Optimizing outcomes in coronary CT imaging.

Cardiac computed tomographic angiography (CCTA) is revolutionizing our approach to the identification and management of coronary artery atherosclerosis. CCTA has the unique ability to assess extracoronary cardiac findings within the standard field of view, including the anatomy of cardiac structures-the atria, ventricles, valves, pericardium, great vessels, and venous anatomy-and any related abnormalities. Appropriate clinical applications include evaluation of intermediate-risk patients with acute chest pain and those with suspected coronary anomalies, uninterpretable or equivocal stress test results, or suspected cardiac morphologic abnormalities. Optimization of this diagnostic examination requires close attention to details such as minimizing motion and attaining sufficient contrast opacification. Iso-osmolar contrast can help achieve maximum patient comfort with the smallest elevation of heart rate and variability, as well as minimize the risk of acute kidney injury. Newer scanning equipment and protocols have improved image quality in difficult cases, including obese patients and those with heavy coronary calcification or metal artifacts. Current imaging protocols have reduced exposure to ionizing radiation and continue to improve safety.