Including a structured impression to the reporting template for coronary CT angiography (CCTA) studies improved result interpretation with regard to the number of vessels with significant stenosis, according to a study published in the June issue of Journal of the American College of Radiology.
The need for effective communication between cardiac imagers and clinicians is critical to integrating CCTA interpretation into clinical decision making, and the impression is of great importance. To support effective integration, the cardiac MR PET CT program at Massachusetts General Hospital (MGH) in Boston, added an impression template to its structured report that describes the patient’s stenosis severity according to six standard categories.
“We hypothesized that a structured impression (SI) would facilitate understanding by referring clinicians and, therefore, result in more accurate interpretations of patients’ coronary artery disease (CAD) severity,” wrote Brian B. Ghoshhajra, MD, MBA, of MGH, and colleagues.
To test their hypothesis, the researchers conducted a retrospective review of 50 clinical CCTA reports from May 2011 to April 2012; 25 reports include free-form impression (FFI) and 25 SI. The reports encompassed the entire CAD spectrum. They distributed a survey addressing understanding of the patient’s CAD and report satisfaction to four cardiologists and two cardiac imaging specialists.
“Overall, interobserver reliability on the worst CAD stenosis severity of each patient (6 categories) was excellent with FFI and with SI,” wrote Ghoshhajra et al. “Interobserver reliability on the presence of nonevaluable segments was moderate for both FFI and SI.”
However, reliability regarding the number of coronary arteries with significant stenosis improved from fair at 53 percent with FFI to moderate at 68 percent with SI.
The researchers expressed concern with this finding, and noted “disagreement mostly arose from overestimation by clinicians.” This could reduce specificity and lead to unnecessary downstream testing, they explained.
Imaging specialists and clinicians expressed high satisfaction with content and clarity of impressions, with specialists indicating higher satisfaction than clinicians for FFI and SI in terms of report grading. Imagers tended to give higher scores to both FFI and SI. “Overall, imaging specialists considered impressions to be approximately grade IV [the highest grade] although clinicians considered these impressions to be approximately grade III.”
Since the study, MGH has revised the impression template to prompt readers to precisely name vessels with moderate stenosis, severe stenosis or occlusions. The change resulted in significant improvement in agreement on the number of vessels with hemodynamically significant stenosis.
Nevertheless, Ghoshhajra et al suggested room for improvement “to optimize the wording and communication of CCTA reports, especially regarding the summary statement in report impressions.”