Rofo 2023; 195(02): 115-134
DOI: 10.1055/a-1973-9687
Positionspapier

German Radiological Society and the Professional Association of German Radiologists Position Paper on Coronary computed tomography: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome[ ]

Article in several languages: English | deutsch
Marcel C. Langenbach 
1   Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Koln, Germany
2   Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
,
Jörn Sandstede 
3   Radiologische Allianz, Hamburg, Germany
4   Berufsverband der deutschen Radiologen e. V. (BDR), München, Deutschland
,
Malte M. Sieren
5   Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Luebeck, Lübeck, Germany
,
Jörg Barkhausen
5   Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Luebeck, Lübeck, Germany
,
Matthias Gutberlet 
6   Department of Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
,
Fabian Bamberg
7   Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Lukas Lehmkuhl
8   Department for Diagnostic and Interventional Radiology, RHÖN Clinic, Campus Bad Neustadt, Germany
,
David Maintz
1   Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Koln, Germany
,
Claas P. Naehle
1   Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Koln, Germany
3   Radiologische Allianz, Hamburg, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

This position paper is a joint statement of the German Radiological Society (DRG) and the Professional Association of German Radiologists (BDR), which reflects the current state of knowledge about coronary computed tomography. It is based on preclinical and clinical studies that have investigated the clinical relevance as well as the technical requirements and fundamentals of cardiac computed tomography.

Citation Format

  • Langenbach MC, Sandstede J, Sieren M et al. DRG and BDR Position Paper on Coronary CT: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome. Fortschr Röntgenstr 2023; 195: 115 – 133

Key words

cardiac - CT - coronary angiography - health policy and practice

Dieses Positionspapier wurde in der Zeitschriften Die Radiologie (https://doi.org/10.1007/s00117-022-01096-2) zeitgleich publiziert.




Publication History

Received: 08 June 2022

Accepted: 29 October 2022

Article published online:
12 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Reference

  • 1 Moncada R, Salinas M, Churchill R. et al. Patency of saphenous aortocoronary-bypass grafts demonstrated by computed tomography. The New England journal of medicine 1980; 303: 503-505 DOI: 10.1056/NEJM198008283030907.
    CrossrefPubMedGoogle Scholar
  • 2 Budoff MJ, Raggi P. Coronary artery disease progression assessed by electron-beam computed tomography. Am J Cardiol 2001; 88: 46E-50E DOI: 10.1016/s0002-9149(01)01767-2.
    CrossrefPubMedGoogle Scholar
  • 3 Achenbach S, Moshage W, Ropers D. et al. Value of electron-beam computed tomography for the noninvasive detection of high-grade coronary-artery stenoses and occlusions. The New England journal of medicine 1998; 339: 1964-1971 DOI: 10.1056/NEJM199812313392702.
    CrossrefPubMedGoogle Scholar
  • 4 Mushtaq S, Conte E, Melotti E. et al. Coronary CT Angiography in Challenging Patients: High Heart Rate and Atrial Fibrillation. A Review. Academic radiology 2019; 26: 1544-1549 DOI: 10.1016/j.acra.2019.01.022.
    CrossrefPubMedGoogle Scholar
  • 5 [Anonym]. Deutscher Herzbericht 2021. In: Deutsche Herzstiftung; 2022
    PubMedGoogle Scholar
  • 6 Mannebach H, Horstkotte D. Arbeitsgruppen Interventionelle Kardiologie und A et al.. 19. Bericht über die Leistungszahlen der Herzkatheterlabore in der Bundesrepublik Deutschland Ergebnisse einer gemeinsamen Umfrage der Kommission für Klinische Kardiologie und der Arbeitsgruppen Interventionelle Kardiologie (für die ESC) und Angiologie der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung über das Jahr 2002. Z Kardiol 2004; 93: 1022-1025 DOI: 10.1007/s00392-004-0191-0.
    CrossrefPubMedGoogle Scholar
  • 7 Wilkins E, Wilson L, Wickramasinghe K. et al. European Cardiovascular Disease Statistics 2017. Brussels: European Heart Network; 2017
    Google Scholar
  • 8 Network EH. Age-standardised death rates from IHD, all ages, by sex, latest available year in the EU. In: 2014
    PubMedGoogle Scholar
  • 9 Programm für Nationale VersorgungsLeitlinien. Nationale VersorgungsLeitlinie Chronische KHK. In: 2016
    PubMedGoogle Scholar
  • 10 Investigators SH, Newby DE, Adamson PD. et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. The New England journal of medicine 2018; 379: 924-933 DOI: 10.1056/NEJMoa1805971.
    CrossrefPubMedGoogle Scholar
  • 11 Hoffmann U, Ferencik M, Udelson JE. et al. Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation 2017; 135: 2320-2332 DOI: 10.1161/CIRCULATIONAHA.116.024360.
