, studies have proposed that laparoscopic prostatectomies may increase the risk of iatrogenic seeding of the peritoneum, causing disease recurrence later in life (4). Cases of peritoneal involvement in the absence of surgical intervention have also been reported, possibly revealing hematogenous or lymphatic spread as a cause. Visceral involvement in prostate cancer is known to be a poor prognostic indicator. Clinicians should consider this diagnosis when performing imaging for patients with a history of prostate adenocarcinoma (Figure).Prostate-specific membrane antigen–targeted fluorine 18 (18F) 2-(3-{1-carboxy-5-[(6-18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (DCFPyL) PET/CT images in an 88-year-old man with a history of prostate adenocarcinoma who presented with worsening fatigue and abdominal distention for over a year. The patient was treated 15 years prior with prostatectomy (Gleason score was 3 + 4 = 7) and continued to receive medical management. Despite treatment, the patient’s prostate-specific antigen level was elevated to 917.61 ng/mL. For restaging, imaging was performed. (A) Coronal PET image shows diffuse intense uptake throughout the peritoneum and omentum. (B, C) Axial PET/CT images show peritoneal nodularity (white arrow), ascites (red arrow), and extensive omental nodularity and stranding (blue arrows), with no evidence of skeletal metastasis. Histologic sample of the mesentery helped confirm prostate adenocarcinoma. No further genetic or histologic testing aided the patient’s diagnosis.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: R.W. No relevant relationships. C.H. Leadership or fiduciary role in Society of Cardiovascular Computed Tomography (SCCT) FiRST committee. P.S. No relevant relationships.Keywords: PET/CT, Prostate, Peritoneum, Omentum, Mesentery, MetastasesAuthors declared no funding for this work.

CAD-RADS™ 2.0 - 2022 Coronary Artery Disease - Reporting and Data System An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America Society of Cardiovascular Imaging (NASCI).

Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care. Keywords: Coronary Artery Disease, Coronary CTA, CAD-RADS, Reporting and Data System, Stenosis Severity, Report Standardization Terminology, Plaque Burden, Ischemia Supplemental material is available for this article. This article is published synchronously in Radiology: Cardiothoracic Imaging, Journal of Cardiovascular Computed Tomography, JACC: Cardiovascular Imaging, Journal of the American College of Radiology, and International Journal for Cardiovascular Imaging. © 2022 Society of Cardiovascular Computed Tomography. Published by RSNA with permission.

Update for the Performance of CT Coronary Angiography - Evidence-Based Application and Technical Guidance According to Current Consensus Guidelines and Practical Advice from the Clinical Routine.

Coronary CT angiography (cCTA) is a class 1 recommendation in the current guidelines by the European Society of Cardiology (ESC) for excluding significant coronary artery stenosis. To achieve optimal image quality at a low radiation dose, the imaging physician may choose different acquisition modes. Therefore, the consensus guidelines by the Society of Cardiovascular Computed Tomography (SCCT) provide helpful guidance for this procedure. The article provides practical recommendations for the application and acquisition of cCTA based on the current literature and our own experience. According to current ESC guidelines, cCTA is recommended in symptomatic patients with a low or intermediate clinical likelihood for coronary artery disease. We recommend premedication with beta blockers and nitrates prior to CT acquisition under certain conditions even with the latest CT scanner generations. The most current CT scanners offer three possible scan modes for cCTA acquisition. Heart rate is the main factor for selecting the scan mode. Other factors may be coronary calcifications and body mass index (BMI). · CCTA is a valid method to exclude coronary artery disease in patients with a low to intermediate clinical likelihood.. · Even with the latest generation CT scanners, premedication with beta blockers and nitrates can improve image quality at low radiation exposure.. · Current CT scanners usually provide retrospective ECG gating and prospective ECG triggering. Dual-source scanners additionally provide a "high pitch" scan mode to scan the whole heart during one heartbeat, which may also be achieved using single-source scanners with broad detectors in some cases.. · Besides the available scanner technology, the choice of scan mode primarily depends on heart rate and heart rate variability (e. g., arrhythmia).. · Soschynski M, Hagar MT, Taron J et al. Update for the Performance of CT Coronary Angiography. Fortschr Röntgenstr 2022; 194: 613 - 624.

Rationale, design, and baseline characteristics of Chinese registry in early detection and risk stratification of coronary plaques (C-STRAT) study.

Rationale, design, and baseline characteristics of Chinese registry in early detection and risk stratification of coronary plaques (C-STRAT) study.

