CT evaluation of the coronary anatomy (CT coronary angiogram) has developed rapidly as scanner technology and software have made dramatic leaps forward in capability. The introduction of multidetector scanners allows for capturing a temporal sequencing needed to image a beating heart, and the resolution allows for the imaging on the scale of the epicardial coronary arteries. The specific scanning protocols have also advanced reducing the patient radiation exposure. All of these factors now allow for the CT coronary angiography to be a powerful tool in the evaluation of of a patient with suspected acute coronary syndrome. The following is a protocol developed at our institution for the emergency department to use in preparing the patient to for a CT coronary angiogram.

Indications to obtain CT coronary angiogram

  • Evaluation of chest pain syndrome or suspected cardiac ischemia.
  • Must be of sufficient risk that, without the test, you would admit to observation.
  • Should be for patients age < 55 (men) <65 (women), or < 45/55 if they have 3 CAD risk factors, or known CAD. Age and risk factors are general guidelines, and exceptions can be made. Exception is also appropriate for very atypical pain or patients with a previous negative or indeterminate stress test. You may use your sound clinical judgment.
  • An initial negative troponin is recommended but not necessary.

How much radiotaiton exposure is there?

  • 3-5 millisevert