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Original research article
Challenges in delivering computed tomography coronary angiography as the first-line test for stable chest pain


Objective The National Institute for Health and Care Excellence (NICE) clinical guidelines ‘chest pain of recent onset: assessment and diagnosis’ (update 2016) state CT coronary angiography (CTCA) should be offered as the first-line investigation for patients with stable chest pain. However, the current provision in the UK is unknown. We aimed to evaluate this and estimate the requirements for full implementation of the guidelines including geographical variation. Ancillary aims included surveying the number of CTCA-capable scanners and accredited practitioners in the UK.

Methods The number of CTCA scans performed annually was surveyed across the National Health Service (NHS). The number of percutaneous coronary interventions performed for stable angina in the NHS in 2015 was applied to a model based on SCOT-HEART (CTCA in patients with suspected angina due to coronary heart disease: an open-label, parallel-group, multicentre trial) data to estimate the requirement for CTCA, for full guideline implementation. Details of CTCA-capable scanners were obtained from manufacturers and formally accredited practitioner details from professional societies.

Results An estimated 42 340 CTCAs are currently performed annually in the UK. We estimate that 350 000 would be required to fully implement the guidelines. 304 CTCA-capable scanners and 198 accredited practitioners were identified. A marked geographical variation between health regions was observed.

Conclusions This study provides insight into the scale of increase in the provision of CTCA required to fully implement the updated NICE guidelines. A small specialist workforce and limited number of CTCA-capable scanners may present challenges to service expansion.

  • cardiac computer tomographic (ct) imaging
  • coronary artery disease
  • health care delivery

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors Study concept and design: JD, EN, CR, SP and GR. Data acquisition: JD, EN, CR and GR. Data analysis: JD, EN and GR. Data interpretation: JD, EN, CR, SP and GR. JD drafted the original report and all authors revised the content of the original and updated manuscript. JD, EN and GR agree to be accountable for all aspects of the work.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data on the subclassifications of scanner capabilities (the results of which were beyond the scope of this article) are available on the British Society of Cardiovascular Imaging/British Society of Cardiac CT (BSCI/BSCCT) website ( to BSCI members and include our survey of '64-slice or better CT scanners' in the UK that are: ‘currently performing CTCA’; ‘ready to perform CTCA’; ‘not ready to perform CTCA but capable with software upgrade(s)’; and ‘not capable of performing CTCA’.

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