Introduction

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CT coronary angiography (CTCA) is a non-invasive, x-ray based, technique that allows assessment of both the coronary artery lumen as well as atheromatous plaque morphology. CTCA has almost 100% accuracy in excluding functionally significant (chest pain producing) coronary artery disease and can help detect those at high risk of developing acute coronary syndromes v.

Whilst current doses for CTCA in the UK are acceptable (median 200mGy.cm) iv, it is a demanding radiological technique, that requires a thorough understanding of ECG-gated protocols, dose optimisation strategies and CT scanner technology. Without specific training of both radiographers and medical practitioners, CTCA can be a high-dose technique delivering sub-optimal image quality.

Specific standards for the acquisition of CTCA have been published by the BSCI/BSCCT
and endorsed by both the Royal College of Radiologists and Royal College of Physicians ii. Additional guidelines on appropriate scanner technology for cardiovascular CT has been published by NICE vi.

CTCA has almost 100% accuracy in excluding significant coronary artery disease (CAD) and when compared with functional imaging tests or invasive angiography it is the lowest cost technique. The rapid technological advances that allow CTCA to be delivered at a low dose and the substantial amount of new scientific evidence published support its widespread use in clinical practice vii viii ix and provide the backdrop to the recent NICE review. The review of the evidence has brought about the new recommendations that propose CTCA as the most clinically and cost effective diagnostic first line test for all patients presenting with stable chest pain.

The new guidelines present considerable delivery challenges in the short term. CTCA is a relatively new technique and therefore the number of professionals trained in its acquisition and reporting are limited, with considerable geographic variation in delivery and practice within the UK. High quality, low dose, CTCA also can only be performed on relatively modern CT equipment.

To assess the current provision and capability within the UK the BSCI/BSCCT has worked closely with industry partners, the Royal College of Radiologists, British Cardiovascular Society, and other national stakeholders to obtain detailed and accurate data on current UK cardiovascular CT (including CTCA) practice. The BSCCT has looked at infrastructure (including equipment), current delivery of CTCA and cardiovascular CT services, and accredited personnel figures to assess the likely impact of the updated NICE guidelines in the delivery of the requirements proposed for assessment of patients with stable chest pain. We have also modelled the expected demands on these services, based on the current sustainability and transformation plan (STP) populations in England and Health Boards in the devolved nations to produce Red-Amber-Green (RAG) maps that visually highlight the key areas that need addressing. 

 

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