Structured CCTA reports provide clearer count of vessels with stenosis

Structured impressions on a coronary CT angiography (CCTA) report improved interpretation agreement with regard to the number of vessels with significant stenosis compared with free-form impressions, according to a study published online Feb. 27 in the Journal of the American College of Radiology.

Using structured reports decreased the tendency of clinicians to overestimate non-significant stenosis, according to authors Brian B. Ghoshhajra, MD, MBA, and colleagues from Massachusetts General Hospital in Boston.

“The utility of [CCTA] relies on precise reporting and accurate result interpretation,” wrote the authors. “Given the rapid development in cardiac imaging and thus evolving terminologies, effective communication between cardiac imaging specialists and referring clinicians is critical to facilitate correct integration of radiological evidence into clinical decision making."

CCTA reports at Massachusetts General Hospital follow a structured format for most sections, explained the authors. The impression section, however, was traditionally a free-form summary where the most clinically relevant items could be conveyed.

In an effort to further improve and standardize reporting, an impression template was implemented that included a description of patients’ stenosis according to the six standard categories laid out by the Society of Cardiovascular Computed Tomography—normal, minimal stenosis, mild stenosis, moderate stenosis, severe stenosis and occluded.

To assess referring clinicians’ understanding of patients’ coronary artery disease (CAD) severity using the template, 50 clinical CCTA reports from May 2011 to April 2012 were retrospectively selected for review, half of which contained structured impressions and half of which contained free-form impressions.

Four cardiologists and two cardiac imaging specialists were given a survey containing only the randomized blinded impressions, and interpretations were examined regarding three questions:

  1. Worst stenosis severity
  2. Number of vessels with significant stenosis
  3. The presences of non-evaluable segments.

Results showed Question 2 was most affected by the structured impressions, with agreement on the number of vessels with significant stenosis improving from fair to moderate compared with free-form impressions. Agreement proportions were 53 percent and 68 percent for free-form and structured impressions, respectively.

Agreement on Question 1 was excellent for both types of impressions, and moderate for both types on Question 3, according to Ghoshhajra and colleagues. They noted that satisfaction was generally high and similar for both free-from and structured impression sections, though imaging specialists, compared with referring clinicians, expressed higher levels of satisfaction.

Ghoshhajra and colleagues concluded that while structured impressions improved interpretations with regard to the number of vessels with significant stenosis, room for improvement still exists to optimize wording of CCTA reports.