{
  "abstract": "Introduction Many NHS trusts still struggle to offer a robust cardiac CT service despite CT having a key role in guidelines for the diagnosis of coronary artery disease. We demonstrate how a relatively large district general hospital can safely rebuild a cardiac CT service from zero without an on-site expert mentor. The CTCA service at Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust ceased in December 2021 and restarted in May 2022 with all CTCAs externally reported by a private provider. During this period, two imaging cardiologists trained and became accredited in cardiac CT and independently re-reported scans in the absence of an internal experienced mentor. As of November 2023, we transitioned to in house CTCA reporting and following further recruitment of two locally appointed radiology doctors the trust now offers three lists a week across two sites and has run lists to support other trusts.Methods We analysed 50% of the scans performed since the service was restarted (n = 595), mean age 56.8 years, 47% were male ( table 1). The most common indication for scan was angina n= 282 (47%) (table 2). Dose of IV metoprolol used: none 238 (41%), 1-10mg 84 (14%), 11-20mg 19 (3%), 21-30mg 122 (21%), >30mg 119 (21%). Data was analysed using R studio and Microsoft Excel. For completeness, as a new service, we also assessed patient satisfaction with the service and the patient information leaflet.Results We compared 23 (3%) of our CTCAs in patients who have, so far, gone on to have the standard invasive angiography (IA) as our gold standard benchmark. Spearman’s Rho showed a moderate statistically significant positive correlation between CTCA and IA findings (ρ= 0.56, p=0.006). Per vessel analysis via Cohen’s kappa test demonstrated: almost perfect agreement between CTCA and IA for LMS involvement (k=1.00), almost perfect agreement for LCx involvement (k= 0.81), substantial agreement for LAD (k= 0.62) and RCA involvement (k= 0.73). The service review also demonstrated high satisfaction with the service with 90% of patients satisfied, 100% of patients would recommend the service and 95% of patients felt well informed. Finally, our average time from request to scan has dropped from 243 days to 36 days.Conclusion We demonstrate a scalable road map to recovery, from no service to a strongly performing, accurate (despite four new reporters) and well received cardiac CT service in 2 years, which we feel other centres could use if placed in a similar situation. Key learning points are succession planning where possible, utilising a flexible and agile cardiology consultant workforce, having a supportive radiology service and judicious usage of an external provider both as a stopgap but also to allow reporters to build experience rapidly on site and on their own scanner, which to our knowledge is not previously reported. Finally, choosing the right level 2 CT course is important as some offer ongoing support long after the course has ended.Abstract 360 Table 1Summary statisticsCategoryn= 595Mean age56.8 yearsMale gender47% (n=282)Mean DLP (mGYcm)178.45Mean heart rate during acquisition60 bpmAbstract 360 Table 2Indication for scanNumber of patientsAngina (%)282 (47)Non-specific chest pain (%)159 (26)Arrhythmia/ECG change (%)18 (3)Shortness of breath (%)13 (2)Structural (e.g dilated cardiomyopathy) (%)12 (2)Myocardial infarction or suspected acute coronary syndrome (%)22 (4)Previous imaging or investigation finding (%)27(5)Other (%)62 (10)",
  "authors": [
    {
      "affiliations": [
        "Diana Princess of Wales Hospital, Grimsby, United Kingdom"
      ],
      "name": "Julia Turner"
    },
    {
      "affiliations": [
        "Doncaster Royal Infirmary, Doncaster, United Kingdom"
      ],
      "name": "Dan Mawhinney"
    },
    {
      "affiliations": [
        "Doncaster Royal Infirmary, Doncaster, United Kingdom"
      ],
      "name": "Rachel Barber"
    },
    {
      "affiliations": [
        "Doncaster Royal Infirmary, Doncaster, United Kingdom"
      ],
      "name": "Faye Vardy"
    },
    {
      "affiliations": [
        "Doncaster Royal Infirmary, Doncaster, United Kingdom"
      ],
      "name": "Gareth Archer"
    },
    {
      "affiliations": [
        "Doncaster Royal Infirmary, Doncaster, United Kingdom"
      ],
      "name": "David Warriner"
    }
  ],
  "title": "360 A hard reset- how to rebuild a cardiac CT service from scratch. Our single centre real world experience",
  "uid": "2a3515fd-ad3a-5615-b917-bcd82891e283"
}