Heart disease remains the leading cause of death for both men and women in the United States, yet many heart attacks occur in people who had few, if any, warning signs. [1]
As interest in preventive cardiology grows, more people are asking about advanced imaging tests, such as CT coronary angiography (CTCA). This technology offers both health professionals and patients an advantage by detecting coronary artery disease well before symptoms appear. This allows physicians to directly see plaque building up inside the coronary arteries rather than simply estimating cardiovascular risk through traditional blood work and other classic heart screenings.
But not all CTCA evaluations are equal. The quality of a CT coronary angiography depends on much more than whether a scan was performed. Image quality, radiation dose, scanner technology, heart rate control, interpretation, and clinical follow-up all influence how useful the study ultimately becomes.
At Biograph, CTCA isn’t performed as a standalone diagnostic test. Instead, it’s one part of an integrated cardiovascular assessment that’s designed to translate results into meaningful clinical action today.
What is a CT coronary angiography?
A CT coronary angiography (CTCA) is a specialized heart CT scan that uses intravenous contrast to create detailed images of the coronary arteries.
Unlike cholesterol testing or cardiovascular risk calculators, CTCA allows physicians to assess the health of your arteries in real time. It can identify narrowing, plaque buildup, congenital abnormalities, and both calcified and non-calcified (soft) plaque that may increase your risk of cardiovascular disease in the future.
What does a CT coronary angiography show?
One of CTCA's greatest strengths is that it answers a different clinical question than many traditional cardiovascular tests.
Those tests still provide valuable information. Blood work measures biomarkers associated with cardiovascular risk, while stress tests evaluate how well blood flows to the heart during exercise. A coronary artery calcium (CAC) scan measures calcified plaque, helping estimate a person’s risk of future cardiovascular disease.
CT coronary angiography goes one step further by visualizing the coronary arteries themselves. Unlike a CAC scan, CTCA can detect both calcified and non-calcified (soft) plaque, as well as areas where plaque is narrowing the arteries. This distinction matters because soft plaque often develops years before it becomes calcified, meaning someone can have a CAC score of zero and still have early coronary artery disease. [2]
Depending on the findings, CTCA can identify:
Calcified plaque
Soft (non-calcified) plaque
Mixed plaque
Coronary artery narrowing (stenosis)
Congenital coronary artery abnormalities
Overall plaque burden
How is Biograph's CTCA program different?
Modern CT technology has made coronary imaging safer and more accurate than ever before, but not every CTCA program is built the same.
At Biograph, our focus isn't simply obtaining an image. Our core focus is producing a high-quality study while minimizing radiation exposure and integrating those findings into a broader cardiovascular prevention strategy.
Read on to learn about the various features that distinguish our approach from other tests.
Advances in CT technology have substantially reduced radiation exposure compared with older-generation scanners. At Biograph, our imaging protocols achieve an average radiation dose approximately 75% lower than many conventional CT scanners, while maintaining diagnostic image quality.
Radiation dose depends on several factors, including scanner technology, patient characteristics, heart rate, and scan technique. However, thoughtful protocol design allows physicians to obtain the data they need with less exposure.
Because the heart is constantly moving, coronary imaging requires exceptional speed and precision. Motion during image acquisition can reduce image quality and make small areas of plaque more difficult to evaluate.
Biograph's advanced CT technology can capture the entire heart in a single rotation, shortening scan time while limiting motion artifact. Combined with heart rate management before the scan, this approach helps maximize image quality while lowering radiation exposure.
The result is clearer visualization of the coronary arteries, greater diagnostic confidence, and fewer repeat scans.
Identifying an abnormality is only valuable if it leads to timely action.
For example, if your CTCA reveals an urgent or clinically significant finding, Biograph’s clinical team reviews the results promptly, contacts you directly, and coordinates the appropriate next steps.
Depending on the findings, that may include consultation with a cardiologist, additional imaging, medication adjustments, or referral for treatment when needed.
CTCA vs. a stress test: What’s the difference?
Stress testing and CT coronary angiography provide complementary information.
A stress test evaluates how well blood reaches the heart during exertion, while CT coronary angiography visualizes the coronary arteries themselves. [3] Because CTCA can detect plaque before it significantly limits blood flow, it may identify coronary artery disease even when stress testing is normal.
