Abbreviations

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BMI Body Mass Index

BSCI/BSCCT British Society of Cardiovascular Imaging / British Society of Cardiovascular Computed Tomography

CT Computed Tomography

CTCA Computed Tomography Coronary Angiography

ED Emergency Deprtment

MRI Magnetic resonance Imaging

NDRL National Dose Reference Level

NICE National Institute of Health & Care Excellence

OECD Organisation for Economic Co-operation and Development RACPC Rapid Access Chest Pain Clinic

RAG Red Amber Green

RCP Royal College of Physicians

RCR Royal College of Radiologists

SCCT Society of Cardiovascular Computed Tomography

STP Sustainability & Transformation Plan

UK United Kingdom 

 

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Education and Training

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Accreditation in cardiovascular CT can be achieved via both the BSCI/BSCCT and the SCCT. Level 2 accreditation indicates competence to report whilst level 3 indicates a level of experience to train others in CTCA. 

Map 7. Level 2 (red dots) and Level 3 (blue pins) accredited CTCA practitioners in the UK. 

To deliver a high quality CTCA service across the UK will require signi cant investment in training. The whole workforce (radiographers, nurses, medical physicists, radiologists and cardiologists) will need to be appropriately trained in both the clinical and technical aspects of CTCA so they are both confident and competent to acquire CTCA images in all patients, including those who may be technically challenging (high heart rates, arrhythmias, high BMI etc.). This will also ensure that Quality Assurance is delivered as a key component of a high quality CTCA service xvi

Whilst core and advanced education in CTCA is provided by both the BSCI/ BSCCT and individual providers, it will be necessary to significantly expand these educational offerings and look at alternative methods of delivery. This will require concerted and co-ordinated effort by those responsible for the clinical and technical education of the workforce, in conjunction with the specialist societies to ensure that high quality CTCA is delivered at optimal (as low as reasonably achievable) radiation doses.

* STP in England, Regional Health Boards in Scotland, Northern Ireland and Wales 

Map7

 

(This is an intercative map. Please click on the map or here and explore it to find out more detailed information)

 

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Projected Requirement for CTCA - Relative Increase in Provision Needed

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Map 5. Percentage increase in number of CTCA required by region* in the UK 

It is clear that the UK cardiovascular CT community faces a significant challenge to deliver the output required from this revision to NICE guidance. Even the best prepared regions and departments face a minimum of a doubling of CTCA scans they are asked to provide.

Many centres will face much greater increases in demand, and some will effectively be starting from scratch. It must also be understood that the revised guidelines come with no additional funding, and for many centres the recommended numbers will remain aspirational for some time. 

* STP in England, Regional Health Boards in Scotland, Northern Ireland and Wales 

 IMG 0037

(This is an intercative map. Please click on the map or here and explore it to find out more detailed information)

 

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Specialist workforce

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CTCA scans require expertise to acquire and report. In the UK CTCA reporting is usually done by Radiologists and/or Cardiologists. However, the number of available specialists is low. 

Map 6. Accredited CTCA Practioners by region* in the UK 

There is a general shortage of Radiologists in the UK with a recent Royal College of Radiologists (RCR) report demonstrating that the UK has a low number of radiologists compared to our European counterparts. The UK has 48 radiologists per million population compared with Germany (92), Spain (112) and France (130) xv. As a result of activity growth outstripping workforce growth, imaging departments are struggling to keep up with demand. In 2015, 99% of departments were unable to meet their general radiology reporting requirements. 

Detailed information of all medical practitioners who have obtained accreditation to report CTCA (either through the BSCI/BSCCT or SCCT) has been collated and whilst accreditation is not currently a requirement to practice, it is a proxy marker of good medical practice, and as such is used for revalidation purposes. Map 4 demonstrates the number of accredited practitioners (Level 2 accreditation) in the UK is relatively small and there is significant regional variability.

* STP in England, Regional Health Boards in Scotland, Northern Ireland and Wales

Practitioners per Million

(This is an intercative map. Please click on the map or here and explore it to find out more detailed information)

 

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Projected Requirement for CTCA - Absolute Increase in Provision Needed

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Map 4. Absolute increase in number of CTCA required by region* in the UK 

Conversely, in more heavily populated regions, such as Greater Manchester, there is also a relatively low provision to the large population and nearly 15,000 extra scans will be required per year to meet the projected NICE guidelines. This represents a 7000% increase compared with current activity. Even in North-West London where CTCA activity is to be highest in the UK, the proportionate increase in activity is the lowest but still requires a 100% increase in throughput. This is not an insigni cant change in delivery for any cardiac CT service.

* STP in England, Regional Health Boards in Scotland, Northern Ireland and Wales 

Map4

(This is an intercative map. Please click on the map and explore it to find out more detailed information)

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