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Cardiac Imaging CAC & CCTA

Advanced imaging to assess coronary artery disease and atherosclerotic plaque burden

1

Two Different Cardiac CT Scans

There are two primary types of cardiac CT scans used to evaluate heart health. While they use similar technology, they provide very different information and have different clinical applications, costs, and radiation exposures.

CT Coronary Calcium Score (CAC)

Non-contrast scan measuring calcified plaque

3-5 min
Time
~1 mSv
Radiation
$75-200
Cost
Usually Yes
Rx Needed

What It Measures

Quantifies calcified (hardened) plaque in coronary arteries. Result is an Agatston score (0-1000+).

Strengths

  • Excellent risk stratification predictor
  • No IV contrast needed (safer)
  • Quick, affordable, low radiation

Limitations

  • Misses soft (non-calcified) plaque
  • Young patients often score 0 despite risk

CT Coronary Angiogram (CCTA)

Contrast-enhanced scan visualizing all plaque

10-20 min
Time
5-15 mSv
Radiation
$1,000+
Cost
Usually Yes
Rx Needed

What It Measures

Visualizes both calcified and soft plaque using IV contrast. Assesses stenosis (blockage) severity.

Strengths

  • Detects all plaque types (complete picture)
  • High negative predictive value
  • Characterizes high-risk plaque features

Limitations

  • Higher radiation & cost
  • Requires IV contrast (risk for some)
2

Which Scan Should You Get?

For Most People: Start with CAC

For asymptomatic individuals interested in cardiovascular risk assessment and prevention, CAC is the preferred first test. It's affordable, low-radiation, and provides excellent risk stratification without the need for IV contrast.

Consider CAC if:

  • Age 40-75 with intermediate risk factors
  • Want cost-effective baseline tracking
  • No active heart disease symptoms

Consider CCTA if:

  • Symptoms suggestive of coronary disease
  • Positive CAC score requiring detail
  • Strong family history or high apoB/Lp(a) scores
  • Physician recommended alternative to cath

Important: If you have active symptoms (chest pain, shortness of breath with exertion, palpitations), do not self-order imaging. Seek medical attention immediately.

3

Radiation Exposure in Context

Source Dose (mSv)
DEXA Scan 0.005
Round-trip flight (NYC to LA) 0.05
Chest X-ray (2 views) 0.1
CT Coronary Calcium Score (CAC) ~1.0
Annual Background Radiation ~3.0
CT Coronary Angiogram (CCTA) 5-15
CAC radiation is minimal (~1/3 of annual background). CCTA is higher but safe for indicated use.
4

Where to Get Imaging

CAC

This test typically requires a prescription, but some centers allow self-booking ($75-200):

  • • HeartScan Services
  • • SimonMed Imaging
  • • Local hospital radiology (self-pay)
Find "calcium score near me"

CCTA

Requires a physician order. Insurance may cover if symptoms are present. Performed at hospitals or advanced imaging centers.

Discuss with your cardiologist.

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