2020 SCCT Guideline for Training Cardiology and Radiology Trainees as Independent Practitioners (Level II) and Advanced Practitioners (Level III) in Cardiovascular Computed Tomography: A Statement from the Society of Cardiovascular Computed Tomography

Cardiovascular computed tomography (CCT) is a well-validated noninvasive imaging tool with an ever-expanding array of applications beyond the assessment of coronary artery disease. These include the evaluation of structural heart diseases, congenital heart diseases, peri-procedural electrophysiology applications, and the functional evaluation of ischemia. This breadth requires a robust and diverse training curriculum to ensure graduates of CCT training programs meet minimum competency standards for independent CCT interpretation. This statement from the Society of Cardiovascular Computed Tomography aims to supplement existing societal training guidelines by providing a curriculum and competency framework to inform the development of a comprehensive, integrated training experience for cardiology and radiology trainees in CCT. This article is being published synchronously in Radiology: Cardiothoracic Imaging, Journal of Cardiovascular Computed Tomography, and JACC: Cardiovascular Imaging. © 2020 Society of Cardiovascular Computed Tomography. Published by RSNA with permission.

Highlights of the 15th annual scientific meeting of the Society of Cardiovascular Computed Tomography

The 15th Society of Cardiovascular Computed Tomography (SCCT) annual scientific meeting (ASM) welcomed 770 digital attendees from 44 countries, over 2 days, with a program that included 30 sessions across three simultaneously streaming channels, 10 exhibitors and a diverse range of scientific abstracts. In addition, #SCCT2020 generated >5900 tweets from nearly 700 engaged social media participants resulting in an estimated 38 million digital impressions and becoming #1 trending medical meeting in social media in the world during the meeting time period. This article summarizes the many themes and topics of presentation and discussion in this meeting, and the many technical advances that are likely to impact future clinical practice in cardiovascular computed tomography.

Utilization and Appropriateness of Transthoracic Echocardiography in Response to the COVID-19 Pandemic

Utilization and Appropriateness of Transthoracic Echocardiography in Response to the COVID-19 Pandemic

Standardized approach to result analysis and interpretation of initial experience of coronary computed tomography angiography in a tertiary care hospital.

Objective:To have a systematic standardized approach to performing and interpretation of coronary CT Angiography (CTA) in order to maintain and enhance the diagnostic accuracy of the imaging modality.Methods:This retrospective observational study was performed in Radiology Department, Lady Reading Hospital, Medical Teaching Institute, Peshawar, Pakistan from August 2018 to September 2019. Patients referred for coronary CT angiography were screened and prepared in radiology department. The examination was performed on Toshiba-160 slice CT Scanner (Prime Aquilion) utilizing standardized protocols tailored towards optimum image acquisition. Interpretation of the images were based on the guidelines provided by the Society of Cardiovascular Computed Tomography (SCCT).Results:Total 95 CTCA procedures were performed in the department, out of which 85 were included in study showing 49(57%) as normal and 36(42%) were positive for coronary disease. Of the abnormal cases 16(18.8%) had mild disease, nine (10.6%) patients had moderate disease, while severe disease was noted in 11 (12.9%) cases. Coronary quantitative stenosis revealed five cases (5.9%) with LAD involvement only and five (5.9%) with severe triple vessel disease. The remaining varied in degree of stenosis and number of segments involved. Post CABG were 14 cases (16%) and native arteries showed triple vessel disease. CTA for percutaneous stent patency were three (3.5%) cases with 100% stent patency.Conclusion:Patient selection with tailored protocols are the mainstay for achieving optimal images. This form the basis for accurate interpretation, based on a standardized and systematic approach, utilizing various post processing tools, in order to maintain the high diagnostic accuracy of this semi-invasive, safe imaging modality in a variety of patients suspected of coronary artery disease, coronary artery bypass grafts and stent patency.

Automatic Identification of Coronary Arteries in Coronary Computed Tomographic Angiography

Cardiovascular disease has seriously affected the lives of modern people. One of the most commonly used imaging methods for diagnosing cardiovascular disease is computed tomography angiography (CTA). To generate a diagnosis report for doctors, every coronary artery needs to be identified and segmented, including the right coronary artery (RCA), the posterior descending artery (PDA), the posterior lateral branch (PLB), the left circumflex (LCx), the left anterior descending branch (LAD), the ramus intermedius (RI), the obtuse marginal branches (OM1, OM2), and the diagonal branches (D1, D2). In this paper, we proposed a coronary artery automatic identification algorithm, which performs better in terms of accuracy than other similar algorithms and works efficiently. Normally, each Coronary Computed Tomographic Angiography (CCTA) dataset can be completed within seconds. This algorithm fully complies with the coronary label standard established by the Society of Cardiovascular Computed Tomography (SCCT). This algorithm has been put into operation in more than 100 hospitals for over one year. According to all previous tests, the labels obtained from the algorithm were compared with results manually corrected by several experts. Among 892 CCTA datasets, 95.96% of the labels obtained from the algorithms were correct.