    CrossrefPubMedGoogle Scholar
  • 12 Maron DJ, Hochman JS, Reynolds HR. et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med 2020; 382: 1395-1407 DOI: 10.1056/NEJMoa1915922.
    CrossrefPubMedGoogle Scholar
  • 13 Juarez-Orozco LE, Saraste A, Capodanno D. et al. Impact of a decreasing pre-test probability on the performance of diagnostic tests for coronary artery disease. Eur Heart J Cardiovasc Imaging 2019; 20: 1198-1207 DOI: 10.1093/ehjci/jez054.
    CrossrefPubMedGoogle Scholar
  • 14 Knuuti J, Wijns W, Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41: 407-477 DOI: 10.1093/eurheartj/ehz425.
    CrossrefPubMedGoogle Scholar
  • 15 Group DT, Maurovich-Horvat P, Bosserdt M. et al. CT or Invasive Coronary Angiography in Stable Chest Pain. The New England journal of medicine 2022; DOI: 10.1056/NEJMoa2200963.
    CrossrefPubMedGoogle Scholar
  • 16 Haasenritter J, Bösner S, Klug J. et al. DEGAM-Leitlinie Nr. 15: Brustschmerz. Zeitschrift für Allgemeinmedizin 2011; 10 DOI: 10.3238/zfa.2011.0182.
    CrossrefPubMedGoogle Scholar
  • 17 Gutberlet M, Krieghoff C, Gohmann R. et al. Die neuen 2019er-ESC-Leitlinien zur Diagnose und Management des chronischen Koronarsyndroms (CCS): Was ändert sich für die Bildgebung?. Radiologie up2date 2019; 21 DOI: 10.1055/a-0966-5977.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Reeh J, Therming CB, Heitmann M. et al. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J 2019; 40: 1426-1435 DOI: 10.1093/eurheartj/ehy806.
    CrossrefPubMedGoogle Scholar
  • 19 Möllmann H, Leistner DM, Schulze PC. et al. Kommentar zu den Leitlinien (2019) der ESC zum chronischen Koronarsyndrom. Kardiologe 2020; 14: 482-491 DOI: 10.1007/s12181-020-00408-x.
    CrossrefPubMedGoogle Scholar
  • 20 Saraste A, Barbato E, Capodanno D. et al. Imaging in ESC clinical guidelines: chronic coronary syndromes. European Heart Journal – Cardiovascular Imaging 2019; 20: 1187-1197 DOI: 10.1093/ehjci/jez219.
    CrossrefPubMedGoogle Scholar
  • 21 Foldyna B, Udelson JE, Karady J. et al. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging 2019; 20: 574-581 DOI: 10.1093/ehjci/jey182.
    CrossrefPubMedGoogle Scholar
  • 22 Programm für Nationale VersorgungsLeitlinien. Nationale VersorgungsLeitlinie Chronische KHK. In: 2019
    PubMedGoogle Scholar
  • 23 Greenland P, Bonow RO, Brundage BH. et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 2007; 49: 378-402 DOI: 10.1016/j.jacc.2006.10.001.
    CrossrefPubMedGoogle Scholar
  • 24 Budoff MJ, Shaw LJ, Liu ST. et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol 2007; 49: 1860-1870 DOI: 10.1016/j.jacc.2006.10.079.
    CrossrefPubMedGoogle Scholar
  • 25 Mohlenkamp S, Lehmann N, Moebus S. et al. [Integration of a new risk marker into cardiovascular prevention, using coronary calcium as an example]. Deutsche medizinische Wochenschrift 2009; 134: 2023-2026 DOI: 10.1055/s-0029-1237552.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Schmermund A, Mohlenkamp S, Stang A. et al. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk Factors, Evaluation of Coronary Calcium and Lifestyle. Am Heart J 2002; 144: 212-218 DOI: 10.1067/mhj.2002.123579.
    CrossrefPubMedGoogle Scholar
  • 27 Sarwar A, Shaw LJ, Shapiro MD. et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging 2009; 2: 675-688 DOI: 10.1016/j.jcmg.2008.12.031.
    CrossrefPubMedGoogle Scholar
  • 28 Bergstrom G, Persson M, Adiels M. et al. Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population. Circulation 2021; 144: 916-929 DOI: 10.1161/CIRCULATIONAHA.121.055340.
    CrossrefPubMedGoogle Scholar
  • 29 Koopman MY, Willemsen RTA, van der Harst P. et al. The Diagnostic and Prognostic Value of Coronary Calcium Scoring in Stable Chest Pain Patients: A Narrative Review. Rofo 2022; 194: 257-265 DOI: 10.1055/a-1662-5711.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Gottlieb I, Miller JM, Arbab-Zadeh A. et al. The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol 2010; 55: 627-634 DOI: 10.1016/j.jacc.2009.07.072.
