Coronary computed tomography angiography – getting the basics right

Coronary computed tomography angiography (CCTA) is a non-invasive cardiovascular imaging modality that provides isotropic resolution of the coronary arteries and associated cardiac anatomy. The new generation of state-of-the-art cardiac-enabled CT scanners offers sub-millimetre spatial resolution of the coronary vasculature, allowing clinicians to detect the presence of coronary artery plaque with high sensitivity. The National Institute of Health and Care Excellence (NICE) 2016 guideline update for the investigation of chest pain of recent onset (CG95) recommends CCTA as the first-line investigation for most patients with stable chest pain. Importantly, CCTA is recommended in all patients presenting with typical or atypical chest pain and in those with non-anginal pain with an abnormal ECG. Of note, patients with chest pain and a history of coronary revascularisation should undergo functional testing as the initial investigation of choice. In the UK, the current provision of CCTA is approximately 75,791 scans per annum. There remains a significant shortfall in provision of CCTA, as the full implementation of NICE 2016 CG95 would require a four-fold increase to 340,000 scans per annum, accounting for one in 17 of all CT scans performed in radiology departments. The availability and use of CCTA in all radiology departments will increase dramatically over coming years. This article will provide an overview of how to perform a high quality CCTA.

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