The what and why of cardiac CT angiography: data interpretation and clinical practice integration

Noninvasive visualization of the coronary arteries is the holy grail of cardiac imaging. Cardiac catheterization, the historic gold standard for coronary imaging, is invasive, costly, and often performed unnecessarily. Cardiac computed tomographic angiography (CCTA) is a widely available, cost-effective imaging modality that effectively images the coronary arteries. The most appropriate patient for a CCTA-guided approach to the evaluation of chest pain is the symptomatic patient at low to intermediate risk. Data are rapidly evolving to further validate the accuracy, prognostic ability, and cost-effectiveness of this technique. The current landscape of the American medical system and the rising cost of United States health care have led to skepticism concerning CCTA and its potential misuse. Technological misunderstanding and concern about excessive radiation exposure also threaten its growth. When used properly by appropriately trained physicians, CCTA adds significant value to the evaluation of chest pain and to the diagnosis of coronary artery disease.