    CrossrefPubMedGoogle Scholar
  • 31 Villines TC, Hulten EA, Shaw LJ. et al. Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry. J Am Coll Cardiol 2011; 58: 2533-2540 DOI: 10.1016/j.jacc.2011.10.851.
    CrossrefPubMedGoogle Scholar
  • 32 Gohmann RF, Lauten P, Seitz P. et al. Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-out Significant Coronary Artery Disease. J Clin Med 2020; 9 DOI: 10.3390/jcm9061623.
    CrossrefPubMedGoogle Scholar
  • 33 Seitz P, Krieghoff C, Gottschling S. et al. Pre-procedural high-pitch coronary CT angiography assessment of patients undergoing transcatheter aortic valve implantation (TAVI) without patient-specific adjustment: analysis of diagnostic performance. Clinical radiology 2021; 76: 862 e829-862 e836 DOI: 10.1016/j.crad.2021.06.008.
    CrossrefPubMedGoogle Scholar
  • 34 Mitchell JD, Fergestrom N, Gage BF. et al. Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring. J Am Coll Cardiol 2018; 72: 3233-3242 DOI: 10.1016/j.jacc.2018.09.051.
    CrossrefPubMedGoogle Scholar
  • 35 Yeboah J, Young R, McClelland RL. et al. Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment. J Am Coll Cardiol 2016; 67: 139-147 DOI: 10.1016/j.jacc.2015.10.058.
    CrossrefPubMedGoogle Scholar
  • 36 Blaha MJ, Cainzos-Achirica M, Greenland P. et al. Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2016; 133: 849-858 DOI: 10.1161/CIRCULATIONAHA.115.018524.
    CrossrefPubMedGoogle Scholar
  • 37 Budoff MJ, Young R, Burke G. et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J 2018; 39: 2401-2408 DOI: 10.1093/eurheartj/ehy217.
    CrossrefPubMedGoogle Scholar
  • 38 Mahabadi AA, Mohlenkamp S, Lehmann N. et al. CAC Score Improves Coronary and CV Risk Assessment Above Statin Indication by ESC and AHA/ACC Primary Prevention Guidelines. JACC Cardiovasc Imaging 2017; 10: 143-153 DOI: 10.1016/j.jcmg.2016.03.022.
    CrossrefPubMedGoogle Scholar
  • 39 Grundy SM, Stone NJ, Bailey AL. et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139: e1046-e1081 DOI: 10.1161/CIR.0000000000000624.
    CrossrefPubMedGoogle Scholar
  • 40 Arnett DK, Khera A, Blumenthal RS. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Part 1, Lifestyle and Behavioral Factors. JAMA Cardiol 2019; 4: 1043-1044 DOI: 10.1001/jamacardio.2019.2604.
    CrossrefPubMedGoogle Scholar
  • 41 DeFilippis AP, Young R, Carrubba CJ. et al. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med 2015; 162: 266-275 DOI: 10.7326/M14-1281.
    CrossrefPubMedGoogle Scholar
  • 42 Cainzos-Achirica M, Quispe R, Dudum R. et al. CAC for Risk Stratification Among Individuals With Hypertriglyceridemia Free of Clinical Atherosclerotic Cardiovascular Disease. JACC Cardiovasc Imaging 2021; DOI: 10.1016/j.jcmg.2021.10.017.
    CrossrefPubMedGoogle Scholar
  • 43 Virani SS, Rifai MA. The Utility of Coronary Artery Calcium for Guiding Treatment With Preventive Pharmacotherapy. JACC: Cardiovascular Imaging 2022; 15: 652-654 DOI: 10.1016/j.jcmg.2021.11.011.
    CrossrefPubMedGoogle Scholar
  • 44 Boden WE, O'Rourke RA, Teo KK. et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. New England Journal of Medicine 2007; 356: 1503-1516 DOI: 10.1056/NEJMoa070829.
    CrossrefPubMedGoogle Scholar
  • 45 Douglas PS, Hoffmann U, Patel MR. et al. Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease. New England Journal of Medicine 2015; 372: 1291-1300 DOI: 10.1056/NEJMoa1415516.
    CrossrefPubMedGoogle Scholar
  • 46 Mancini GBJ, Leipsic J, Budoff MJ. et al. CT Angiography Followed by Invasive Angiography in Patients With Moderate or Severe Ischemia-Insights From the ISCHEMIA Trial. JACC Cardiovasc Imaging 2021; 14: 1384-1393 DOI: 10.1016/j.jcmg.2020.11.012.
    CrossrefPubMedGoogle Scholar
  • 47 Bundesgesetzblatt, 2017, Nr. 42, 1966-2067.
