Coronary CTA: What the Scan Sees, What the Numbers Mean

The Scene

The following scene is drawn from the composite of patients I have cared for in clinic and on the hospital floor. All identifying details are changed.

She came in with what she called “a weird tightness” in her chest that appeared when she walked briskly from the parking lot to her office building. It had been happening for three weeks. She was fifty-four years old, a former smoker who had quit eight years prior, with a family history of coronary artery disease on her father’s side and a fasting LDL of 142 mg/dL that her primary care doctor had not yet moved to treat. Her resting ECG was normal. Her blood pressure was 136/84. She was not in distress.

She had read enough online to arrive with a question already formed: “Can I just get the scan and know if my arteries are blocked?”

That question sounds simple. It is not.

What she was asking about was coronary computed tomography angiography, or coronary CTA, a study that uses a high-resolution CT scanner synchronized to the cardiac cycle to image the coronary arteries directly. In the right hands, with the right patient selection, it is one of the most powerful diagnostic tools in cardiology. It can show plaque that would be invisible on a stress test. It can quantify the degree of narrowing in a coronary artery to within a few percentage points. And it can identify the type of plaque, distinguishing soft, lipid-rich deposits that are prone to rupture from dense calcified lesions that are more stable.

But the question “Are my arteries blocked?” is a narrower question than she realized. Coronary CTA does not just answer whether a lumen is obstructed. It describes the architecture of disease that may have been building for decades. A scan that shows “moderate non-obstructive plaque” with 40 percent stenosis is not a clean scan. It is a warning. A scan that shows no stenosis but extensive mixed plaque is not reassuring in the way most patients assume. The lumen may be open now because the vessel has remodeled outward to accommodate the plaque, a process called positive remodeling or the Glagov phenomenon. When that remodeling capacity is exhausted, the lumen narrows. By then, the patient may have years of “normal” stress tests in their file.

At Carle Foundation Hospital in Urbana-Champaign, the coronary CTA program sits inside a clinical framework that tries to answer not just the anatomical question but the physiological one: does this plaque matter now, and what does it predict over the next ten years? That framing is what this article is about.

There is also the radiation question. There is the contrast question. There is the question of what to do with the incidental findings that appear on every chest CT, findings that have nothing to do with the coronaries and everything to do with what comes next. None of that fits in a waiting room conversation. It is the subject matter of this piece.

What It Is

Coronary CTA is a non-invasive imaging study that captures the coronary arteries in three dimensions using a multi-detector CT scanner. The study is synchronized to the cardiac cycle, typically via ECG gating, so that images are acquired during the phase of diastole when the heart is least mobile and the coronary vessels are most easily resolved.

What the scan produces: A volumetric dataset of the heart and coronary tree that is then reconstructed into multiple views, including curved multiplanar reconstructions that “straighten” each coronary artery for length-wise review, and cross-sectional cuts that allow measurement of the lumen diameter and the plaque burden in the vessel wall. The interpreting physician can scroll through a virtual coronary angiogram without inserting a catheter.

What it measures:

• Coronary stenosis: The degree to which a plaque narrows the internal diameter of the vessel, reported as a percentage
• Plaque composition: Calcified plaque, non-calcified plaque (soft or lipid-rich), and mixed plaque (partially calcified)
• Plaque volume: Total burden of atherosclerotic material within the vessel wall
• Coronary calcium score: A derived metric from the same dataset, expressed as Agatston units, reflecting the volume and density of calcified deposits

How it differs from invasive coronary angiography: Traditional catheter-based angiography injects contrast directly into the coronary ostia and produces two-dimensional silhouettes of the lumen. It is excellent at identifying significant stenoses but is largely blind to the vessel wall. Coronary CTA sees both the lumen and the wall. It can identify disease that is remodeling outward and has not yet caused any luminal narrowing, disease that is entirely invisible to conventional angiography (Hoffmann, JAMA. 1998; doi:10.1001/jama.280.21.1851).

What it does not measure directly: Coronary CTA does not quantify the functional significance of a stenosis. A 60 percent narrowing identified on CTA may or may not be causing ischemia at peak exercise. This is a fundamental limitation. The same dataset can now be used to calculate coronary flow reserve computationally, a technique called CT-derived fractional flow reserve (FFRct), covered in PROC-010. But standard coronary CTA reports a degree of stenosis, not a hemodynamic consequence (Norgaard, JACC. 2014; doi:10.1016/j.jacc.2014.11.019).

