Coronary Calcium Detection

Purpose	Detection and quantification of coronary calcium on CT images
Tag(s)
Panel	Cardiac Panel
Define-AI ID	19040029
Originator	Marly van Assen
Lead	Marly van Assen
Panel Chair	Carlo N. De Cecco
Panel Reviewers	Cardiac Panel
License	Creative Commons 4.0
Status	Public Comment
RadElement Set	RDES139

Clinical Implementation

Value Proposition

Coronary artery calcium scoring (CACS) serves as a reliable tool for CVD risk assessment and to guide follow-up testing. CAC is defined as a hyperattenuating lesion >130 Hounsfield units with an area of ≥3 pixels. Having a zero calcium score is currently used in guidelines (NICE) as a gatekeeper for any further investigations in patients presenting to the emergency department (ED) with chest pain. It can also be used for risk assessments in patients with low-intermediate risk. CACS scoring can guide further treatment or diagnosis and can help adjust scan parameters for subsequent scan acquisitions. It also offers possibilities to assess coronary calcium progression and the effectiveness of lipid therapy.

Narrative(s)

Patients who arrive with angina complains with intermediate risk profiles. According to the calcium score the risk profile can be either scaled up or down. Subsequent testing can be optimized according to the Agatston score. Investigational:
Asymptomatic patients (screening purposes)

Workflow Description

CACS scoring scan are taken and send to the AI algorithm. The algorithm automatically detects and quantifies the calcium and constructs an Agatston score.

Considerations for Dataset Development

Procedure(s)	{ECG triggered non-contrast CT}
View(s)	{Short Axis}
Sex at Birth	{Male, Female}
Age	[18,90]
CT	Patients with known coronary artery disease and high risk profiles should be excluded; no stents, or bypasses, pacemaker wires or other foreign material
Clinical Note: Patients with a recent CACS (within a year) should not be scanned again specifically for this goal Clinical Note: Calcifications in the cardiac region but outside the coronaries might cause problems with CACS quantification and should be treated with care.

Technical Specifications

Inputs

DICOM Study

Procedure	ECG triggered non-contrast cardiac CT (in the future CCTA or chest CT’s)
Views	Short axis
Data Type	DICOM
Modality	CT
Body Region	Cardiac
Anatomic Focus	Coronary arteries

Primary Outputs

Agatston Score

RadElement ID	RDE924
Definition	Representation of the amount of coronary calcium. The Agatston score is calculated by multiplying the lesion area(mm2) by a density factor (between 1 and 4)
Data Type	Numeric
Value Set	[0,10000]
Units	Agatston

Secondary Outputs

Calcium Volume

RadElement ID	RDE925
Definition	Volume of calcium present in the coronary arteries
Data Type	Numeric
Value Set	N/A
Units	ml

Risk Category

RadElement ID	RDE926
Definition	Risk assessment based on calcium present in the coronary arteries
Data Type	Categorical
Value Set	No evidence of CAD: 0 calcium score minimal: 1-10 mild: 11-100 moderate: 101-400 severe: >400
Units	N/Al

Future Development Ideas

Traditionally CACS is performed on dedicated ECG-triggered non-contrast cardiac CT acquisitions. However, with the increased use of CACS and the increased numbers of additional CACS acquisition, we also see an emerging role of non-contrast non-gated chest CTs and contrast enhanced ECG-triggered coronary computed tomographic angiography (CCTA) acquisitions for the analysis of coronary calcium. The use of these already clinically accepted acquisitions allows for risk assessment without the need for an additional acquisition, thereby reducing radiation dose. Artificial Intelligence could aid to reduce the variability and decrease the labor intensity of this task.

Related Datasets

No known related public datasets at this time, please alert us if you know of any.