    PubMedGoogle Scholar
  • 48 Adamson PD, Newby DE. The SCOT-HEART Trial. What we observed and what we learned. J Cardiovasc Comput Tomogr 2019; 13: 54-58 DOI: 10.1016/j.jcct.2019.01.006.
    CrossrefPubMedGoogle Scholar
  • 49 Ferencik M, Mayrhofer T, Bittner DO. et al. Use of High-Risk Coronary Atherosclerotic Plaque Detection for Risk Stratification of Patients With Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial. JAMA Cardiol 2018; 3: 144-152 DOI: 10.1001/jamacardio.2017.4973.
    CrossrefPubMedGoogle Scholar
  • 50 Leipsic J, Abbara S, Achenbach S. et al. SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2014; 8: 342-358 DOI: 10.1016/j.jcct.2014.07.003.
    CrossrefPubMedGoogle Scholar
  • 51 Gaede L, Mˆllmann H, Rudolph T. et al. Koronarangiografie mit Druckdraht und fraktioneller Flussreserve. Dtsch Arztebl International 2019; 116: 205-211 DOI: 10.3238/arztebl.2019.0205.
    CrossrefPubMedGoogle Scholar
  • 52 Taron J, Foldyna B, Eslami P. et al. Cardiac Computed Tomography – More Than Coronary Arteries? A Clinical Update. Rofo 2019; 191: 817-826 DOI: 10.1055/a-0924-5883.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 53 Taylor CA, Fonte TA, Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol 2013; 61: 2233-2241 DOI: 10.1016/j.jacc.2012.11.083.
    CrossrefPubMedGoogle Scholar
  • 54 Levine GN, Bates ER, Bittl JA. et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation 2016; 134: e123-e155 DOI: 10.1161/CIR.0000000000000404.
    CrossrefPubMedGoogle Scholar
  • 55 Douglas PS, Pontone G, Hlatky MA. et al. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFR(CT): outcome and resource impacts study. Eur Heart J 2015; 36: 3359-3367 DOI: 10.1093/eurheartj/ehv444.
    CrossrefPubMedGoogle Scholar
  • 56 Gohmann RF, Pawelka K, Seitz P. et al. Combined cCTA and TAVR Planning for Ruling Out Significant CAD: Added Value of ML-Based CT-FFR. JACC Cardiovasc Imaging 2022; 15: 476-486 DOI: 10.1016/j.jcmg.2021.09.013.
    CrossrefPubMedGoogle Scholar
  • 57 Gutberlet M, Krieghoff C, Gohmann R. [Is FFRCT a game changer in coronary CT angiography?]. Herz 2020; 45: 431-440 DOI: 10.1007/s00059-020-04944-w.
    CrossrefPubMedGoogle Scholar
  • 58 Hecht HS, Cronin P, Blaha MJ. et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. Journal of cardiovascular computed tomography 2017; 11: 74-84 DOI: 10.1016/j.jcct.2016.11.003.
    CrossrefPubMedGoogle Scholar
  • 59 Mihl C, Maas M, Turek J. et al. Contrast Media Administration in Coronary Computed Tomography Angiography – A Systematic Review. Rofo 2017; 189: 312-325 DOI: 10.1055/s-0042-121609.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 60 Soschynski M, Hagar MT, Taron J. et al. Update for the Performance of CT Coronary Angiography. Rofo 2022; DOI: 10.1055/a-1747-3554.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 61 [Anonym]. Strahlenschutzgesetz vom 27. Juni 2017 (BGBl. I S. 1966), das zuletzt durch Artikel 2 des Gesetzes vom 20. Mai 2021 (BGBl. I S. 1194) geändert worden ist.
    PubMedGoogle Scholar
  • 62 McCollough CH, Bushberg JT, Fletcher JG. et al. Answers to Common Questions About the Use and Safety of CT Scans. Mayo Clinic proceedings 2015; 90: 1380-1392 DOI: 10.1016/j.mayocp.2015.07.011.
    CrossrefPubMedGoogle Scholar
  • 63 FDA. What are the Radiation Risks from CT?. In: 2017
    PubMedGoogle Scholar
  • 64 Shao YH, Tsai K, Kim S. et al. Exposure to Tomographic Scans and Cancer Risks. JNCI Cancer Spectr 2020; 4: pkz072 DOI: 10.1093/jncics/pkz072.
    CrossrefPubMedGoogle Scholar
  • 65 Vijayalakshmi K, Kelly D, Chapple CL. et al. Cardiac catheterisation: radiation doses and lifetime risk of malignancy. Heart 2007; 93: 370-371 DOI: 10.1136/hrt.2006.098731.
    CrossrefPubMedGoogle Scholar
  • 66 Kosmala A, Petritsch B, Weng AM. et al. Radiation dose of coronary CT angiography with a third-generation dual-source CT in a "real-world" patient population. Eur Radiol 2019; 29: 4341-4348 DOI: 10.1007/s00330-018-5856-6.
