Coronary Artery Disease Reporting and Data System

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 1.50
Procedures: 1.50
Diagnostic and Conduction System Studies: 1.50

Computed Tomography: 1.50
Procedures: 1.50
Neck and Chest: 1.50

Registered Radiologist Assistant: 1.50
Procedures: 1.50
Thoracic Section: 1.50

Outline

1. Introduction
2. CAD-RADS Categories
3. Modifiers
4. Challenging Situations in CAD-RADS
   1. Scenario 1: Nonevaluable Segments at Coronary CT AngiographyóCategory N versus Modifier N
   2. Scenario 2: Significant Stenosis of the Left Main Coronary Artery
   3. Scenario 3: Two-Vessel Disease at CT Angiography
   4. Scenario 4: High-Grade Stenosis in Small Vessels
   5. Scenario 5: In-Stent Stenosis or Occlusion
   6. Scenario 6: Nonevaluable Stent
   7. Scenario 7: Severe Stenosis of a Graft
   8. Scenario 8: Graft with Occlusion, Stenosis, or Stent
   9. Scenario 9: Two High-Risk Features on Different Plaques
5. Limitations of CAD-RADS Classification
   1. Scenario 10: Stent Complications
   2. Scenario 11: Volume of Plaque and Multiple Plaques
   3. Scenario 12: Coronary Artery Anomalies
   4. Scenario 13: Nonatherosclerotic Causes of CAD
   5. Scenario 14: Coronary Artery Ectasia and Aneurysm
   6. Scenario 15: Hemodynamic Significance of the Stenosis
   7. Scenario 16: Incidental Noncoronary Findings
6. Current Status of CAD-RADS and Future Directions
7. Conclusion

Objectives

Upon completion of this course, students will:

1. know the societies that sponsored the CAD-RADS initiative
2. understand the goads of the CAD-RADS
3. know the information derived from coronary CTA that the CAD-RADS involves
4. know the basis on which the CAD-RADS categories are assigned
5. understand the CAD-RADS category N designation
6. know the % at which a vessel is classified as obstructive CAD
7. know the kind of stenosis represented by CAD-RADS categories 3, 4A, 4B, & 5
8. know the diameter of coronary vessels evaluated by the CAD-RADS
9. know why stenosis diameter is the measurement used in the CAD-RADS, even though stenosis area measurements may be more representative of luminal stenosis severity
10. know some techniques for reducing calcium blooming artifacts on coronary CTA images
11. know some techniques for improving CT image spatial resolution
12. be familiar with CAD-RADS recommendations for stable chest pain patients
13. be familiar with CAD-RADS recommendations for acute chest pain patients
14. know when a CAD-RADS modifier N would be applied to a category
15. know when a CAD-RADS modifier S would be applied to a category
16. understand how coronary artery bypass grafts are graded or categorized by the CAD-RADS
17. be familiar with the features of high-risk (vulnerable) atherosclerotic plaques that are highly associated with acute coronary syndrome
18. know the most common causes of motion artifacts at coronary CTA
19. know what is needed before a coronary CTA examination to minimize motion artifacts and decrease the possibility of non-evaluable segments
20. understand why left main coronary artery stenosis is associated with higher mortality and morbidity rates
21. know which revascularization technique for obstructive left main stenosis in symptomatic patients provides the best patient mortality rate
22. understand the significance of severe stenosis in the LAD and LCX arteries in a left-dominant system
23. know the basis of the CAD-RADS assigned category for patients with a coronary stent
24. know what a CAD-RADS category 5 with a modifier S represents
25. be familiar with coronary stent appearance and methods via coronary CTA
26. know what can improve stent lumen evaluation accuracy at coronary CTA
27. know the factors that might improve coronary CTA image quality by eliminating metallic artifacts
28. know which coronary bypass vein grafts are more prone to atherosclerosis
29. know what a CAD-RADS category 5 with modifier S/G represents
30. understand how high-risk features of atherosclerotic plaque can be predictors of future events
31. be familiar with various potential complications of coronary stents
32. understand why plaque characterization and estimation of total plaque volume are essential components of coronary CTA interpretation
33. be familiar with coronary anomalies and how they are reported with coronary CTA
34. be familiar with the three broad mechanisms by which coronary arteries can be compromised by non-atherosclerotic disease
35. understand why coronary CTA is the modality of choice for the evaluation of non-atherosclerotic causes of coronary artery narrowing
36. understand and differentiate between the terms that can be associated with an enlargement of the coronary artery with a diameter of 1.5 times more than the normal diameter of the artery
37. know what is indicated when a perfusion mismatch is present in stress/rest CT perfusion imaging
38. know why the detection of hemodynamically significant stenosis is important
39. be familiar with some advances in CT technology which allow for the evaluation of the hemodynamic significance of stenosis
40. know the common sites for coronary CTA incidental findings