title: Detection of Cardiac Incidental Findings on Routine Chest CT: The Impact of Dedicated Training in Cardiac Imaging.
abstract: OBJECTIVE
  Routine chest CT and cardiac CT angiography (CTA) both image the heart, albeit with different precision and intent. The aim of this study was 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.
  
  
  METHODS
  Electrocardiographically gated cardiac CT angiographic studies performed between January 2005 to January 2010 in patients with routine chest CT within six months were retrospectively identified. Fourteen radiologists at four stages of training (stage 1, residents with no cardiac training [n = 4]; stage 2, residents who had completed at least one dedicated rotation of cardiac imaging [n = 3]; stage 3, radiologists without cardiac training [n = 3]; and stage 4, radiologists with formal cardiac fellowship training [n = 4]) performed blinded, anonymized cardiac readings of chest CT images. Findings were categorized (coronary arterial, noncoronary vessel, cardiac chamber, myocardial, pericardial, and valve findings) with cardiac CTA as a reference standard.
  
  
  RESULTS
  Overall, 140 cardiac CT angiographic findings were reported in 63 of 77 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of nongated CTA were 43.6%, 96.8%, 83.0%, 81.6%, and 81.8%, respectively, for all readers. Increasing training was associated with higher sensitivity (30.3%, 35.7%, 45.7%, and 61.2% from stages 1 to 4) but similar specificity (96.4%, 96.7%, 96.3%, and 97.6% from stages 1 to 4). Frequently missed findings categories were coronary arterial, myocardial, and cardiac chamber findings.
  
  
  CONCLUSIONS
  Increasing cardiac imaging training correlates with increased sensitivity and stable specificity to detect cardiac findings on routine chest CT without electrocardiographic gating. Cardiac findings should be noted on chest CT when observed, and cardiac training should be encouraged.
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Daniel
authors.initials: D
authors.lastname: Verdini
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Lee
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Anand M
authors.initials: AM
authors.lastname: Prabhakar
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: bghoshhajra@mgh.harvard.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Ghoshhajra
mesh_terms: D057791:Cardiac Imaging Techniques / Q000592:standards*; D055424:Cardiac-Gated Imaging Techniques / Q000592:standards; D002983:Clinical Competence; D000072226:Computed Tomography Angiography / Q000592:standards*; D017023:Coronary Angiography / Q000592:standards; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: ECG gated CT; Incidental findings; cardiac CTA; chest CT; coronary artery