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

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


Procedures(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

Pharmaceutical

N/A

Scenario

N/A



Primary Outputs

Agatston score

RadElement ID

to be defined

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


Definition

volume of calcium present in the coronary arteries

Data Type

Numeric

Value Set


Units

ml



Risk Category

RadElement ID


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


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.