This Expert Consensus Document proposes a standardized protocol for reporting of coronary computed tomography (CT) angiography results. The following are several key points:

1. Other medical imaging fields (e.g., screening mammography, screening lung CT) have developed standardized reporting protocols.
2. Standardized protocols permit data collection for study registries, standardize image interpretation, and provide clinical recommendations that can guide patient management following results.
3. This document proposes a reporting system called CAD-RADS (Coronary Artery Disease Reporting and Data System) specifically for coronary CT angiography. The goals of this system are to improve communications between reading and referring providers, streamline research, and improve patient care.
4. For patients with stable chest pain, proposed categories range from 0 (no plaque) to 5 (total occlusion). Patients with <50% stenosis are considered to have nonobstructive CAD, and no further investigations are recommended. Patients with a stenosis of 50-69%, 70-99%, or 100% are recommended to be considered for a functional study, invasive angiography or functional study, and invasive angiography and/or viability study, respectively. Patients with >50% left main or severe three-vessel CAD are recommended to undergo invasive angiography.
5. In patients with acute chest pain, negative initial troponin, negative/nondiagnostic electrocardiogram (ECG), and considered to be at low to intermediate risk of acute coronary syndrome (ACS), the proposed categories also range from 0 (normal) to 5 (total occlusion). For a stenosis <50%, an ACS is considered unlikely, although a borderline stenosis in the setting of increased clinical suspicion or high-risk plaque features may merit cardiology consultation. Patients with a 50-69% stenosis may have a “possible” ACS, while those with a ≥70% stenosis are likely to have an ACS. For both of these latter categories, further testing and cardiology consultation as well as anti-ischemic treatment should be considered. Individuals with a total occlusion should also be considered for expedited invasive angiography and potential revascularization.

Keywords: Acute Coronary Syndrome, Angiography, Chest Pain, Coronary Angiography, Constriction, Pathologic, Coronary Artery Disease, Coronary Occlusion, Coronary Stenosis, Diagnostic Imaging, Electrocardiography, Mammography, Plaque, Atherosclerotic, Tomography, X-Ray Computed, Troponin

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