These guidelines were initially developed with the Lung Cancer Screening Programme in mind; however, they apply to all patients undergoing CT of the thorax and at all sites within Frimley Health.

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition.

Print copies must be destroyed after use.

Abbreviations

Mild calcification will not be commented on in the conclusion of the report.

Moderate and severe calcification will be reported. Suggested autotext may be used:

Please refer to Cardiology if appropriate, taking into account patient frailty, etc.

Referral into the Cardiology service: These referrals will be routed to the cardiology referrals Epic inbasket.

Required clinical details from the referrer include frailty score and significant co-morbidities.

These patients will all require echocardiography, the purpose of which is to establish if there is associated stenosis of the aortic valve. This will be requested by the triaging cardiologist. The timing of this echo will be determined by any historical echocardiograms that may be present on the system:

• “Routine” time frame if no echocardiogram within the last 12 months

• If they have had an echo in the last 12 months then this does not need to be repeated unless it showed stenosis that was borderline severe and performed more than 6 months ago.

With the exceptions of very frail or co-morbid patients (i.e., those to whom TAVI would clearly not be offered), all other patients will require follow-up, either in the form of ongoing echocardiographic surveillance in the Valve Clinic for moderate stenosis, or a review in cardiology clinic for patients with severe aortic stenosis. The latter group of patients can be allocated to any consultant cardiologist clinic.

In line with recently released NHSE guidance, the size of the thoracic aorta will only be reported in patients aged ≥55 years old if the diameter is ≥4.5cm i.e. patients aged 55+ with a thoracic aortic diameter of 4.0 – 4.4cm will not have autotext.

Patients ≤54 years old with a thoracic aortic diameter of 4.0-4.4cm will have it reported. Suggested autotext may be used:

Please refer to Cardiology if appropriate, taking into account patient frailty, etc.

Referral into the Cardiology service: These referrals will be routed to the cardiology referrals Epic in-basket.

Required information from the referrer includes:

• family history of aortic dissection or bicuspid aortic valve disease

• dimensions of the aorta on any previous CT or echo imaging

• date of any previous echocardiogram

• diagnosis of hypertension

• frailty score and significant co-morbidities.

They will require an echocardiogram if one has not been performed in the last 12 months. This should be requested in a “routine” timeframe by the triaging cardiologist.

Exceptions to this “routine” timeframe echo include:

• patient with known bicuspid aortic valve

• patient with a family history of aortic dissection or bicuspid aortic valve.

These patients should have an echocardiogram requested in an “urgent” timeframe.

They will be reviewed with the result of the echocardiogram in cardiology clinic, either by a consultant / registrar or the valve specialist nurse. The purpose of this visit is to assess blood pressure control and review medication. For patients with bicuspid aortic valve, family screening letters for first degree relatives will be created, and the patients will be given advice to reduce the risk of developing endocarditis.

Patients with an ascending thoracic / arch of aorta approaching 5.5 cm should have an echocardiogram requested in an “urgent” timeframe, followed by a cardiology clinic appointment with a consultant.

Patients with severe coronary calcification will have it reported. Suggested autotext may be used in the report conclusion:

Consider primary prevention with a statin and Cardiology opinion if appropriate, taking into account patient frailty, etc.

Referral into the Cardiology service: These referrals will be routed to the cardiology referrals Epic in-basket.

Required clinical details from the referrer include frailty score and significant co-morbidities.

Individual cardiology consultants will manage these patients according to their own preference; some may choose to appoint to clinic, whereas others may choose to send a letter to the patient, advising them to contact their GP or RASAC if they experience chest pain.

NHS England (2025) Standard protocol and quality assurance standards for the Lung Cancer Screening Programme. Available at: https://www.england.nhs.uk/publication/targeted-screening-for-lung-cancer/ (Accessed: 2 April 2025).

Williams, M. C. et al. (2021) ‘Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI/BSCCT and BSTI’, British Journal of Radiology, 94(1117), article no. 20200894. Available at: https://doi.org/10.1259/bjr.20200894 (Accessed: 20 November 2024).

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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