SCCT President: Key trends in cardiac CT

Major trends include advanced imaging for planning and guiding structural heart procedures, and coronary computed tomography angiography (CCTA) for chest pain evaluation, percutaneous coronary intervention (PCI) planning, and the rapidly expanding area of artificial intelligence (AI) assessments or coronary disease. Many cardiac imaging experts say these AI technologies may facilitate a paradigm shift in personalized cardiac care, especially for screening and earlier preventive care.

"AI and machine learning is really where we have seen explosive growth in the past few years. We still need more data on how to apply this in preventive medicine and in our day-to-day cardiology practice and what this means, especially plaque imaging assessments and FFR-CT. There are also some newer tools such as fat attenuation index, and AI to assess myocardial patterns such as those we see in cardiac MRI," Chinnaiyan explained.

New reimbursement codes for technologies like AI plaque assessments and FFR-CT are also helping accelerate adoption. This is making cardiac CT one of the few imaging areas where AI-enabled tools are seeing tangible financial pathways, mainly because the tech is backed by years of clinical study data.

From diagnosis to interventional planning

One of the most transformative developments is the emergence of CT-guided intervention planning. Advances in imaging quality and software are enabling clinicians to use CT not only for diagnosis, but also to guide percutaneous coronary intervention (PCI). Interventional cardiologists traditionally perform a diagnostic cath and have no idea of what they will see or what they will need to perform any procedures and make decisions on the fly. However, new CCTA tools, including PCI planning platforms, allow physicians to assess lesion characteristics, anticipate procedural risks and select appropriate devices before entering the catheterization lab. This shift to CCTA imaging is already reducing the need for  invasive diagnostic angiography.

"With cardiac CT, gone are those days when you needed to take a patient to the cath lab for a diagnostic cath to understand what to do next. With the improvement of CT technology, we can do away with diagnostic caths and all the risks that come with it to the patient, and instead use CT not just to see what kind of disease, but what kind of intervention might be the best for the patient," Chinnaiyan said.

Use of CCTA for preventive cardiology gains momentum

CCTA is also gaining traction in preventive care, where it may enable earlier and more precise identification of at-risk patients and get them on statins and other drug therapies years before they become symptomatic. Efforts such as the Atherosclerosis Computed Tomographic Imaging to Optimize New Drug Development (ACTION A2D2) consortium are exploring the use of coronary plaque as an endpoint in clinical trials, potentially redefining how therapies are evaluated, she explained.

This approach could shift decision-making away from population-based risk models toward individualized imaging-based assessments, opening the door to much earlier intervention years before the current standard of care to prevent the development of advanced coronary disease when it is much harder to treat.

SCCT education reflects evolving needs

The rapid expansion of cardiac CT is being mirrored in SCCT’s educational programming. The 2026 meeting will feature dedicated tracks on structural heart disease, AI, coronary disease management and CT-guided interventions. Additional clinical sessions focus on including sex- and gender-based imaging, and the role of cardiac CT in women’s health across their lifespan.

There also is a focus on the business and economics side as health systems look to initiate or expand CCTA programs. SCCT wants to address the practical realities of building and maintaining cardiac CT programs, including reimbursement strategies and operational considerations for both clinicians and C-suite administrators.

Despite the technology’s growth, Chinnaiyan highlighted persistent disparities in access to cardiac CT, both globally and within the United States. These challenges are compounded by concerns about cost, infrastructure and sustainability, particularly as newer technologies like photon-counting CT scanners enter the market that offer much improved image quality, but at a high price point. She said sessions will also discuss these issues and how to building sustainability and health equity into CCTA programs.

“Just because we can do something is not a reason to do it,” she said, emphasizing the need to balance innovation with responsible implementation.

CCTA requires collaboration between radiology, cardiology and heart teams

A defining feature of cardiac CT’s evolution is its collaborative nature. SCCT continues to bring together both cardiologists and radiologists at its annual meeting, reflecting the shared expertise required to advance the field. While CCTA has played a critical role in structural heart teams for more than a decade, that type of collaboration is now expansing into cardiac surgery and interventional cardiology as CT becomes more central to clinical decision-making.