Calcium scoring as a companion study: The coronary artery calcium (CAC) score is frequently discussed in the same breath as coronary CTA because it uses the same imaging platform. However, CAC scoring is a non-contrast study that only counts calcified deposits and reports a total score. It is faster, involves lower radiation dose, and is used primarily for risk stratification in asymptomatic individuals. Coronary CTA is a contrast-enhanced study and is appropriate for symptomatic patients with an intermediate pre-test probability of obstructive coronary artery disease. These are related but distinct tools, and the distinction matters for patient selection and reimbursement (Grundy, JACC. 2019; doi:10.1016/j.jacc.2019.03.010).

The Mechanism

How CT imaging works: CT uses a rotating X-ray source and detector array to acquire projection data from multiple angles around the patient. A computer reconstruction algorithm converts that raw data into a three-dimensional volume. Modern cardiac CT scanners use 64 to 320 detector rows, rotating at sub-second speeds, allowing the entire heart to be imaged in a single heartbeat or a small number of heartbeats.

ECG synchronization: The coronary arteries move with the heart. At 70 beats per minute, the right coronary artery travels several centimeters per second during systole. To freeze that motion, the CT acquisition is synchronized to the ECG. There are two approaches:

Retrospective gating: The scanner acquires data continuously throughout the cardiac cycle, and the computer selects the images from the desired phase retrospectively. This approach allows reconstruction of multiple phases and functional assessment of wall motion, but it involves higher radiation dose because the tube is active throughout the cycle.

Prospective triggering: The scanner fires the X-ray tube only during the target diastolic window, typically at 70 to 80 percent of the R-R interval. This substantially reduces radiation dose but provides less flexibility in reconstruction phase selection. In patients with a regular, slow heart rate, prospective triggering has become the standard approach (Husmann, Eur Heart J. 2008; doi:10.1093/eurheartj/ehn472).

Heart rate preparation: Image quality degrades significantly at heart rates above 65 to 70 beats per minute because a faster rate shortens diastole. Most protocols involve pre-procedure administration of a beta-blocker, typically oral metoprolol given 60 to 90 minutes before scanning, to bring the resting heart rate below 65. Sublingual nitroglycerin is also administered immediately before scanning to dilate the coronary arteries and improve visualization of distal vessels.

Contrast delivery: Iodinated contrast is injected intravenously at a high flow rate (5 to 7 mL per second) through a large-bore peripheral IV, typically in the antecubital fossa. The timing of the scan acquisition is synchronized to the arrival of contrast in the coronary arteries, most commonly using either a bolus-tracking technique or a timing bolus. The total iodinated contrast volume is typically 50 to 80 mL, substantially less than the 100 to 200 mL used in invasive catheterization procedures.

Radiation dose: Modern prospectively gated coronary CTA protocols deliver effective doses in the range of 1 to 3 millisieverts (mSv) in most patients, comparable to three to seven months of natural background radiation (Hausleiter, JAMA. 2009; doi:10.1001/jama.2009.190). Early retrospective protocols delivered 10 to 15 mSv. Dose reduction techniques including iterative reconstruction algorithms, tube current modulation, and high-pitch acquisition modes have substantially reduced exposure over the past decade. For context, invasive coronary angiography typically delivers 3 to 7 mSv, and nuclear stress perfusion imaging delivers 7 to 12 mSv depending on the radiotracer used.

Image resolution and plaque characterization: Spatial resolution of modern cardiac CT is approximately 0.3 to 0.5 mm isotropic, sufficient to resolve coronary arteries as small as 1.5 to 2 mm in diameter and to characterize plaque composition. Calcified plaque appears bright (high Hounsfield units). Non-calcified, lipid-rich plaque appears dark (low Hounsfield units). High-risk plaque features identified on coronary CTA include low CT attenuation plaque (less than 30 HU), positive remodeling, napkin-ring sign, and spotty calcification. These features are associated with higher rates of subsequent acute coronary syndrome 4 / Promising .

How It Is Used

Patient selection: Coronary CTA is most appropriate for symptomatic patients with an intermediate pre-test probability of obstructive coronary artery disease (typically 15 to 65 percent based on age, sex, symptom quality, and risk factors). Patients with very low pre-test probability are unlikely to benefit from any anatomical imaging. Patients with very high pre-test probability are better served by proceeding directly to invasive evaluation or functional testing. The intermediate zone is where coronary CTA has the highest diagnostic yield and the most meaningful impact on management 5 / Solid .

