CT Angiography of Acute Chest Pain

An overview of triple-rule-out appropriateness criteria and CT technique to provide a cost-effective evaluation of acute coronary syndrome patients, while differentiating patients who instead should be discharged.

Course ID: Q00291 Category:
Modalities: , ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 0.75
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 0.50
Diagnostic and Conduction System Studies: 0.50

Computed Tomography: 2.00
Patient Care: 0.50
Patient Interactions and Management: 0.50
Safety: 0.25
Radiation Safety and Dose: 0.25
Image Production: 0.25
Image Formation: 0.25
Procedures: 1.00
Neck and Chest: 1.00

Nuclear Medicine Technology: 0.75
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 0.50
Cardiac Procedures: 0.50

Registered Radiologist Assistant: 2.00
Patient Care: 0.50
Patient Management: 0.25
Pharmacology: 0.25
Safety: 0.25
Patient Safety, Radiation Protection and Equipment Operation: 0.25
Procedures: 1.25
Thoracic Section: 1.25


  1. Introduction
  2. Clinical Role of Triple-Rule-Out CT
  3. Patient Selection
  4. CT Hardware and Radiation Issues
  5. TRO CT Technique and Image Quality
  6. Patient Preparation and Monitoring
  7. Setting Up the Scan
  8. Contrast Agent Injection and Timing of Image Acquisition
  9. Image Interpretation
  10. Conclusion


Upon completion of this course, students will:

  1. recognize what condition comprises most adult emergency department visits
  2. understand which group of patients are the prime candidates for the TRO CT
  3. understand how TRO CT can benefit a healthcare facility
  4. comprehend how coronary calcium burden affects TRO CT
  5. know acceptable symptoms for TRO CT candidates
  6. understand appropriate heart rate for the TRO CT study
  7. understand the effects of beta blockers
  8. recognize relative contraindications to the contrast media used in the TRO study
  9. know what compound is used to dilate the coronary arteries
  10. identify equipment requirements necessary for performing TRO CT
  11. recognize scan requirements for the TRO CT exam
  12. realize hardware requirements for the TRO CT exam
  13. understand how to reduce radiation exposure during the TRO scan
  14. identify pitfalls of prospective TRO CT
  15. identify prime candidates for prospective TRO CT
  16. realize the important aspects of dedicated TRO CT protocols
  17. recognize the vessels evaluated with TRO CT
  18. comprehend the goals of TRO CT
  19. know the appropriate size catheters for TRO CT
  20. know the best location for the IV catheter during TRO CT
  21. know the best placement for the patient’s arm during the TRO CT study
  22. realize acceptable heart rates for the TRO CT exam
  23. know how to administer beta blockers
  24. know when to administer beta blockers
  25. identify the reaction time of IV beta blockers
  26. know patient-related factors beta blockers can affect
  27. recognize important blood pressure minimum at which point beta blockers must be stopped
  28. understand when nitroglycerin should be administered
  29. learn why patient breathing should be practiced
  30. know how image quality is affected if the patient’s inspiration is too great
  31. understand how radiation dose relates to distance covered by scan
  32. understand the recommended scanning direction for TRO CT
  33. understand how to achieve homogeneous enhancement across both the left and right side of the heart
  34. realize how to scan at “peak plateau”
  35. know image types used for interpretation
  36. understand what reconstructions are used to evaluate wall motion
  37. understand standard cardiac imaging planes
  38. realize developments that will aid in ACS detection in the futute
  39. understand what considerations must be taken in TRO CT
  40. understand the important benefits of TRO CT