How to Successfully Launch a CCTA Program at Your Hospital or Practice
Emphasizing increasing recognition of the capability of coronary computed tomography angiography (CCTA) for the evaluation of acute and stable chest pain, this author defuses common misperceptions and reviews key considerations for implementation of a CCTA program.
In the United States, heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups. In fact, someone has a heart attack every 40 seconds and one person dies every 33 seconds from cardiovascular disease.1
With staggering statistics like these, clinicians need every possible weapon to wage war on heart disease in America. Coronary computed tomography angiography (CCTA) can be a powerful diagnostic tool in the clinician’s arsenal for early detection of heart disease, even prior to the appearance of symptoms.
Coronary computed tomography angiography is used to detect and assess a wide variety of heart conditions including plaque buildup, coronary artery disease (CAD), blood vessel abnormalities, heart muscle issues, and more. Left unchecked, these conditions can lead to heart attack and sometimes death.
Consider some of the most recent data. In 2022, 702,880 people died from heart disease.1 That is one in every five deaths. Additionally, coronary heart disease is the most common type of heart disease. It killed 371,506 people in 2022.1
We know CCTA works and can help save lives. However, payment for CCTA was previously lower than the cost of performing the test. Providers could — and often did — lose money on it, which is one reason many did not offer the test.
Beginning in 2025, the Centers for Medicare and Medicaid Services (CMS) doubled the reimbursement for CCTA. This higher payment incentive offers the promise for wider acceptance and adoption of 3D imaging in cardiac and diagnostic programs.
However, additional barriers to adoption remain. Accordingly, let’s take a closer look at common hurdles and misperceptions, the value of CCTA and pertinent steps for successful implementation of a CCTA program.
Research has demonstrated that coronary computed tomography angiography (CCTA) is a reliable and efficient diagnostic alternative to traditional non-invasive tests with high diagnostic accuracy contributing to faster decision-making and reduced need for invasive procedures. However, less than 50 percent of safety-net hospitals offer CCTA. (Image courtesy of Radiology.)
Addressing Barriers to Adoption
As health-care providers continue to evaluate whether to implement a CCTA program, advocates often encounter nay sayers based on misconceptions and outdated information. For starters, there is a great deal of misinformation still circulating that claims CCTA is not cost-effective and delivers high radiation exposure. However, research clearly shows that CT does not lead to higher downstream costs, and the once high radiation dose associated with CT has dropped by about 70 percent over the past 15 years.2
In addition, many administrators think the detector equipment required for CCTA exams is too expensive. However, that simply isn’t the case. There are systems on the market to fit every facility’s size and budget. For example, some Fujifilm systems were built with community hospitals and outpatient practices in mind and even remotely located rural providers with very tight capital budgets have found them to be cost-effective.
Then there is the problem of real skepticism about the value of CCTA to improve outcomes. All too often, clinical and administrative teams are making decisions about the benefit of CCTA based on old data. In the past, the picture was unclear.However today, CT is associated with an approximate 30 percent reduction in the rate of subsequent myocardial infarctions.2
Finally, implementing a CCTA program can often cause a “people problem” for health systems. Simply put, experts agree there is a shortage of trained imagers.3 For example, it appears that not enough physicians are trained to read cardiac CT scans as compared to nuclear cardiology. There is also a shortage of CT technologists skilled in performing cardiac CCTA.
What the Research Reveals About the Efficacy of CCTA
Despite the pushback from some, several hospitals around the country have started or completed the implementation of CCTA programs.
The last decade saw a paradigm shift that favors a “CT first” approach, which was initially fueled by results of the 2015 SCOT-HEART and PROMISE trials.4 In 2019, CCTA was given a class 1 recommendation from the European Society of Cardiology for suspected coronary artery disease (CAD).4
Then in 2021, the U.S. Chest Pain guidelines elevated CCTA to a class 1A recommendation for the evaluation of acute and stable chest pain in patients without known CAD. The 2023 update in the Multimodality Appropriate Use Criteria (AUC) for chronic coronary disease rated CCTA “Appropriate” in nearly all symptomatic patient scenarios, a significant gain compared to the 2013 iteration.4
In a retrospective analysis conducted in 2024, researchers found the adoption of CCTA led to over a six-day decrease in the average length of stay for patients in the ED-run Observation Medicine Unit at the Mayo Clinic Arizona in Phoenix.5
The bottom line is that research shows that CCTA is a reliable and efficient diagnostic alternative to traditional non-invasive tests with high diagnostic accuracy contributing to faster decision-making and reduced need for invasive procedures.
However, according to one recent report, out of 391 safety-net hospitals identified in the U.S., 179 (45.8 percent) offer CCTA.6 That means that fewer than half of identified U.S. safety-net hospitals were found to provide CCTA for the evaluation of cardiac patients despite recent and growing evidence of its efficacy.
With multiple benefits, hospitals and outpatient imaging centers alike simply need to know how to plan for and implement an effective CCTA program.