Stable chest pain: This is the primary indication. A patient with new exertional chest pain, an intermediate pre-test probability, and a normal resting ECG is an excellent candidate. The ESC guidelines updated in 2019 position coronary CTA as the preferred first-line test for stable chest pain in this population, ahead of functional stress testing, based on evidence from SCOT-HEART and other trials (Knuuti, Eur Heart J. 2020; doi:10.1093/eurheartj/ehz425).

Emergency department chest pain: Several large RCTs have evaluated coronary CTA as an accelerated rule-out strategy in patients presenting to the emergency department with acute chest pain and a low-to-intermediate TIMI risk score. The ROMICAT-II trial demonstrated that coronary CTA in this setting reduced time to diagnosis and length of stay compared with standard evaluation, though the 28-day event rates were similar 5 / Solid .

Known coronary artery disease: Coronary CTA has limited utility in patients with prior PCI or CABG because metallic stents and surgical clips produce blooming artifacts that obscure the vessel lumen. For stent evaluation, stents 3.5 mm or larger can sometimes be assessed, but diagnostic accuracy is lower than for native vessels.

Congenital coronary anomaly evaluation: Coronary CTA is the preferred modality for delineating anomalous coronary artery origin and course, particularly in young patients with exertional symptoms or a family history of sudden cardiac death in athletes. The three-dimensional dataset allows precise characterization of the inter-arterial course that is not possible with conventional angiography alone.

Pre-operative evaluation: Coronary CTA has been evaluated as a non-invasive alternative to invasive angiography before valve surgery in selected patients, reducing procedural risk while providing equivalent anatomical information (Meijboom, JACC. 2007; doi:10.1016/j.jacc.2007.04.092).

What “stenosis severity” categories mean:

What “moderate non-obstructive plaque” means for the patient: A report that reads “40 percent stenosis in the proximal LAD with non-calcified and mixed plaque” does not mean “no problem.” It means there is visible atherosclerotic disease in the largest and most consequential coronary artery. The lumen is not obstructed at rest. The patient is not having a heart attack. But the plaque is there. It carries a higher annual event rate than a truly clean scan. It changes the conversation about statin therapy intensity, blood pressure targets, lifestyle modification, and repeat imaging intervals 5 / Solid .

The Evidence

SCOT-HEART (Scottish Computed Tomography of the Heart Trial)

The SCOT-HEART trial is the most influential randomized controlled trial of coronary CTA in stable chest pain. Published in the New England Journal of Medicine in 2018, the trial enrolled 4,146 patients with stable chest pain presenting to outpatient cardiology clinics in Scotland and randomized them to coronary CTA plus standard care versus standard care alone 5 / Solid .

The primary outcome was death from coronary artery disease or nonfatal myocardial infarction at five years.

Results:

• CTA group: 2.3 percent primary outcome rate
• Standard care group: 3.9 percent primary outcome rate
• Hazard ratio: 0.59 (95% CI 0.41 to 0.84; p = 0.004)
• Absolute risk reduction: 1.6 percent over five years
• Number needed to treat: 63 patients to prevent one MI or coronary death

The mechanism of benefit was not that CTA directly treated disease. It changed clinical management. Patients in the CTA arm were significantly more likely to receive preventive therapies including statins and aspirin, because the scan made the plaque visible and compelling in a way that a normal stress test could not. Preventive therapy use increased from 24 percent to 40 percent in the CTA arm. Invasive coronary angiography was more accurately targeted, with fewer angiograms showing entirely normal arteries.

This is a critical finding. The trial did not show that CTA reduced MI by finding significant stenoses and triggering revascularization. It showed that CTA reduced MI by identifying subclinical plaque and changing the pharmacological treatment of that plaque. The anatomy changed the prescription. The image changed behavior.

PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)

The PROMISE trial was a large US-based pragmatic RCT that randomized 10,003 symptomatic outpatients with suspected coronary artery disease to anatomic strategy (coronary CTA) versus functional strategy (exercise ECG, nuclear stress, or stress echocardiography) 5 / Solid .

The primary outcome was death, MI, hospitalization for unstable angina, or major procedural complication at median 25 months.