BI-RADS, C-RADS, CAD-RADS, LI-RADS, Lung-RADS, NI-RADS, O-RADS, PI-RADS, TI-RADS: Reporting and Data Systems.

In this online presentation, nine American College of Radiology Reporting and Data Systems, from BI-RADS to TI-RADS, are individually reviewed, and the publication trends for each and expert resour...

Coronary artery calcium scoring in low risk patients with family history of coronary heart disease: Validation of the SCCT guideline approach in the coronary artery calcium consortium

BackgroundThe Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk <5%. No dedicated study has examined the prognostic significance of CAC scoring among this population. MethodsThe CAC Consortium is a multi-center observational cohort study from four clinical centers linked to long-term follow-up for cause-specific mortality. All CAC scans were physician referred and performed in patients without a history of CHD. Our analysis includes 14,169 patients with ASCVD scores <5% and self-reported FH of CHD. ResultsThis cohort had a mean age of 48.1 (SD 7.4), was 91.3% white, 47.4% female, had an average ASCVD score of 2.3% (SD 1.3), and 59.4% had a CAC = 0. The event rate for all-cause mortality was 1.2 per 1000 person-years, 0.3 per 1000 person-years for CVD-specific mortality, and 0.2 per 1000 person-years for CHD-specific mortality. In multivariable Cox proportional hazard models, those with CAC>100 had a 2.2 (95% CI 1.5–3.3) higher risk of all-cause mortality, 4.3 (95% CI 1.9–9.5) times higher risk of CVD-specific mortality, and a 10.4 (95% CI 3.2–33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9. ConclusionIn otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD.

Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines.

In this review, we evaluate the coronary artery calcium (CAC) score as a biomarker for advanced atherosclerotic cardiovascular disease (ASCVD) risk assessment. We summarize the evidence from multiple epidemiological studies, which show a clear advantage of CAC compared to traditional and non-traditional cardiovascular risk factors. We then compare the recommendations included in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) and in the 2017 Society of Cardiovascular Computed Tomography (SCCT) guidelines for the use of CAC in ASCVD risk assessment, and examine the recent 2018 US Preventive Services Task Force (USPSTF) document. Finally, based on the currently available evidence, we provide constructive input for the upcoming ACC/AHA guidelines, regarding the population in whom CAC is most likely to be informative, the level of evidence that we believe should be assigned to CAC as an advanced ASCVD risk assessment tool, and the special populations in whom CAC might be beneficial for further risk assessment. We support a pragmatic approach that combines the pooled cohort equations (PCE) for initial ASCVD risk stratification, followed by CAC for refining ASCVD risk assessment among a broad range of intermediate risk patients and other special groups.

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness.

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness.

The Role of the ACR Appropriateness Criteria in the Medical Literature

The most recent ACR Appropriateness Criteria (AC) supplement contains 17 new or revised topics and augments the total number of citable AC publications. These topics come from 9 of the 11 AC specialty areas and build the comprehensive body of diagnostic imaging literature. A recent review by the College found that roughly one-third of all visits to the ACR website go to an AC document. With more awareness of the AC fostered by journal publications, my hope is that AC documents become routinely cited throughout the radiology literature, and beyond. The AC program has made important advances over the last 6 months. First, based on a concept that originated with the leadership of JACR, Bruce Hillman, MD, editor-in-chief, and Andrea Borondy Kitts, MS, MPH, associate editor, have spearheaded the creation of patient-friendly summaries of the AC documents. A number of these documents have already been published. After this, the AC created the Patient Engagement Subcommittee and appointed Jennifer Uyeda, MD, as chair. An editorial describing the committee’s activities has been published [1Uyeda J.W. Kitts A.B. Rybicki F.J. The ACR Appropriateness Criteria Patient Engagement Subcommittee.J Am Coll Radiol. 2018; (Available at:)https://doi.org/10.1016/j.jacr.2018.03.038PubMed Google Scholar]. Developing and supporting patient advocacy input expands the AC program’s scope. Third, we have forged new relationships with cardiovascular societies—namely, the Society of Cardiovascular Computed Tomography and the Society of Cardiovascular Magnetic Resonance—to augment the clinical expertise within the AC for our cardiac and vascular groups. Finally, we added AC subspecialty panels to provide a more expansive collection of AC documents that ordering providers demand. Future efforts will focus on reducing time required to review and incorporate the relevant medical developments into our recommendations. Although the AC represents the largest body of evidence-based recommendations for diagnostic imaging, ACR is not the only entity developing appropriate use criteria. To meet the challenges of the dynamic appropriate use criteria development milieu, two additional committees, the Rapid Response Committee (RRC) led by Michael A. Bettmann, MD, and the Gaps and Harmonization Committee (GAHC) led by E. Kent Yucel, MD, were formed. The RRC addresses the users’ needs and questions by providing clarification of the clinical decision support mechanism that delivers AC content, creating localized rules, and facilitating communication between the marketplace and ACR. The GAHC uses the feedback from the RRC to determine gaps in AC content and harmonize AC content with other societies’ guidance, and the GAHC works with the AC Committee to prioritize content development. Future work will include analyses of the contributions from medical professionals that influence radiology practice. The ACR Appropriateness Criteria® Patient Engagement SubcommitteeJournal of the American College of RadiologyVol. 16Issue 3PreviewPatient- and family-centered care (PFCC) is defined as “a model of providing care in which the patient and family are partners with the provider and care team” [1-3]. The role of the radiologist in PFCC can be challenging since our direct contact with patients is often limited. Patient satisfaction and outcomes are increasingly being associated with quality medical care and also with reimbursement as alternative payment models are introduced. Imaging is essential for screening, diagnosis, and therapy monitoring. Full-Text PDF

