Introduction
Coronary CT angiography noninvasively visualizes coronary artery anatomy plaque and stenosis and is widely used for chest pain evaluation and coronary assessment. Heart rate control ECG gating and optimized contrast timing are critical for diagnostic image quality. Standardized reporting and plaque characterization support clinical decision making.
Acquisition Techniques
Prospective ECG gating reduces radiation dose for stable low heart rate patients while retrospective gating is used for arrhythmia or functional assessment. Beta blockade and nitrates improve image quality and coronary vasodilation when appropriate. Thin collimation and iterative reconstruction enhance spatial resolution and reduce noise.
Interpretation and Reporting
Reporting should include stenosis severity plaque composition and coronary calcium assessment with clear statements about limitations. Functional correlation with perfusion imaging or invasive testing may be necessary for intermediate lesions. Structured reporting templates improve communication with referring clinicians.
Radiation and Contrast Considerations
Dose optimization strategies include tube current modulation low kVp protocols and iterative reconstruction. Contrast volume and injection rate should be tailored to patient size and cardiac output to ensure arterial enhancement. Renal function assessment and hydration protocols mitigate contrast related risks.