Results:

• CTA group: 3.3 percent primary outcome rate
• Functional testing group: 3.0 percent primary outcome rate
• Adjusted hazard ratio: 1.04 (95% CI 0.83 to 1.29; p = 0.75)
• Not significantly different

This trial is sometimes cited as evidence that coronary CTA offers no advantage over functional testing. That reading is partly correct and partly misleading. PROMISE was a pragmatic trial comparing two entire strategies. The CTA group had fewer normal subsequent catheterizations (3.4 percent vs 4.3 percent of catheterizations showing normal or near-normal coronaries, p = 0.02), meaning CTA was more accurate at identifying who truly needed invasive testing. The two strategies were equivalent at preventing events at two years, but PROMISE followed patients for a shorter duration than SCOT-HEART, and the populations were different. PROMISE enrolled predominantly lower-risk patients in the US, where preventive therapy rates were already higher at baseline.

The reconciliation between PROMISE and SCOT-HEART is this: in a short-term comparison of strategies in a well-treated population, coronary CTA and functional testing produce similar outcomes. Over five years in a population with undertreated preventive risk factors, the diagnostic specificity of CTA translates into meaningful clinical benefit by driving more intensive medical management of identified plaque.

Meta-analytic Evidence

A 2016 meta-analysis of 65 studies and 5,332 patients reported a pooled sensitivity of 95 to 99 percent and specificity of 64 to 83 percent for detecting obstructive coronary artery disease (defined as greater than 50 percent stenosis) compared with invasive angiography 5 / Solid . High sensitivity means coronary CTA is excellent at ruling out significant disease. Lower specificity means a positive finding on CTA (stenosis reported as 50 to 70 percent) requires confirmation with functional testing before proceeding to revascularization.

Coronary Calcium Score as a Risk Stratifier

The coronary artery calcium score, while a separate study from coronary CTA, provides context. A CAC score of zero in an intermediate-risk patient reduces the 10-year MACE risk to below 1 percent and supports deferral of statin therapy in appropriate candidates 5 / Solid . The MESA (Multi-Ethnic Study of Atherosclerosis) data, with over 6,800 participants, demonstrated that CAC score adds incremental prognostic value beyond traditional Framingham risk factors (Detrano, N Engl J Med. 2008; doi:10.1056/NEJMoa072100).

Prognostic Yield of Plaque Characterization

The PARADIGM registry enrolled 1,764 patients with serial coronary CTA scans and demonstrated that progression of total plaque volume, particularly non-calcified plaque, was independently associated with major adverse cardiovascular events 4 / Promising . Patients with high-risk plaque features on CTA had a 10-fold higher rate of MACE at 3.3 years compared with those without such features.

The ICONIC registry demonstrated that low-attenuation plaque on CTA was associated with a 10-year MI rate of 9.9 percent versus 2.9 percent in those without such plaque 4 / Promising .

Radiation Risk

The attributable cancer risk from a single prospectively gated coronary CTA at 2 mSv is estimated at 1 in 5,000 to 1 in 10,000 based on the linear no-threshold model 3 / Early . This risk must be contextualized against the 10-year cardiovascular event rate in the patient being imaged. For a 55-year-old with intermediate risk, the expected cardiovascular benefit far exceeds the estimated radiation risk. For a 35-year-old with very low pre-test probability, the calculus shifts.

The Patient Experience

Before the Scan

The preparation begins 24 to 48 hours before the appointment. Patients are asked to avoid caffeine during this window because caffeine raises the heart rate. If oral metoprolol is planned for heart rate preparation, the cardiologist prescribes it in advance with instructions on timing (typically 100 mg orally 60 to 90 minutes before the scan). Patients who take daily beta-blockers should continue those medications. NPO status is not required for most protocols, though light eating is recommended in the hours before contrast injection.

The imaging center places a large-bore IV (typically 18 to 20 gauge) in the antecubital fossa at arrival. Heart rate and blood pressure are checked. A 12-lead ECG confirms the rhythm. If the heart rate remains above 65 to 70 bpm despite oral premedication, additional IV metoprolol may be given in small increments in the CT suite, typically 2.5 to 5 mg boluses with monitoring.

During the Scan

The patient lies supine on the CT table with arms raised above the head (to reduce scatter artifacts over the chest). ECG electrodes are placed. The scanner gantry is large and open, nothing like the enclosed tube of an MRI. Scanning takes seconds to minutes depending on the protocol.

Sublingual nitroglycerin (0.4 mg) is sprayed or placed under the tongue immediately before scanning. Patients should expect a brief warm flush, a mild headache, and sometimes a brief drop in blood pressure. These are expected effects, not adverse reactions.

