title: The impact of training on diagnostic accuracy with computed tomography coronary angiography.
abstract: OBJECTIVE
  The aim of this study is to assess the image quality and diagnostic accuracy of computed tomography (CT) coronary angiography (CTCA) in different hospital settings with the same trained team.
  
  
  METHODS
  Four hundred patients were consecutively enrolled for CTCA in a large academic hospital (Group 1; Sensation 64 Cardiac, Siemens - Iomeprol 400, Bracco; 200 patients) and in a small local hospital (Group 2; VCT, GE Healthcare - Iodixanol 320, GE Healthcare; 200 patients). All patients were enrolled for suspected coronary artery disease (CAD) and patients with stents or who had previously undergone coronary bypass were excluded. Scan protocols (retrospectively ECG-gated; no dose reduction modulation applied) were performed in accordance with standards reported in the international literature with the best solution available on site. Image quality was assessed in each coronary segment with a 4-point Likert scale: 0, not assessable; 1, low; 2, average; 3, good. Diagnostic accuracy was calculated against conventional coronary angiography with a threshold of at least 50% for significant stenosis.
  
  
  RESULTS
  There was no significant difference between demographics, BMI, prevalence of obstructive CAD, calcium score and heart rate between the two populations. The average image quality was 2.83 ± 0.37 for Group 1 and 2.86 ± 0.31 for Group 2 (P > 0.05). Per-segment sensitivity, specificity, positive and negative predictive values were 92.6% (87-95), 97.9% (97-98), 75.9% (69-81) and 99.5% (99-99), respectively, for Group 1, and 90.4% (85-93), 98.6% (98-99), 84.2% (78-88) and 99.2% (98-99), respectively, for Group 2 (P > 0.05).
  
  
  CONCLUSIONS
  There is no significant difference in image quality and diagnostic accuracy of CTCA when the investigation is performed by the same properly trained team. CTCA is a robust imaging modality for the detection of coronary artery stenosis.
authors: aDepartment of Radiology, Giovanni XXIII Clinic, Monastier di Treviso (TV) bDepartment of Radiology, Ospedale di Carrara, Carrara, Italy cDepartment of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands dDepartment of Radiology, SDN-IRCCS, Napoli, Italy.
authors: Erica
authors: E
authors: Maffei
authors: Teresa
authors: T
authors: Arcadi
authors: Alessandra
authors: A
authors: Zuccarelli
authors: Alberto
authors: A
authors: Clemente
authors: Tito
authors: T
authors: Torri
authors: Piercarlo
authors: P
authors: Rossi
authors: Sara
authors: S
authors: Seitun
authors: Onofrio
authors: O
authors: Catalano
authors: Filippo
authors: F
authors: Cademartiri
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055424:Cardiac-Gated Imaging Techniques; D002983:Clinical Competence; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D006742:Hospital Bed Capacity; D006801:Humans; D007558:Italy / Q000453:epidemiology; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol