Standard CT Coronary Angiography Report Template
A standardized CT coronary angiography report should follow the CAD-RADS 2.0 framework established by the Society of Cardiovascular Computed Tomography (SCCT), American College of Cardiology (ACC), American College of Radiology (ACR), and North American Society of Cardiovascular Imaging (NASCI). 1
Report Structure
The 2022 CAD-RADS 2.0 guidelines provide a comprehensive template that ensures standardized communication and facilitates clinical decision-making. Here is the recommended format:
EXAM:
CORONARY CT ANGIOGRAPHY WITH CALCIUM SCORE
TECHNIQUE:
- Scanner type specification
- Preliminary scout study obtained
- Calcium scoring protocol performed
- Intravenous contrast administration
- 0.5 mm collimated images obtained through coronary arteries
ACQUISITION:
- ECG triggering method: Prospective or Retrospective
- Data transferred offline for 3D reconstructions
- Heart rate at acquisition: [specify] bpm
MEDICATIONS:
- Beta-blocker: 100mg oral metoprolol (if administered)
- Nitrate: 0.4mg sublingual nitroglycerin (if administered)
TECHNICAL QUALITY:
Rate as one of the following:
- Excellent (no artifacts)
- Good (minor artifact but diagnostic quality maintained)
- Acceptable (moderate artifacts)
- Poor/suboptimal (severe artifacts)
FINDINGS:
Calcium Score:
- Total calcium score with interpretation (zero indicates absence of calcified plaque)
Coronary Anatomy:
- Origin of coronary arteries (normal position)
- Dominance pattern (right/left/co-dominant)
Individual Vessel Assessment:
Left Main:
- Size (short/medium/large)
- Bifurcation or trifurcation pattern
- Presence/absence of plaque or stenosis
LAD (Left Anterior Descending):
- Plaque and stenosis assessment
- Diagonal branch patency
LCX (Left Circumflex):
- Plaque and stenosis assessment
- Obtuse marginal branch patency
RCA (Right Coronary Artery):
- Plaque and stenosis assessment
- Posterior descending artery patency
- Posterior left ventricular branch patency
Non-Coronary Cardiac Findings:
Cardiac Valves:
- Aortic valve morphology (trileaflet/bicuspid)
- Valve thickening or calcifications
Pericardium:
- Contour assessment
- Effusion, thickening, or calcifications
Extra-cardiac Findings:
- Limited views of lungs, mediastinum, upper abdomen
IMPRESSION:
1. Stenosis Assessment:
- Quantify stenosis by severity:
- Mild: 25-49%
- Moderate: 50-69%
- Severe: 70-99%
- Specify location (proximal/mid/distal) and vessel
2. Plaque Burden:
- Overall plaque characterization (mild/moderate/severe/extensive)
- Calcium score correlation
3. Modifiers:
- Note any relevant modifiers (stents, grafts, anomalies)
RECOMMENDATION:
CAD-RADS Classification with Management Recommendations: 1
| CAD-RADS | Plaque | Management |
|---|---|---|
| 0 | N/A | Reassurance. Consider non-atherosclerotic causes |
| 1 or 2 | P1 | Consider non-atherosclerotic causes |
| 1 or 2 | P2 | Non-atherosclerotic causes + risk factor modification + preventive pharmacotherapy |
| 1 or 2 | P3/P4 | Non-atherosclerotic causes + aggressive risk factor modification + preventive pharmacotherapy |
| 3 | P1/P2/P3/P4 | Consider CT-FFR, CTP, or stress testing + aggressive risk modification + anti-anginal therapy per guidelines |
| 3 | If I+ modifier | Consider ICA, especially if symptoms persist despite medical therapy |
| 4 | P1/P2/P3/P4 | Consider ICA or functional assessment + aggressive risk modification + anti-anginal therapy + revascularization options |
| 5 | P1/P2/P3/P4 | Consider ICA, functional and/or viability assessment + aggressive risk modification + anti-anginal therapy + revascularization options |
Key Reporting Principles
The CAD-RADS classification must be used in conjunction with the impression section, not as a replacement. 1 The standardized format improves communication among the clinical care team, facilitates data collection for research and quality improvement, and enables decision support technologies.
Common Pitfalls to Avoid:
- Incomplete vessel assessment: All major vessels and branches must be systematically evaluated
- Omitting technical quality: This affects interpretation confidence
- Missing extra-cardiac findings: Wide FOV imaging often reveals clinically significant incidental findings 2
- Failing to provide specific management recommendations: The CAD-RADS score should directly translate to actionable clinical guidance
- Not documenting medications: Beta-blockers and nitrates affect image quality and interpretation
The structured format ensures consistency, improves quality of reporting, and facilitates data mining for registries and research 3, 4. This standardization is particularly valuable as electronic medical records become universal in healthcare systems.