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CCTA Recommendations

Coronary CT Angiography Requirements and Recommendations for the HeartFlow Analysis

 

HeartFlow’s requirements for CCTA are consistent with those of the Society of Coronary Computed Tomography (SCCT) Performance of CCTA Guidance Document, the Royal College of Radiology (RCR), and the British Society of Cardiovascular Imaging (BSCI).1,2,3

 

Society-Based Guidelines

SCCT 2016 Guidelines for the Performance and Acquisition of Coronary Computed Tomographic Angiography

View Guideline

How to Perform Optimal Coronary CT Angiography

Webinar: A 6 segment video by Dr. Guy Weigold sharing best practices for the acquisition of CCTA, image reconstruction, reducing artifacts, post processing techniques and interpretation of the results that lead to accurate clinical interpretation. The webinar also discusses cases that include FFRCT results and the impact of FFRCT in clinical decision making.

Watch Video

Disclaimer: In order to watch this free webinar, please create a guest account on the SCCT website. Upon completing registration, please click on SCCT Learning Center under the Education tab. The webinar will be available in your Education Library.

RCR Guidelines 2014 (UK): Standards of Practice of Computed Tomography Coronary Angiography (CTCA) in Adult Patients

View Guideline

CCTA Acquisition Protocols

Acquisition and Reconstruction Techniques for Coronary CT Angiography

Impact of Nitrates in the Acquisition of Coronary CT Angiography

A 4 segment video by Dr. Jonathon Leipsic MD, FRCPC, FSCCT summarizing the rationale and best practices for administering nitroglycerin for acquiring CCTA in accordance with the SCCT guidelines. The video also highlights the effect of nitrates administration on the coronary vasculature, and ultimately the CCTA diagnostic accuracy.

Section 1: Effect on Vasculature

Section 3: Physiologic effects, Dosage and Timing

Section 2: Nitrate Recommendations

Section 4: Summary

HeartFlow-Specific Recommendations

Required

  1. The ability to meet minimum quality requirements for the HeartFlow Analysis process (minimum 8/10 consecutive cases pass initial quality acceptance).
  2. Willingness to participate in the HeartFlow onboarding process which includes on-site review of the institution’s CCTA program, training for imagers on HeartFlow requirements, review of CCTA best practices and SCCT guidelines for performance of CCTA.
  3. At least one accredited CCTA reader (or equivalent experience of >150 cardiac CTs) – may be SCCT Level 1+ or accredited through other organizations/fellowship.
  4. Access to scheduled time on the scanner for CCTA.

Suggested

  1. Nurses available and experienced with administering IV beta blockers and monitoring patients for cardiac scans.
  2. An SCCT level 2 accredited cardiac reader.
  3. A dedicated patient preparation area for the CCTA program.
Customizable Resources

All of these resources are available to HeartFlow sites and can be customized. Please reach out to a local HeartFlow CT Application Specialist to gain access.

CT Technologist Training

The training provides 2.25 Category A ASRT credit hours. It reviews the current invasive and noninvasive technologies used to assess the coronary artery disease (CAD). The discussions also focus on how the growth of coronary CT angiography (CCTA) are answering patient and clinician questions more effectively than ever before.

Customizable Reminder: Ordering of PO Beta Blockers by Referring Physicians

CT readers can use this customizable poster to remind the referring cardiologist to order PO Beta Blockers.

Customizable CT Acquisition Protocols for the HeartFlow Analysis

Provides instructions and important reminders on CCTA acquisition protocols such as patient preparation, image acquisition, and image reconstruction. This poster can be created with site specific protocols and is intended to be displayed at the CT scanner console.

Customizable Presentation: Evidence on CCTA and FFRCT

Reviews evidence on the diagnostic accuracy of CCTA, and the impact of CCTA on patient management and outcomes. CT readers and referring physicians can utilize this tool in their pre-authorization peer to peer discussions with the medical directors of various health plans.

HeartFlow CT Applications Support

HeartFlow’s field-based Clinical Account and CT Applications Teams help advance the site’s CT capabilities throughout the lifetime of their account. These teams use best practices and several education and teaching methods (including hands-on case reviews and training).

  1. Site Startup: HeartFlow’s implementation team, including CT Applications specialists and Clinical Account Managers, actively work with sites to ensure they can achieve acceptable image quality for HeartFlow Analysis.HeartFlow performs a baseline evaluation of CCTA quality and provides detailed image quality feedback and observations of site’s practices (note: this baseline review is conducted following HeartFlow’s on-site assessment and review training on best practices for CCTA and a review of the SCCT guidelines).Training and educational materials are provided to imaging physicians and radiographers on SCCT cardiac CTA guidance and image specifications for the HeartFlow Analysis. In addition, training on the use of the HeartFlow Analysis is provided to radiologists, radiographers and cardiologists, as well as other support staff.
  2. Continuous Monitoring: HeartFlow’s CT Applications team works with customers to ensure imaging quality continues to be sufficient for HeartFlow Analysis. HeartFlow monitors quality and acquisition parameters, and routinely reviews cases and best practices with sites to optimize acceptance rates for HeartFlow Analysis.
  3. Education Programs: In addition to site-specific education, HeartFlow sponsors educational events at large conferences, symposia, etc., and supports physician continuing education. HeartFlow offers education programs for Radiographers and Clinicians alike, including physician-led videos, webinars, peer-to-peer discussions, and instructor-led programs (including some with SOR or category A ASRT Credits).
REFERENCES

1 Abbara S, Blanke P, Maroules CD, et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography, Journal of Cardiovascular Computed Tomograph (2016), doi: 10.1016/j.jcct.2016.10.002.

2 The Royal College of Physicians, the British Society of Cardiovascular Imaging and The Royal College of Radiologists. Standards of practice of computed tomography coronary angiography (CTCA) in adult patients. London: The Royal College of Radiologists, 2014.

3 CT Coronary Angiography Service Specification from the British Society of Cardiovascular Imaging (BSCI) – May 2012.