Triple rule-out cardiac computed tomography: is it finally a reality?

Acute coronary syndrome (ACS), pulmonary embolism and acute aortic syndrome are the most common causes of life threatening chest pain. The triple rule-out CT (TRO CT) has emerged as a technology that can simultaneously visualize the coronary arteries, aorta and pulmonary arteries as well as other intrathoracic structures. It has been proposed as a one-stop imaging modality in patients who present to the emergency department with low to intermediate risk of ACS in whom pulmonary embolism and/or acute aortic syndrome are also considered. This review focuses on the TRO CT imaging technique, image quality, radiation dose, diagnostic accuracy, yield, efficiency and cost through a series of frequently asked questions.