    CrossrefPubMedGoogle Scholar
  • 67 Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Glob J Health Sci 2012; 4: 65-93 DOI: 10.5539/gjhs.v4n1p65.
    CrossrefPubMedGoogle Scholar
  • 68 Jansson K, Fransson SG. Mortality related to coronary angiography. Clinical radiology 1996; 51: 858-860 DOI: 10.1016/s0009-9260(96)80082-1.
    CrossrefPubMedGoogle Scholar
  • 69 Aoun J, Hattar L, Dgayli K. et al. Update on complications and their management during transradial cardiac catheterization. Expert review of cardiovascular therapy 2019; 17: 741-751 DOI: 10.1080/14779072.2019.1675510.
    CrossrefPubMedGoogle Scholar
  • 70 BVerfG, 2004.
    PubMedGoogle Scholar
  • 71 BVerfG, 2010.
    PubMedGoogle Scholar
  • 72 Coylewright M, Blumenthal RS, Post W. Placing COURAGE in context: review of the recent literature on managing stable coronary artery disease. Mayo Clinic proceedings 2008; 83: 799-805 DOI: 10.4065/83.7.799.
    CrossrefPubMedGoogle Scholar
  • 73 Mortele KJ, Oliva MR, Ondategui S. et al. Universal use of nonionic iodinated contrast medium for CT: evaluation of safety in a large urban teaching hospital. Am J Roentgenol 2005; 184: 31-34 DOI: 10.2214/ajr.184.1.01840031.
    CrossrefPubMedGoogle Scholar
  • 74 Wang CL, Cohan RH, Ellis JH. et al. Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. Am J Roentgenol 2008; 191: 409-415 DOI: 10.2214/Am J Roentgenol.07.3421.
    CrossrefPubMedGoogle Scholar
  • 75 Katayama H, Yamaguchi K, Kozuka T. et al. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990; 175: 621-628 DOI: 10.1148/radiology.175.3.2343107.
    CrossrefPubMedGoogle Scholar
  • 76 Cochran ST. Anaphylactoid reactions to radiocontrast media. Curr Allergy Asthma Rep 2005; 5: 28-31 DOI: 10.1007/s11882-005-0051-7.
    CrossrefPubMedGoogle Scholar
  • 77 Newmark JL, Mehra A, Singla AK. Radiocontrast media allergic reactions and interventional pain practice--a review. Pain Physician 2012; 15: E665-E675
    CrossrefPubMedGoogle Scholar
  • 78 Rosado Ingelmo A, Dona Diaz I, Cabanas Moreno R. et al. Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media. J Investig Allergol Clin Immunol 2016; 26: 144-155 DOI: 10.18176/jiaci.0058.
    CrossrefPubMedGoogle Scholar
  • 79 Cha MJ, Kang DY, Lee W. et al. Hypersensitivity Reactions to Iodinated Contrast Media: A Multicenter Study of 196 081 Patients. Radiology 2019; 293: 117-124 DOI: 10.1148/radiol.2019190485.
    CrossrefPubMedGoogle Scholar
  • 80 McDonald RJ, McDonald JS, Bida JP. et al. Intravenous contrast material-induced nephropathy: causal or coincident phenomenon?. Radiology 2013; 267: 106-118 DOI: 10.1148/radiol.12121823.
    CrossrefPubMedGoogle Scholar
  • 81 McDonald JS, McDonald RJ, Carter RE. et al. Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate. Radiology 2014; 271: 65-73 DOI: 10.1148/radiol.13130775.
    CrossrefPubMedGoogle Scholar
  • 82 Davenport MS, Cohan RH, Khalatbari S. et al. The challenges in assessing contrast-induced nephropathy: where are we now?. Am J Roentgenol 2014; 202: 784-789 DOI: 10.2214/Am J Roentgenol.13.11369.
    CrossrefPubMedGoogle Scholar
  • 83 Davenport MS, Khalatbari S, Dillman JR. et al. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material. Radiology 2013; 267: 94-105 DOI: 10.1148/radiol.12121394.
    CrossrefPubMedGoogle Scholar
  • 84 Katzberg RW, Newhouse JH. Intravenous contrast medium-induced nephrotoxicity: is the medical risk really as great as we have come to believe?. Radiology 2010; 256: 21-28 DOI: 10.1148/radiol.10092000.
    CrossrefPubMedGoogle Scholar
  • 85 Karlsberg RP, Dohad SY, Sheng R. et al. Contrast medium-induced acute kidney injury: comparison of intravenous and intraarterial administration of iodinated contrast medium. Journal of vascular and interventional radiology: JVIR 2011; 22: 1159-1165 DOI: 10.1016/j.jvir.2011.03.020.
