Cardiovascular disease is the leading cause of death and disability in the world, killing 17.7 million people a year. That's a third of all deaths on the planet and half of all non-communicable-disease-related deaths. Cardiac imaging and vascular imaging are critical in foreseeing an event before it happens.
A coronary CT angiography (coronary CTA) uses an injection of iodine-rich contrast material and CT scanning to examine the arteries that supply blood to the heart and determine whether they have been narrowed by plaque buildup.
CAD-RADS™ – Coronary Artery Disease Reporting and Data System – is the language radiologists are developing to standardize the way we communicate with clinicians about coronary CT angiography (coronary CTA), facilitating better care decisions for cardiac patients.
The concept of a standard reporting and data system for a given pathology is not new, but the success of this approach has dramatically improved the speed and accuracy of diagnoses for other disorders, enabling faster, more informed treatment plans. It is time to apply the approach to coronary disease.
BI-RADS, the Breast Imaging Reporting and Data System, was first introduced in 1993 for mammography interpretations. Periodic refinements over its lifespan have evolved BI-RADS into an indispensible tool in advancing the detection and treatment of breast cancer. It has also inspired the successful development of other pathology-driven lexicons.
- LI-RADS™ – Liver Imaging Reporting and Data System for chronic liver disease
- Lung-RADS™ – Lung CT Screening Reporting and Data System for high-risk smokers
- PI-RADS™ – Prostate Imaging Reporting and Data System for multi-parametric MR imaging in the context of prostate cancer
Following the BI-RADS model, we anticipate CAD-RADS will enhance communication between radiologists and clinicians regarding complex coronary CTA. The benefits include:
- Concise descriptions of findings in consistent, understandable language
- More orderly thought processes, logical assessments and recommendations
- Standardized data and reporting for performance tracking, locally and globally
- Enhanced ability to computerize data, allowing greater access to decision-support technologies while fueling the development of artificial intelligence algorithms
- Better comprehension of imaging results by all members of the care team, from surgeons and pathologists to the patient and her family members.
Coronary stenosis occurs when the coronary artery narrows due to plaque build-up. Eventually, this leads to limited blood supply to the heart muscle, and this can cause symptoms like chest pain as well as possibly heart attacks. Your treatment depends on the severity of your condition. CAD-RADS first categorizes coronary CTA images by coronary stenosis severity, using the Society of Cardiovascular CT (SCCT) classification system noted in the below table.
SCCT grading scale for stenosis severity
|Degree of luminal diameter stenosis||Terminology||CAD-RADS
|0%||No visible stenosis||0|
Then, based on whether the patient is presenting with stable chest pain or acute chest pain*, the radiologist may provide a clearly-defined interpretation, with guidelines for further cardiac investigation if necessary, and recommendations for emergent care or non-emergency treatment options.
*Acute chest pain, negative first troponin, negative or non-diagnostic electrocardiogram and low to intermediate risk (TIMI risk score <4) in emergency department or hospital setting.
Complete CAD-RADS categorization and guidelines are published in the Journal of Cardiovascular Computed Tomography. [Cury RC, et al., CAD-RADS™ Coronary Artery Disease e 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. 2016]
Spread the Word
Include CAD-RADS classification in every coronary CTA examination and final assessment. Educate Residency and Fellowship trainees in CAD-RADS terminology, assessment categories and management recommendations.
Through new scientific data, expert guidance from leaders in cardiac imaging, and a multi-disciplinary effort among radiology and cardiology societies, CAD-RADS will continue to evolve. As it does, we will speak the language of better education, compliant research, and more productive peer-review, with the ultimate goal of improved patient care.
About the Author
Ricardo C. Cury, M.D., FAHA, FSCCT, FACC is Chairman of Radiology, Radiology Associates of South Florida (RASF), an affiliate of MEDNAX, Director of Cardiac Imaging, Miami Cardiac and Vascular Institute, Baptist Health of South Florida and Vice-Chairman of Radiology, Florida International University. Dr. Cury was born to practice medicine, following in the footsteps of his parents, who are both physicians.
RASF has served as a site for excellence in cardiac imaging, with one of the highest cardiac CT caseloads in the country. It’s multimodality program includes high-level coronary CTA and cardiac MRI, assessment of congenital heart disease, nuclear cardiology and emergency department use of myocardial perfusion imaging. Its cardiac imaging section has pioneered the clinical implementation of non-invasive imaging for assessment of chest pain in the emergency department in the mid to late 90s with nuclear myocardial perfusion imaging (MPI) and since 2008 with Coronary CTA. RASF has one of the first and busiest dedicated Coronary CTA programs on the country covering five hospitals and several imaging centers.