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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 Cardiovascular 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


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Recommendations

Society-Based Recommendations

HeartFlow-Specific Recommendations

CCTA Acquisition Protocols

  1. A 64 or greater slice CT scanner with cardiac gating capability.
  2. Dual syringe injector for 2 phase injection.
  3. Experience, willingness, and staffing to use sublingual nitrates and beta blockers (oral or IV) for proper vessel visualization and heart rate control respectively.
  4. At least 1 Radiographer trained in CCTA, including adequate knowledge of the ALARA (As Low As Reasonably Achievable) principle and experienced with cardiac reconstructions.
  5. The interpreting physician(s) should have adequate training as described in competency statements issued by medical specialty societies, e.g., the British Society of Cardiovascular Imaging, the ACC/AHA Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance, or the ACR Practice Guideline for the Performance and Interpretation of Cardiac Computed Tomography.
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.

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.