    CrossrefPubMedGoogle Scholar
  • 86 Nyman U, Almen T, Jacobsson B. et al. Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?. Eur Radiol 2012; 22: 1366-1371 DOI: 10.1007/s00330-011-2371-4.
    CrossrefPubMedGoogle Scholar
  • 87 van der Molen AJ, Thomsen HS, Morcos SK. et al. Effect of iodinated contrast media on thyroid function in adults. European Radiology 2004; 14: 902-907 DOI: 10.1007/s00330-004-2238-z.
    CrossrefPubMedGoogle Scholar
  • 88 Leung AM, Braverman LE. Iodine-induced thyroid dysfunction. Curr Opin Endocrinol Diabetes Obes 2012; 19: 414-419 DOI: 10.1097/MED.0b013e3283565bb2.
    CrossrefPubMedGoogle Scholar
  • 89 Lee SY, Rhee CM, Leung AM. et al. A review: Radiographic iodinated contrast media-induced thyroid dysfunction. J Clin Endocrinol Metab 2015; 100: 376-383 DOI: 10.1210/jc.2014-3292.
    CrossrefPubMedGoogle Scholar
  • 90 Rhee CM, Bhan I, Alexander EK. et al. Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Archives of internal medicine 2012; 172: 153-159 DOI: 10.1001/archinternmed.2011.677.
    CrossrefPubMedGoogle Scholar
  • 91 Hudzik B, Zubelewicz-Szkodzinska B. Radiocontrast-induced thyroid dysfunction: is it common and what should we do about it?. Clin Endocrinol (Oxf) 2014; 80: 322-327 DOI: 10.1111/cen.12376.
    CrossrefPubMedGoogle Scholar
  • 92 Dewey M, Hoffmann H, Hamm B. Multislice CT coronary angiography: effect of sublingual nitroglycerine on the diameter of coronary arteries. Rofo 2006; 178: 600-604 DOI: 10.1055/s-2006-926755.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 93 Scholtz JE, Baliyan V, Hedgire S. et al. Randomized Trial Comparing Transdermal With Sublingual Nitroglycerin Administration for Coronary Vasodilation in CTA. JACC Cardiovasc Imaging 2019; 12: 1890-1893 DOI: 10.1016/j.jcmg.2019.02.027.
    CrossrefPubMedGoogle Scholar
  • 94 Abbara S, Blanke P, Maroules CD. et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2016; 10: 435-449 DOI: 10.1016/j.jcct.2016.10.002.
    CrossrefPubMedGoogle Scholar
  • 95 Bachmann KF, Gansser RE. Nitroglycerin oral spray: evaluation of its coronary artery dilative action by quantitative angiography. The American journal of cardiology 1988; 61: 7-11
    CrossrefPubMedGoogle Scholar
  • 96 Takx RAP, Suchá D, Park J. et al. Sublingual Nitroglycerin Administration in Coronary Computed Tomography Angiography: a Systematic Review. Eur Radiol 2015; 25: 3536-3542 DOI: 10.1007/s00330-015-3791-3.
    CrossrefPubMedGoogle Scholar
  • 97 Roberts WT, Wright AR, Timmis JB. et al. Safety and efficacy of a rate control protocol for cardiac CT. Br J Radiol 2009; 82: 267-271 DOI: 10.1259/bjr/24574758.
    CrossrefPubMedGoogle Scholar
  • 98 Mahabadi AA, Achenbach S, Burgstahler C. et al. Safety, efficacy, and indications of beta-adrenergic receptor blockade to reduce heart rate prior to coronary CT angiography. Radiology 2010; 257: 614-623 DOI: 10.1148/radiol.10100140.
    CrossrefPubMedGoogle Scholar
  • 99 Raju VM, Gosling OE, Morgan-Hughes G. et al. High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: efficacy and safety. Clinical radiology 2014; 69: 739-744 DOI: 10.1016/j.crad.2014.03.003.
    CrossrefPubMedGoogle Scholar
  • 100 Al-Hijji MA, Lennon RJ, Gulati R. et al. Safety and Risk of Major Complications With Diagnostic Cardiac Catheterization. Circ Cardiovasc Interv 2019; 12: e007791 DOI: 10.1161/CIRCINTERVENTIONS.119.007791.
    CrossrefPubMedGoogle Scholar
  • 101 [Anonym]. Deutscher Herzbericht 2017. In: Deutsche Herzstiftung; 2018
    PubMedGoogle Scholar
  • 102 [Anonym]. Weiterbildungscurriculum Radiologie. In: Germany: 2021
    PubMedGoogle Scholar
  • 103 Dos Santos DP, Hempel JM, Mildenberger P. et al. Structured reporting in clinical routine. In: RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. Georg Thieme Verlag KG; 2019: 33-39
    Google Scholar
  • 104 Morgan TA, Helibrun ME, Kahn CE. et al. Reporting initiative of the Radiological Society of North America: progress and new directions. Radiology 2014; 273: 642-645 DOI: 10.1148/radiol.14141227.
