Abstract 13323: Impact of an Institutional Process Change Adopting End-Systolic Coronary CTA Acquisition on Patient Throughput and Image Quality

Introduction: Prospective ECG-triggered end-systolic coronary computed tomographic angiography (CCTA) acquisition is less prone to motion artifacts with arrhythmias and high heart rates, and with increasing utilization, has the potential to improve scan and CT laboratory efficiency by reducing the need for IV/oral beta-blockers (BB) prior to the scan.

Methods: We implemented an institutional process change in CCTA performance effective January 2023, transitioning from prospective ECG-triggered mid-diastolic acquisitions supervised by a physician at the scanner to an algorithmic approach with prospective end-systolic acquisition (200-400 ms after R peak) without BB administration, all on 3 ^rd -generation 192 slice dual-source scanners. We reviewed 100 consecutive CCTAs done pre- and post-process change in Jan 2022 and Jan 2023. Two experienced CCTA readers assessed segmental image quality by consensus using an 18-segment SCCT model on a 5-point Likert scale (1=non-interpretable; 2=poor; 3=satisfactory; 4=good; 5=excellent).

Results: Post-process change, median overall patient appointment [94 (78 - 127) min vs. 69 (53 - 86) min; P < 0.001] and scan times [12 (10 - 16) min vs. 7 (6 - 9) min; P <.001] were significantly lower, and patient throughput doubled [2 (2 - 3)/day vs. 4 (3 - 6)/day; P =.024]. Median segmental image quality score decreased from excellent to good [5 (4 - 5) vs. 4 (4 - 5); P <.001], with a decrease in signal-noise ratio [23.5 (18 - 28.8) vs. 11.8 (8.7 - 14.7); P <.001], and no significant difference in poor or non-interpretable segments in the end-systolic cohort. More scans were repeated with end-systolic scans (10% vs. 18%), with no significant change in radiation dose (Table 1).

Conclusion: Utilizing prospective ECG-triggered end-systolic acquisition avoided the use of BB, significantly reduced scan times, doubled patient throughput, at similar radiation doses, and maintained diagnostic performance with only a mild compromise in image quality.