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

• DOI: 10.1007/s10140-021-01911-8
• Publication Date: 2021-02-19T18:49:03Z
• Authors: Vincenzo Russo; Camilla Sportoletti; Giulia Scalas; Domenico Attinà; Francesco Buia; Fabio Niro; Cecilia Modolon; Carlo De Luca; Francesco Monteduro; Luigi Lovato
• Keywords: Adult; Chest Pain; 610; Coronary Angiography; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; 616; Radiologists; Humans; Original Article; Emergency Service, Hospital; Pulmonary Embolism; Tomography, X-Ray Computed; Retrospective Studies

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.