    CrossrefPubMedGoogle Scholar
  • 105 Ghoshhajra BB, Lee AM, Ferencik M. et al. Interpreting the interpretations: the use of structured reporting improves referring clinicians' comprehension of coronary CT angiography reports. J Am Coll Radiol 2013; 10: 432-438 DOI: 10.1016/j.jacr.2012.11.012.
    CrossrefPubMedGoogle Scholar
  • 106 Dunnick NR, Langlotz CP. The radiology report of the future: a summary of the 2007 Intersociety Conference. J Am Coll Radiol 2008; 5: 626-629 DOI: 10.1016/j.jacr.2007.12.015.
    CrossrefPubMedGoogle Scholar
  • 107 Radiology ESo. Good practice for radiological reporting. Guidelines from the European Society of Radiology (ESR). Insights into imaging 2011; 2: 93-96
    CrossrefPubMedGoogle Scholar
  • 108 Douglas PS, Hendel RC, Cummings JE. et al. ACCF/ACR/AHA/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR 2008 Health Policy Statement on Structured Reporting in Cardiovascular Imaging. J Am Coll Cardiol 2009; 53: 76-90 DOI: 10.1016/j.jacc.2008.09.005.
    CrossrefPubMedGoogle Scholar
  • 109 Francone M, Budde RPJ, Bremerich J. et al. CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR). Eur Radiol 2020; 30: 2627-2650 DOI: 10.1007/s00330-019-06357-8.
    CrossrefPubMedGoogle Scholar
  • 110 Bunck AC, Baessler B, Ritter C. et al. Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Cardiomyopathies (Myocarditis, Dilated Cardiomyopathy, Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Siderosis). Rofo 2020; 192: 27-37 DOI: 10.1055/a-0998-4116.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 111 Foldyna B, Szilveszter B, Scholtz JE. et al. CAD-RADS – a new clinical decision support tool for coronary computed tomography angiography. European radiology 2018; 28: 1365-1372 DOI: 10.1007/s00330-017-5105-4.
    CrossrefPubMedGoogle Scholar
  • 112 Hecht HS, Blaha MJ, Kazerooni EA. et al. CAC-DRS: Coronary Artery Calcium Data and Reporting System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT). Journal of cardiovascular computed tomography 2018; 12: 185-191 DOI: 10.1016/j.jcct.2018.03.008.
    CrossrefPubMedGoogle Scholar
  • 113 Detrano R, Guerci AD, Carr JJ. et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. The New England journal of medicine 2008; 358: 1336-1345 DOI: 10.1056/NEJMoa072100.
    CrossrefPubMedGoogle Scholar
  • 114 Osborne-Grinter M, Kwiecinski J, Doris M. et al. Association of coronary artery calcium score with qualitatively and quantitatively assessed adverse plaque on coronary CT angiography in the SCOT-HEART trial. Eur Heart J Cardiovasc Imaging 2021; DOI: 10.1093/ehjci/jeab135.
    CrossrefPubMedGoogle Scholar
  • 115 Cury RC, Abbara S, Achenbach S. et al. Coronary Artery Disease – Reporting and Data System (CAD-RADS): An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC. JACC Cardiovasc Imaging 2016; 9: 1099-1113 DOI: 10.1016/j.jcmg.2016.05.005.
    CrossrefPubMedGoogle Scholar
  • 116 Macmillan MT, Williams MC. Incidental Non-cardiac Findings in Cardiovascular Imaging. Curr Treat Options Cardiovasc Med 2018; 20: 93-93 DOI: 10.1007/s11936-018-0700-5.
    CrossrefPubMedGoogle Scholar
  • 117 Gil BN, Ran K, Tamar G. et al. Prevalence of significant noncardiac findings on coronary multidetector computed tomography angiography in asymptomatic patients. J Comput Assist Tomogr 2007; 31: 1-4 DOI: 10.1097/01.rct.0000233125.83184.33.
    CrossrefPubMedGoogle Scholar
  • 118 Kim JW, Kang EY, Yong HS. et al. Incidental extracardiac findings at cardiac CT angiography: comparison of prevalence and clinical significance between precontrast low-dose whole thoracic scan and postcontrast retrospective ECG-gated cardiac scan. Int J Cardiovasc Imaging 2009; 25 (Suppl. 01) 75-81 DOI: 10.1007/s10554-008-9417-y.
    CrossrefPubMedGoogle Scholar
  • 119 Killeen RP, Dodd JD, Cury RC. Noncardiac findings on cardiac CT part I: Pros and cons. J Cardiovasc Comput Tomogr 2009; 3: 293-299 DOI: 10.1016/j.jcct.2009.05.003.
