Patient prep & appropriate use

What the patient needs to do, what to give them before scanning, and where CCTA fits — and doesn't fit — in the workup.

Patient selection and preparation for CCTA — a pre-scan checklist — The pre-scan checklist — appropriateness, rate control, contrast prep, nitroglycerin, positioning, and the final technical check.

For a successful cardiac CT, the patient must be able to:

Hold still
Lift both arms above the shoulders
Follow breathing instructions — moderate inspiration without bearing down
Receive iodinated contrast and rate-controlling medications

1 Pharmacology

Beta-blockers (e.g. metoprolol) or calcium-channel blockers (e.g. diltiazem) to lower the heart rate below 70 bpm, prolonging the diastolic rest period needed for a motion-free image.
Nitroglycerin concurrently for coronary vasodilation.

2 Appropriate use

CCTA is most appropriate for:

Excluding CAD in symptomatic patients with low-to-intermediate pre-test probability
Evaluating structural morphology — TAVR planning, bypass graft patency
Cases where prior stress testing is equivocal

3 Inappropriate use

Generally contraindicated for:

Asymptomatic low-risk patients (for full contrast angiograms)
Severe renal failure (Cr > 1.8)
Severe contrast anaphylaxis
Uninterpretable high heart rates
Morbid obesity (BMI > 40)
High pre-test probability cases where invasive catheterization would be definitively preferred

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Image quality: the 5 C's