Keys to Smart Implementation of CCTA
There are several considerations associated with adopting CCTA. However, with proper planning, any hospital or imaging facility — large, medium-sized or small — can smoothly implement CCTA into their cardiac practice and reap numerous clinical and, potentially, business benefits. The following are some key steps to follow as you plan your implementation.
• Establish a governance body. Leadership must support the goal. Establish a committee that strives for “buy-in” by all stakeholders, including the technology, human and educational investment that will be required to implement CCTA. Set quantifiable clinical goals (i.e., speedier, more accurate diagnoses, better heart patient outcomes, shorter hospital stays, etc.) as well as staffing requirements (i.e., number of dedicated or shared techs, nurses, etc.)
• Invest in training and education. In a 2024 study, researchers discussed key principles to facilitating and growing a successful CCTA program.5
“Provider and nursing education initiatives were crucial in overcoming initial resistance and improving the implementation of CCTA,” noted lead study author Catherine Williams, M.D., and other researchers from Mayo Clinic Arizona and the Mayo Clinic Allix School of Medicine in Scottsdale, Ariz. “Post-education, there was a marked increase in the volume of CCTA performed and a decrease in the length of stay, enhancing overall departmental throughput. Continuous education for providers and nursing staff was essential to ensure adherence to the new protocol and improve clinical outcomes.”
• Choose the right technology partner. Carefully vet several vendors. Seek out a partner that offers an end-to-end solution. For example, Fujifilm’s Scenaria View CT can assist in scan parameter selection, cardiac phase optimization and coronary motion correction to optimize CCTA results and throughput for high volume cardiac scan users. Your vendor should also be committed to service and support, providing a speedy response when needed so your practice or hospital experiences little, if any, downtime.
• Track results and demonstrate success/ROI. Identify short-term (monthly) and long-term (annual) clinical and practice successes (i.e., speedier/accurate diagnoses in a percentage of patients, fewer repeat/return patients, shorter patient stays, increased throughput, etc.). Use your success story to justify the investment in CCTA internally while building a long-term commitment to your overall program.
• Market your new CCTA capability. Share your CCTA success story via your website, annual report, and other communication vehicles to generate goodwill with referring physicians, community, and patients. Letting the world know how effective your program is can also give your facility a competitive edge. Consider participating in educational events like community health fairs and speaking engagements to inform consumers and referring doctors about the benefits of CCTA for good heart health. Your CT vendor partner may be able (as Fujifilm can at no charge) to support your marketing program.
Final Notes
With careful planning, your hospital or practice can implement a successful CCTA program that improves patient outcomes and is no longer a “loss leader” as in the past. In fact, given the right support, CCTA can be a new revenue stream and an opportunity to set your health system apart.
Coronary computed tomography angiography can be an advantage for patients and a competitive edge for your institution, especially with the new boost in reimbursement. Clearly, some noteworthy hospitals are seeing success as they implement CCTA. As a reporter noted after RSNA 2023, “Many healthcare systems have seen bumps in CCTA imaging volumes” over the past two years.7 Northwell Health, the largest health system in New York, has seen more than a 200 percent increase in CCTA exams. Other systems such as Mass General Brigham in Boston have also reported large increases in cardiac CT.
Now is the time to consider CCTA for your organization. It could prove to be a very healthy endeavor for your patients as well as your practice.
References
1. Heart disease facts. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html . Published October 24, 2024. Accessed June 11, 2025.
2. Maxwell YL. Biggest barriers to cardiac CT? Old myths, fair payment, and de-adoption. tctMD. Available at: https://www.tctmd.com/news/biggest-barriers-cardiac-ct-old-myths-fair-payment-and-de-adoption#:~:text=The%20main%20barriers%20currently%20impeding,Society%20of%20Cardiovascular%20Computed%20Tomography%20( . Published July 22, 2020. Accessed June 11, 2025.
3. Fornell D. How to address staffing shortages in cardiac CT. Cardiovascular Business. Available at: https://cardiovascularbusiness.com/topics/healthcare-management/healthcare-staffing/how-address-staffing-shortages-cardiac-ct . Published October 12, 2023. Accessed June 11, 2024.
4. Delshad J, Weis T, Bayona C, et al. Access to CCTA at safety-net hospitals across the United States. J Cardiovasc Comput Tomogr. 2025 May 2:S1934-5925(25)00079-6. doi: 10.1016/j.jcct.2025.04.006. Online ahead of print.
5. Sequeira A, Feradov D, Almeida SO. Unlocking the gates: Uptake of cardiac CT and barriers to wider adoption among primary care providers. J Cardiovasc Comput Tomogr. 2025;19(1):149-151.
6. Williams C, Van Ligten MJ, Tomlinson B, et al. Challenges and successes in introducing coronary CT angiography in an emergency medicine-run observation unit. Cureus. 2024;16(7):e63620. doi: 10.7759/cureus.63620. eCollection 2024 Jul.
7. Fornell D. Cardiac CT’s continued rise on display at RSNA 2023. Cardiovascular Business. Published December 5, 2023. Accessed June 11, 2025.
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