February 27, 2013 — The Society of Cardiovascular Computed Tomography (SCCT) has released a list of five interventions whose appropriateness physicians and patients should discuss as part of Choosing Wisely. The list includes:
- Do not use coronary artery calcium scoring for asymptomatic patients with known coronary artery disease (including stents and bypass grafts).
- Do not order coronary artery calcium scoring for preoperative evaluation for any surgery, irrespective of patient risk.
- Do not order coronary artery calcium scoring for screening purposes on low risk asymptomatic individuals except for those with a family history of premature coronary artery disease.
- Do not routinely order coronary computed tomography angiography for screening asymptomatic individuals.
- Do not use coronary computed tomography angiography in high risk* emergency department patients presenting with acute chest pain.
*Risk defined by the Thrombolysis In Myocardial Infarction (TIMI) risk score for unstable angina/acute coronary syndromes.
The goal of Choosing Wisely is to promote conversations between physicians and patients about utilizing the most appropriate tests and treatments and avoiding care that may provide no benefit. SCCT identified these interventions after careful review of evidence and clinical guidelines.
A committee panel made up of expert members of its existing Guidelines Committee and Publications and Statements committee was formed and dedicated to recommending between five and 10 questions that should be considered when ordering Coronary CT angiography and coronary artery calcium scoring. The panel reviewed and referred to SCCT's currently existing and published guidelines, appropriate use criteria and support statements. Once questions were chosen, the list was referred to the SCCT Board of Directors and Executive Board for final review, edits and approval.
"The Society of Cardiovascular Computed Tomography is pleased to participate with the Choosing Wisely campaign in raising physician and public awareness relating to the proper use of CT for imaging the heart," says John Lesser, current president of SCCT. "We believe that through the choosing wisely campaign, we can minimize the ordering of unnecessary CT scans. By identifying five indications to avoid when ordering cardiac CT scans, we should improve the likelihood that a scan is chosen based on the evidence of its utility in a specific situation."
SCCT encourages all cardiologists and radiologists to read the "Five Things Physicians and Patients Should Question" lists and to engage their patients in conversations about reducing inappropriate tests and procedures with a goal of improving care and avoiding harm.