It's in the Field of View! Coronary Artery Analysis on Chest Computed Tomographic Angiography.

Several questions of great importance to the cardiovascular community loom large in chest CT imaging: 1. Is the imager responsible for reporting all relevant cardiovascular findings in the field of view? 2. If imaging of the requested organs (aorta and pulmonary arteries) on computed tomographic angiography is enhanced by simple techniques that enable analysis of the coronary arteries, should the acquisition standard of care be changed to permit coronary analysis and reporting? The Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology have answered the first question in the 2016 SCCT/STR Guidelines for Coronary Artery Calcium Scoring of noncontrast noncardiac chest CT scans.1 Because Coronary Artery Calcium Scoring analysis is always feasible and the information provides robust prediction of cardiovascular events in asymptomatic patients, the guideline states that Coronary Artery Calcium Scoring by quantitative or semiquantitative analysis should be part of every noncontract chest CT analysis and report, whether gated or nongated, even though it has not been requested by the referring physician. The second question, which has not been addressed by any guideline, relates to coronary artery analysis and reporting on contrast CT scans ordered for the acute scenarios of aortic dissection (AD) and pulmonary embolus (PE) and for the chronic surveillance of thoracic aortic aneurysms, both before and after repair. This should be differentiated from the triple rule out in ED chest pain patients with clinical presentations consistent with coronary artery disease (CAD) in which AD and PE are also of concern. In this ED setting, in 1555 patients, 15.5% had >50% coronary diameter stenosis, 1.1% had PE and 0.4% had AD.2 In a second series of 1192 patients, significant CAD was found in 11.7%, PE in 2.3%, and AD in 0.3%.3 As with all imaging paradigm changes, technical feasibility and a favorable benefit to risk …

ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 Appropriate use criteria for the treatment of patients with severe aortic stenosis.

The American College of Cardiology collaborated with the American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons to develop and evaluate Appropriate Use Criteria (AUC) for the treatment of patients with severe aortic stenosis (AS). This is the first AUC to address the topic of AS and its treatment options, including surgical aortic valve replacement and transcatheter aortic valve replacement. A number of common patient scenarios experienced in daily practice were developed along with assumptions and definitions for those scenarios, which were all created using guidelines, clinical trial data and expert opinion in the field of AS. The '2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines' [1] and its 2017 focused update paper [2] were used as the primary guiding references in developing these indications. The Writing Group identified 95 clinical scenarios based on patient symptoms and clinical presentation, and up to 6 potential treatment options for those patients. A separate, independent Rating Panel was asked to score each indication from 1 to 9, with 1-3 categorized as 'Rarely Appropriate', 4-6 as 'May Be Appropriate' and 7-9 as 'Appropriate'. After considering factors such as symptom status, left ventricular function, surgical risk, and the presence of concomitant coronary or other valve disease, the Rating Panel determined that either surgical aortic valve replacement or transcatheter aortic valve replacement is appropriate in most patients with symptomatic AS at intermediate or high surgical risk; however, situations commonly arise in clinical practice in which the indications for surgical aortic valve replacement or transcatheter aortic valve replacement are less clear, including situations in which one form of valve replacement would appear reasonable when the other is less so, as do other circumstances in which neither intervention is the suitable treatment option. The purpose of this AUC is to provide guidance to clinicians in the care of patients with severe AS by identifying the reasonable treatment and intervention options available based on the myriad clinical scenarios with which patients present. This AUC document also serves as an educational and quality improvement tool to identify patterns of care and reduce the number of rarely appropriate interventions in clinical practice.