ACRAD36 – Incidental Coronary Artery Calcification Reported on Chest CT

Measure Title: Incidental Coronary Artery Calcification Reported on Chest CT

Measure Description Percentage of final reports for male patients aged 18 years through 50 and female patients aged 18 through 65 years undergoing noncardiac noncontrast chest CT exams or with and without contrast chest CT exams that note presence or absence of coronary artery calcification or not evaluable

Denominator: All final reports for male patients aged 18 years through 50 and female patients aged 18 through 65 years undergoing noncardiac noncontrast chest CT exams or with and without contrast chest CT exams

Numerator: Final reports that note presence or absence of coronary artery calcification or not evaluable

Denominator Exclusions: Patients who have received prior coronary artery bypass grafts or prior percutaneous coronary intervention with stent

Denominator Exceptions: None

Numerator Exclusions: None

Published Specialty: Radiology

High Priority Measure: Yes

Measure Type: Process

Include Telehealth: No

Inverse Measure: No

Proportional Measure: Yes

Continuous Variable Measure: No

Ratio Measure: No

Score Range: N/A

Number of Performance Rates: 1

Performance Rate Description: Percentage of final reports for male patients aged 18 years through 50 and female patients aged 18 through 65 years undergoing noncardiac noncontrast chest CT exams or with and without contrast chest CT exams that note presence or absence of coronary artery calcification or not evaluable

Risk Adjusted Status: No

MIPS Reporting Options: Traditional MIPS

Care Setting: Ambulatory; Hospital Inpatient; Hospital Outpatient; Imaging Facility

Clinical Recommendation Statement: The following evidence statements are quoted verbatim from the referenced clinical guidelines and other sources, where applicable:
[Coronary Artery Calcium (CAC)] should be evaluated and reported on all noncontrast chest CT examinations (Class I Recommendation) (SCCT/STR, 2016)

Measure Rationale: Coronary artery calcium scoring predicts cardiovascular risk. Any calcification that is present is a predictor of cardiovascular disease and can be described without specific scoring. In cases where CAC is present, a standard referral for clinical evaluation can be made. While patients undergoing noncardiac chest CTs are not undergoing an evaluation for coronary artery calcium scoring, there are cases where coronary artery calcifications are found. Studies have shown that these incidental findings have value and can be used to stratify patient cardiovascular risk based on findings in conjunction with patient history, which can lead to improved prognosis and outcome. Documentation of the presence of coronary artery calcium on noncardiac chest CTs is often underreported in radiology reports, even though primary physicians would likely use this information to inform treatment decisions. In a retrospective review of non-gated non contrast chest CTs, researchers found approximately one-third of the time, the presence of coronary artery calcium was not documented, even though it was present on the chest CT. This measure aims to improve the communication of CAC findings to referring physicians to improve patient’s cardiovascular care management.