Audit template using CAD-RADS TM - Computed tomography coronary angiography (CTCA) versus the gold standard of invasive coronary angiography (ICA)

Sep 2, 2026

Upload by Bintang

Audit template defining a clinical audit cycle to compare CAD-RADS™ grading on CT coronary angiography reports against stenosis findings from invasive coronary angiography (ICA) for each patient and vessel. The standard targets a pre-test and prevalence threshold of 60% CAD, with indicators focused on per-patient and per-vessel prevalence of CAD-RADS 4 and ≥70% ICA stenosis using a decision-matrix approach. Data are collected retrospectively from CRIS and referral letters, including demographics, risk factors, heart rate, exam dates, and vessel-specific CAD-RADS grading. Outcomes are reported as per-patient and per-vessel true positives, true negatives, false positives, and false negatives, with exclusions for specific timing and diagnostic limitations. Suggested cohort size is 50, with actions if targets are not met via risk stratification discussions and alternative testing decisions.

LanguageEnglish

CategoryForms

FormatDOCX

Pages3

Reading Time1 min

AccessFree to download

The cycle

The standard and target

Indicators and data items to collect

Reporter and exclusions

Suggested number and resources

Audit template using CAD-RADS TM - Computed tomography coronary angiography (CTCA) versus the gold standard of invasive coronary angiography (ICA). Descriptor: An audit template using a recognised grading system for stenosis severity Coronary Artery Disease - Reporting and Data System (CAD-RADSTM)[1] for CTCA reports in comparison with invasive coronary angiogram stenosis for each patient to assess the prevalence of disease sufficient to indicate catheter angiography. Background: CT coronary angiography is increasingly used for first line investigation of coronary artery disease (CAD) in patients with typical and atypical angina. With this increasing volume of work it is important to develop robust clinical audit tools to ensure quality. To date within the UK, there has been significant work ensuring the lowest appropriate radiation dose in CTCA, and national audit evaluating individual centre mean dose as a surrogate for quality [2]. We propose and evaluate an audit tool evaluating report quality. Previous guidelines (NICE CG95)[3] have suggested a pretest probability of greater than 60% incidence of disease is sufficient to indicate catheter angiography[4]. We propose this is an appropriate audit standard for those patients referred for ICA following CTCA. In our institution we use standardised reporting templates including a recognised grading system for stenosis severity (CAD-RADSTM). This has enabled us to perform a secondary audit analysis evaluating discrepancy between CTCA and ICA. The Cycle The standard: Pre-test probability of CAD 60%. Target: Prevalence of CAD 60%. Assess local practice Indicators: The prevalence of patients with ≥ CAD-RADS 4 and a ≥ 70% stenosis of CAD in ICA in a per patient and per vessel analysis based on decision matrix of test CTCA and gold standard ICA. Data items to be collected: A retrospective search on Clinical Radiology Information System (CRIS) for patients with CTCA and ICA Use CRIS and referral letters to find: Baseline demographics of study population (age, gender, height, weight, BMI) Risk factors for ischaemic heart disease (diabetes, smoking, family history of premature CAD, Agaston calcium score) Heart rate Date of CTCA and ICA performed CAD-RADS grading for the most severe stenosis for each vessel (right coronary artery, left main stem, left anterior descending artery and circumflex artery) for CTCA and ICA. Reporter Per patient and per vessel status of CAD-RADS 4 (true positive, true negative, false positive, false negative) Patients with ICA before CTCA, assessment for grafts/ stents, non diagnostic images and greater than 6 months between CTCA and ICA were excluded. Suggested number: 50 Suggestions for change if target not met: Risk stratification discussed by the accepting radiologist and discussion with the clinicians on alternative tests when appropriate. Resources: Excel spreadsheet to analyse data attached CAD-RADS grading system (see references) HYPERLINK "https://www.rcr.ac.uk/sites/default/files/audit_template/audit_template_spreadsheet_ctca_vs_ica_1.xlsx" audit_template_spreadsheet_ctca_vs_ica.xlsxEXCEL - 12.81 KB References: Cury, Ricardo C. et al. CAD-RADSTM Coronary Artery Disease – Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. Journal of Cardiovascular Computed Tomography, Volume 10, Issue 4, 2016, 269-281. Isabel A. Castellano, Edward D. Nicol, Russell K. Bull, Carl A. Roobottom, Michelle C. Williams, Stephen P. Harden. A prospective national survey of coronary CT angiography radiation doses in the United Kingdom. Journal of Cardiovascular Computed Tomography, Volume 11, Issue 4, 2017, 268-273. National Institute for Health and Care Excellence. CG95 Chest pain of recent onset. 2016. HYPERLINK "https://www.nice.org.uk/guidance/cg95/evi

FAQs

What is the audit standard and target used in the template?

The standard sets pre-test probability of CAD at 60%, and the target prevalence of CAD is also set at 60%.

Which indicators are used to assess local practice quality?

Indicators measure the prevalence of patients with CAD-RADS ≥4 and ≥70% stenosis on ICA, analyzed per patient and per vessel using a decision matrix comparing CTCA with the gold standard ICA.

What data items must be collected for each patient and vessel?

Collect baseline demographics, ischemic heart disease risk factors, heart rate, dates of CTCA and ICA, and CAD-RADS grading for the most severe stenosis across each major vessel for both CTCA and ICA.

Sep 2, 2026

Upload by Bintang