Contrast injection delivers a transient but intense warm sensation that many patients describe as spreading from the arm through the chest to the pelvis, and briefly mimicking the sensation of urination. This lasts 20 to 30 seconds. Patients should be warned explicitly so they are not alarmed.

What Your Cardiologist Will Not Have Time to Explain

The scan produces several hundred to several thousand images that the radiologist or cardiologist processes using specialized workstations. The reconstruction and interpretation takes 30 to 60 minutes after the raw data is acquired. What gets reported is a summary of findings. What often does not get communicated in the follow-up call or clinic note is the distinction between:

• “No stenosis identified” (which may still show diffuse non-calcified plaque in the vessel wall that is not causing luminal narrowing)
• “Non-obstructive plaque” (which is disease, not absence of disease)
• “Moderate stenosis, 50 to 69 percent” (which requires functional follow-up and is not an indication for immediate stenting)

The report also frequently includes findings outside the coronary arteries. Every coronary CTA images a volume of chest that includes the lung bases, pericardium, aorta, mediastinum, and upper liver. Lung nodules appear on 10 to 20 percent of coronary CTAs. Most are benign. Most require follow-up per Lung-RADS criteria. The patient needs to understand this before the scan, not after.

Contrast Nephropathy

Iodinated contrast can cause acute kidney injury in patients with pre-existing renal insufficiency. The threshold for caution is an estimated GFR below 45 mL/min/1.73 m². In patients with GFR between 30 and 45, the risk and benefit must be explicitly discussed and IV hydration protocols considered. In patients with GFR below 30, coronary CTA is generally avoided unless the clinical need is urgent. The actual incidence of contrast-induced AKI in modern series with adequate hydration is lower than historical estimates, but the risk is non-zero 5 / Solid .

Sex Differences

Women referred for coronary CTA are more likely than men to have non-obstructive coronary artery disease and less likely to have obstructive stenoses, yet their risk of MACE associated with non-obstructive plaque is proportionally equivalent. Women with diffuse non-obstructive disease on CTA have a significantly higher long-term event rate than women with a completely normal scan 5 / Solid . The presentation in women is also more commonly atypical (dyspnea, fatigue, jaw pressure), meaning that normal stress test results in symptomatic women should trigger stronger consideration of anatomical imaging rather than reassurance. Coronary CTA is particularly well-positioned as a first-line test in women with intermediate pre-test probability and atypical symptoms.

Geographic Access in Illinois

Coronary CTA requires a multi-detector CT scanner capable of prospective gating, which is not present in every community hospital. In the Urbana-Champaign area, Carle Foundation Hospital operates a cardiac imaging center with 256-slice CT capability and dedicated cardiac CT interpretation. Northwestern Medicine Bluhm Cardiovascular Institute in Chicago offers complete coronary CTA with same-day FFRct analysis. OSF Saint Francis Medical Center in Peoria operates a cardiac CT program with chest pain protocol integration. Patients in rural Central Illinois who require coronary CTA can typically be seen within two to five days at these centers.

Decisions and Trade-Offs

Coronary CTA Versus Stress Testing: Which Comes First?

The choice between an anatomical test (coronary CTA) and a functional test (stress ECG, nuclear stress, stress echo) depends on what clinical question is being asked.

Stress testing asks: Is this patient ischemic at peak exercise? It measures the physiological consequence of coronary artery disease. A positive stress test means significant ischemia. A negative stress test means no significant ischemia at the level of exercise achieved, which is not the same as no disease.

Coronary CTA asks: Does this patient have plaque? It measures the anatomical substrate. A positive CTA means plaque is present. It does not tell you whether that plaque is causing ischemia today.

The two tests answer different questions and are both useful. The 2021 AHA/ACC Chest Pain Guidelines give a Class I recommendation to either coronary CTA or exercise ECG as first-line evaluation for intermediate-risk stable chest pain, with coronary CTA preferred when functional testing is inconclusive or when pre-test probability is in the intermediate-to-higher range (Gulati, JACC. 2021; doi:10.1016/j.jacc.2021.07.053).

Coronary CTA Versus Invasive Angiography

Coronary CTA cannot substitute for invasive angiography in patients with high pre-test probability, acute coronary syndrome, known severe disease requiring revascularization planning, or hemodynamic instability. It is a triage tool, not a treatment platform. When CTA identifies severe stenosis (70 to 99 percent) or the clinical picture is compelling, the next step is invasive evaluation, which offers the option of simultaneous percutaneous coronary intervention.

