Effect of Cardiac Training on Chest CT Findings

April 18, 2016

Assessing radiologists with and without cardiac training when reading chest CT.

Cardiac training should be encouraged for evaluation of cardiac findings on chest CT without electrocardiographic gating, according to a study published in the Journal of the American College of Radiology.

Researchers from Harvard Medical School in Boston, MA, sought to evaluate the diagnostic ability of radiologists with different levels of cardiac training to identify cardiac findings on chest CT without electrocardiographic gating compared with a reference standard of electrocardiographically gated cardiac CTA.[[{"type":"media","view_mode":"media_crop","fid":"47809","attributes":{"alt":"Cardiac imaging","class":"media-image media-image-right","id":"media_crop_4827810731146","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5665","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 107px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©hywards/Shutterstock.com","typeof":"foaf:Image"}}]]

The researchers retrospectively identified findings from electrocardiographically gated cardiac CT angiographic studies performed between January 2005 and January 2010 in patients with routine chest CT within six months. Fourteen radiologists performed blinded, anonymized cardiac readings of chest CT images: four were in stage 1 (residents with no cardiac training); three in stage 2 (residents who had completed at least one dedicated rotation of cardiac imaging; three in stage 3 (radiologists without cardiac training); and four in stage 4 (radiologists with formal cardiac fellowship training). They categorized their findings as coronary arterial, noncoronary vessel, cardiac chamber, myocardial, pericardial, and valve findings, with cardiac CTA as a reference standard.

The results showed that overall, 140 cardiac CT angiographic findings were reported in 63 of 77 patients:

 Nongated CTA
Sensitivity43.6%
Specificity96.8%
Positive predictive value83.0%
Negative predictive value81.6%
Accuracy81.8%

 

 

 

 

 

 

Increasing training was associated with higher sensitivity, but similar specificity:

 SensitivitySpecificity
Stage 130.3%96.4%
Stage 235.7%96.7%
Stage 345.7%96.3%
Stage 461.2%97.6%

 

 

 

 

 

Categories of frequently missed findings were coronary arterial, myocardial, and cardiac chamber findings, the researchers noted.

“Increasing cardiac imaging training correlates with increased sensitivity and stable specificity to detect cardiac findings on routine chest CT without electrocardiographic gating,” the authors concluded. “Cardiac findings should be noted on chest CT when observed, and cardiac training should be encouraged.”