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01-08-2021 | CT Angiography | Original Article

The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

Authors: Vincenzo Russo, Camilla Sportoletti, Giulia Scalas, Domenico Attinà, Francesco Buia, Fabio Niro, Cecilia Modolon, Carlo De Luca, Francesco Monteduro, Luigi Lovato

Published in: Emergency Radiology | Issue 4/2021

Abstract

Purpose

To evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of emergency TRO-CT studies in patients with acute and atypical chest pain.

Methods

Between July 2017 and December 2019, 350 adult patients underwent TRO-CT studies for the assessment of atypical chest pain. Three radiologists with different fields and years of expertise (a cardioradiologist—CR, an emergency senior radiologist—SER, and an emergency junior radiologist—JER) retrospectively and independently reviewed all TRO-CT studies, by trans-axial and multiplanar reconstruction only. Concordance rates were then calculated using as reference blinded results from a different senior cardioradiologist, who previously evaluated studies using all available analysis software.

Results

Concordance rate was 100% for acute aortic syndrome (AAS) and pulmonary embolism (PE). About coronary stenosis (CS) for non-obstructive (<50%), CS concordance rates were 97.98%, 90.91%, and 97.18%, respectively, for CR, SER, and JER; for obstructive CS (>50%), concordance rates were respectively 88%, 85.7%, and 71.43%. Moreover, it was globally observed a better performance in the evaluation of last half of examinations compared with the first one.

Conclusions

Our study confirm the feasibility of the TRO-CT even in an Emergency Radiology department that cannot rely on a 24/7 availability of a dedicated skilled cardiovascular radiologist. The “undedicated” radiologists could exclude with good diagnostic accuracy the presence of obstructive stenosis, those with a clinical impact on patient management, without needing time-consuming software and/or reconstructions.

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Title: The triple rule out CT in acute chest pain: a challenge for emergency radiologists?
Authors: Vincenzo Russo
Camilla Sportoletti
Giulia Scalas
Domenico Attinà
Francesco Buia
Fabio Niro
Cecilia Modolon
Carlo De Luca
Francesco Monteduro
Luigi Lovato
Publication date: 01-08-2021
Publisher: Springer International Publishing
Keyword: CT Angiography
Published in: Emergency Radiology / Issue 4/2021
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-021-01911-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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