The advantage of CTA in the intermediate-risk population is that it identifies patients who do not need invasive angiography, thereby avoiding the 0.1 percent periprocedural stroke and MI rate of diagnostic catheterization in lower-risk patients.

The “Normal” CTA Problem

A coronary CTA reported as “no stenosis, no calcified plaque” in a patient with multiple cardiovascular risk factors may provide false reassurance if the report is interpreted as “no cardiovascular risk.” Non-calcified plaque is invisible on calcium scoring and may be present even when the CTA shows no stenosis if disease is entirely within the vessel wall. A clean lumen does not mean clean arteries. The conversation after a normal CTA should focus on sustained lifestyle modification and continued risk factor management, not discontinuation of preventive therapies.

Borderline Results: The 50 to 69 Percent Gray Zone

A stenosis reported as 50 to 69 percent on coronary CTA falls in the zone where the functional significance is uncertain. CTA identifies the anatomy; it cannot confirm whether that stenosis is causing ischemia. The current standard of care for an intermediate stenosis on CTA is functional confirmation, either through FFRct analysis of the same dataset, nuclear stress testing, or stress echocardiography, before proceeding to revascularization. Revascularization of a non-ischemic intermediate stenosis does not reduce MI or death based on the COURAGE and ISCHEMIA trials 5 / Solid .

The Three Questions Every Patient Should Ask

1. “What does my report mean for my ten-year risk, not just my lumen diameter?” The degree of stenosis is one number. The plaque burden, the plaque type, and the coronary calcium score together determine long-term risk. Ask for the full characterization, not just the maximum stenosis.

2. “Does a normal result change my medications?” If you were going to start a statin based on your Pooled Cohort Equations score, a normal CTA with a CAC of zero is a legitimate reason to defer. If you already have non-calcified plaque, a “normal” stenosis measurement does not change the need for statin therapy.

3. “When do I need this repeated?” Coronary CTA is not a surveillance test for most patients. A baseline scan that shows no disease in a low-intermediate risk patient does not need to be repeated in three years. A scan that shows moderate non-obstructive plaque should prompt discussion of repeat imaging only in the context of a changed clinical picture or a question about progression. Routine serial CTA without a clinical trigger is not evidence-based and adds radiation exposure without documented benefit (Unsupported, no trial has shown benefit from serial CTA at fixed intervals in stable asymptomatic patients).

Clinical Synthesis

Coronary CTA is the study that removes the “I wonder” from the chest pain conversation. When a patient has intermediate pre-test probability and you want to know whether they have coronary artery disease before deciding on medical therapy intensity, CTA gives you anatomy. That anatomy changes prescriptions, as SCOT-HEART demonstrated with a 34 percent reduction in fatal MI and nonfatal MI at five years.

But the synthesis from a preventive cardiology perspective is about what happens after the scan. The patient leaves with a report. The report says “moderate non-obstructive plaque” or “CAC score 187.” Now what? Most patients receive a one-sentence summary from their ordering provider and return to the same behaviors that produced the plaque in the first place.

A structured cardiovascular assessment is the entry point for patients who have had coronary CTA and want to understand what their result actually means for their ten-year trajectory. The audit collects the CTA report alongside lipid panels, blood pressure logs, metabolic parameters, family history, and behavioral data to produce a single integrated picture: this is where you are, this is what the plaque is telling us, and this is what must change.

For patients with established non-obstructive CAD who want a structured six-month recalibration program, a structured metabolic reset provides a longitudinal framework for lifestyle, pharmacological optimization, and follow-up imaging decisions. For executives and professionals who want coronary CTA included in an annual advanced cardiovascular screen, a preventive cardiology program protocol includes interpretation of the scan within the context of full metabolic and functional assessment.

Patients in Central Illinois seeking coronary CTA evaluation can access the program through Carle Foundation Hospital’s cardiac imaging center. Patients in the greater Chicagoland area can connect through the clinical network affiliated with Northwestern Medicine Bluhm Cardiovascular Institute and Rush University Medical Center. The scan is the beginning of the conversation, not the end of it.

Paired Foundations Articles:

• PROC-010: FFRct (functional extension of the coronary CTA dataset)
• PROC-009: IVUS and OCT (invasive plaque characterization when CTA is insufficient)
• PROC-013: Stress Testing (functional complement to anatomical CTA)
• PROC-001: Cardiac Catheterization (the invasive next step when CTA shows severe stenosis)