    CrossrefPubMedGoogle Scholar
  • 120 Karius P, Schuetz GM, Schlattmann P. et al. Extracardiac findings on coronary CT angiography: a systematic review. J Cardiovasc Comput Tomogr 2014; 8: 174-182 e171-176 DOI: 10.1016/j.jcct.2014.04.002.
    CrossrefPubMedGoogle Scholar
  • 121 Onuma Y, Tanabe K, Nakazawa G. et al. Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol 2006; 48: 402-406 DOI: 10.1016/j.jacc.2006.04.071.
    CrossrefPubMedGoogle Scholar
  • 122 Laskowski D, Feger S, Bosserdt M. et al. Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography. Eur Radiol 2022; 32: 122-131 DOI: 10.1007/s00330-021-07967-x.
    CrossrefPubMedGoogle Scholar
  • 123 Lehman SJ, Abbara S, Cury RC. et al. Significance of cardiac computed tomography incidental findings in acute chest pain. Am J Med 2009; 122: 543-549 DOI: 10.1016/j.amjmed.2008.10.039.
    CrossrefPubMedGoogle Scholar
  • 124 Aglan I, Jodocy D, Hiehs S. et al. Clinical relevance and scope of accidental extracoronary findings in coronary computed tomography angiography: a cardiac versus thoracic FOV study. Eur J Radiol 2010; 74: 166-174 DOI: 10.1016/j.ejrad.2009.01.038.
    CrossrefPubMedGoogle Scholar
  • 125 Budoff MJ, Fischer H, Gopal A. Incidental findings with cardiac CT evaluation: should we read beyond the heart?. Catheter Cardiovasc Interv 2006; 68: 965-973 DOI: 10.1002/ccd.20924.
    CrossrefPubMedGoogle Scholar
  • 126 Wichmann JL, Bauer RW, Doss M. et al. Diagnostic accuracy of late iodine-enhancement dual-energy computed tomography for the detection of chronic myocardial infarction compared with late gadolinium-enhancement 3-T magnetic resonance imaging. Invest Radiol 2013; 48: 851-856 DOI: 10.1097/RLI.0b013e31829d91a8.
    CrossrefPubMedGoogle Scholar
  • 127 Sala ML, Bizino MB, Amersfoort J. et al. Computed tomography evaluation of cardiac structure and function. J Thorac Imaging 2014; 29: 173-184 DOI: 10.1097/RTI.0000000000000080.
    CrossrefPubMedGoogle Scholar
  • 128 Panetta D, Gabelloni M, Faggioni L. et al. Cardiac Computed Tomography Perfusion: Contrast Agents, Challenges and Emerging Methodologies from Preclinical Research to the Clinics. Academic radiology 2021; 28: e1-e13 DOI: 10.1016/j.acra.2019.12.026.
    CrossrefPubMedGoogle Scholar
  • 129 Sieren M, Naehle CP. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Programme, ESCR-Registry, and Survey among Radiologists. RoeFo 2021; DOI: 10.1055/a-1554-9236.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 130 Nabavi DG, Ossenbrink M, Busse O. Qualitätsmanagement in der Stroke Unit. Aktuelle Neurologie 2018; 45: 655-664
    Article in Thieme ConnectPubMedGoogle Scholar
  • 131 Breuckmann F, Nabavi DG, Post F. et al. Vergleich von Chest Pain Units und Stroke Units. Herz 2021; 46: 141-150 DOI: 10.1007/s00059-020-04984-2.
    CrossrefPubMedGoogle Scholar
  • 132 Foldyna B, Uhlig J, Gohmann R. et al. Quality and safety of coronary computed tomography angiography at academic and non-academic sites: insights from a large European registry (ESCR MR/CT Registry). Eur Radiol 2022; 32: 5246-5255 DOI: 10.1007/s00330-022-08639-0.
    CrossrefPubMedGoogle Scholar
  • 133 Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen. CT- oder MRT-Diagnostik bei Verdacht auf chronische koronare Herzkrankheit: eine Evidenzkartierung. 2020
    PubMedGoogle Scholar
  • 134 Gemeinsamer Bundessauschuss. Bekanntmachung des Gemeinsamen Bundesausschusses: Computertomographie-Koronarangiographie zur Diagnosestellung bei Patientinnen und Patienten mit Verdacht auf eine chronische koronare Herzkrankheit. Deutsches Ärzteblatt 2022; 119 (08) 350-351
    PubMedGoogle Scholar
  • 135 Beer M, Miller S, Sandstede J. et al. Abrechnung Herzdiagnostik mit MRT und CT nach GOÄ. RoeFo 2018; 190: 2
    PubMedGoogle Scholar