Rethinking Our Approach to Acquisitions of Coronary Computed Tomography Angiography (CCTA) Scans
In the age of advanced CCTA imaging, a one-size-fits-all approach to image acquisition is a disservice to patients.
For years, coronary computed tomography angiography (CCTA) has followed a familiar approach: Lower the heart rate. Scan with lowest radiation. Maximize image quality.
New research challenges that paradigm.
In a presentation at the recent Society for Cardiovascular Computed Tomography (SCCT) conference, investigators found that in a cohort of predominantly young, low-risk patients, a single-heartbeat CCTA acquisition was diagnostic in the vast majority of cases, substantially reducing radiation exposure without compromising diagnostic performance.1
At first glance, this looks like another incremental improvement in CT technology. I think it's more than that.
The real message isn't about scanning faster. It's about matching the acquisition to the patient instead of forcing every patient into the same acquisition strategy. In my opinion, that is also why you must not standardize to the extremes procedural details in cardiac CT. This is especially the case with photon counting CT (PCCT).
The study authors noted thatnot everyone requires the most sophisticated protocol. Correct. It depends on the indications, context, inherent limitations (technical and clinical).
The study authors suggested that not everyone needs the highest possible temporal resolution. This is where I disagree. It is always wise to go for the highest temporal resolution.
Certainly not everyone needs unnecessary radiation. The nuances are everything. What do you want to diagnose? What is your threshold for a good diagnosis now and for the time being in the natural history of an individual/patient? I know it's tough and maybe rough, but we should not restrict the focus on atherosclerotic cardiovascular disease (ASCVD) true prevention right when we are on the very edge of being able to defeat the complications in the majority of patients.
However, let’s not over- or under-generalize this issue.
The key words are young and low risk. This is not a new standard for every CCTA. Patients with obesity, high coronary calcium, arrhythmias, prior stents, bypass grafts, or higher heart rates remain a completely different challenge.
One protocol will never fit all.
Where PCCT Comes into the Picture
Suddenly, this discussion becomes even more interesting in the era of PCCT.
If detector efficiency, spatial resolution, temporal resolution, and spectral performance continue to improve, the question may no longer be: “Can we scan in one heartbeat?"
It may become: “Which patients still need more than one?”
That is a much better question. The future of CCTA is probably not about making every scan identical. It's about making every scan personalized.
Dr. Cademartiri is the director of advanced cardiovascular imaging and photon-counting CT at the Scientific Institute for Research, Hospitalization, and Healthcare Synlab Diagnostic Network in Naples, Italy. He is also a consultant in advanced cardiovascular imaging at CDI/Centro Diagnostico Italiano in Milan, Italy.
(Editor’s note: This blog is adapted with permission from Dr. Cademartiri’s original LinkedIn post at:
Reference
- Maxwell YL. Single heartbeat CCTA acquisition suffices in many young, low-risk patients. TCTMD.com . Available at:
https://www.tctmd.com/news/single-heartbeat-ccta-acquisition-suffices-many-young-low-risk-patients . Published July 13, 2026. Accessed July 16, 2026.
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