Key things to consider when building the team for your cardiac CT program
As the use of cardiac CT angiography (CCTA) expands rapidly across health systems, imaging leaders are increasingly looking beyond physician expertise to build the multidisciplinary teams needed to deliver consistent, high-quality exams. While physician champions are needed to make these programs successful, technologist champions are equally important.
Brennen Johnston, BASRT(R)(CT), ARRT, radiology director of enterprise advanced cardiac imaging for Advocate Health in Charlotte, North Carolina, discussed the growing role of lead cardiac CT technologists and nurse coordinators with Cardiovascular Business for a new video interview. He said these titles are key to scaling programs while maintaining image quality and patient safety.
A major challenge is that cardiac CT requires a different skill set from general CT. Technologists need additional knowledge of ECG, the circulatory system and detailed cardiac anatomy, while also understanding how to optimize imaging based on each patient's physiology and the capabilities of the scanner.
"There's a little bit more at stake to get it correct the first time," Johnston said, noting that prospectively ECG-gated examinations require careful planning. Poor image quality can reduce physicians' confidence in the study and impact subsequent care decisions.
Scanner technology adds another layer of complexity. Differences between older and newer systems, including wide-detector, dual-source and photon-counting scanners, can influence how exams are performed and the need for medications such as beta blockers to control heart rate.
That makes the nurse-technologist relationship particularly important. Nurses may be responsible for medication screening and administration, depending on institutional policies and state requirements. At Johnston's program, nurses screen patients for factors relevant to nitroglycerin administration, including blood pressure, recent use of vasodilators and a history of severe aortic stenosis. Technologists then repeat safety checks and administer medications in the imaging room under physician guidance.
The goal is not simply to follow a protocol, Johnston said, but to understand the patient's physiology and adjust the examination accordingly. A patient whose heart rate is in the low 60s before imaging, for example, may experience a rise in heart rate after nitroglycerin lowers their blood pressure. Recognizing those changes allows nurses and technologists to discuss whether additional medication or a different acquisition strategy could improve the examination while minimizing radiation exposure.
Training has become another significant issue as CCTA adoption outpaces the ability of accrediting organizations to produce enough formally trained technologists. Johnston said much of the education within his program is currently "homegrown," with standardized learning materials, competency assessments and quality metrics helping create consistency among staff.
His program includes about 85 technologists, making standardization especially important. A dedicated program lead can reduce variability in how cardiac CT training is delivered and establish clear expectations for ongoing competency and quality.
Johnston also advocates for moving beyond the traditional model of relying primarily on a physician champion. His health system has developed champions across nursing, patient navigators and CT technology.
That model becomes especially important as health systems integrate cardiac CT programs across geographically distant facilities.
"A week-long work boot camp does not suffice," Johnston explained. "We are not looking to install cardiac CT programs, we want to integrate them into one cohesive system. So its needs to be the idea that this should be a long-term relationship."
After an initial go-live week for CCTA as Advocate expands its program, he said they use a lot of remote scanning software to help assist or double check technologists at the new sites. They also have cross-market visibility on their electronic medical record (EMR)
"What we're really interested in isn't a week-long bootcamp. We're interested in making sure that they have a spot at the table for the collective. And so we have to establish a relationship because yes, while a physician champion is important for all initiatives, the relationships that you can have peer-to-peer are very important as well," he explained.
The approach can also reduce the burden on physicians. Technologists can work directly with other technologists, while nurses can address questions with nursing colleagues, allowing physicians to focus more of their time on interpreting examinations and managing complex clinical decisions.
As CCTA continues to scale, Johnston's message is that sustainable growth will depend not only on scanners and physician expertise, but on building a coordinated workforce capable of delivering consistent, safe and diagnostically confident imaging across an entire health system.
Johnston spoke on this topic in sessions at the Society of Cardiovascular Computed Tomography (SCCT) 2026 meeting. Find more coverage from this meeting.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]