The most appropriate test depends on your symptoms, medical history, and cardiovascular risk.
One Biograph member in her 60s sought additional reassurance after experiencing intermittent chest discomfort.
She underwent an electrocardiogram (ECG), blood tests, and a stress test outside of Biograph, all of which were reassuring. Still concerned, she chose to undergo a CTCA at Biograph.
The scan revealed a complete blockage of her left anterior descending (LAD) coronary artery despite a relatively low coronary calcium score. Because the blockage had developed gradually, her body had formed collateral blood vessels that helped preserve blood flow, making the condition difficult to detect with conventional testing alone.
Biograph’s clinical team coordinated urgent follow-up care within 48 hours, allowing her to move quickly toward definitive treatment.
While every patient's situation is different, her experience highlights an important lesson: no single test tells the whole story. Blood biomarkers, stress testing, and advanced imaging each provide different insights into your cardiovascular health. You may need all of them to get an accurate snapshot.
Among Biograph members with normal lipid levels, approximately two out of three still show hidden signs of cardiovascular risk on advanced imaging, including coronary plaque or small vessel disease. And among members aged 40 and older who undergo CTCA, about 41% receive a recommendation to modify their treatment plan based on the findings.
Who may benefit from CT coronary angiography?
Remember this: a “normal” blood test is not a clean bill of health. CTCA may benefit individuals who want a more complete understanding of their cardiovascular health. Depending on their clinical circumstances, candidates may include individuals who:
Have intermediate or elevated cardiovascular risk
Have a strong family history of premature heart disease
Have symptoms such as chest discomfort or unexplained shortness of breath
Have cardiovascular risk factors despite otherwise reassuring laboratory results
Want a more comprehensive assessment as part of a preventive health evaluation
What are the risks or limitations of CT coronary angiography?
No medical test is perfect. As illuminating as a CTCA can be, it still comes with limitations.
The examination requires intravenous contrast, which may not be appropriate for people with severe kidney disease or certain contrast allergies.
Although radiation exposure has declined substantially with modern scanners, CTCA still involves a small amount of ionizing radiation. The exact dose varies depending on scanner technology, patient characteristics, and imaging technique.
Also, CTCA does not replace healthy lifestyle habits or ongoing cardiovascular risk management. Imaging provides valuable information, but it works best when interpreted alongside blood biomarkers, body composition, cardiorespiratory fitness, blood pressure, and other measures of overall health.
CT coronary angiography can reveal coronary artery disease before symptoms develop, but the scan is only one part of the process. Its value depends on high-quality imaging, expert interpretation, and a care team prepared to act on the findings.
At Biograph, CTCA is part of an integrated cardiovascular assessment that combines advanced imaging with blood biomarkers, cardiovascular fitness testing, and personalized clinical guidance to identify hidden risk and inform long-term prevention.
Commonly asked questions about Biograph's CT Coronary Angiography Program
Is a CT coronary angiography invasive?
No. CT coronary angiography is a non-invasive imaging test that uses a CT scanner and intravenous contrast to visualize the coronary arteries without inserting catheters into the heart.
Does CT coronary angiography use contrast?
Yes. CTCA uses iodinated intravenous contrast to highlight the coronary arteries and improve visualization of plaque, narrowing, and other abnormalities.
How much radiation is involved in a CT coronary angiography?
Radiation exposure varies depending on the scanner, imaging protocol, heart rate, and patient characteristics. Modern CT technology has substantially reduced radiation doses compared with older-generation scanners. At Biograph, advanced protocols achieve an average radiation dose approximately 75% lower than many conventional CT scanners while maintaining high-quality images.
Can CT coronary angiography detect soft plaque?
Yes. Unlike a coronary artery calcium scan, CT coronary angiography can identify both calcified and non-calcified (soft) plaque, providing a more comprehensive view of coronary artery disease.
Why does Biograph screen CT coronary angiography images before VO2 max testing?
VO2 max testing requires maximal cardiovascular effort. Screening CT coronary angiography images beforehand helps identify significant coronary artery disease or other findings that may warrant additional evaluation before exercise testing, supporting both safety and informed clinical decision-making.
Dr. Michael Doney is Biograph’s Executive Medical Director, with over 20 years of experience leading clinical care and advancing a more proactive, data-driven approach to medicine.
Clinical references
Centers for Disease Control and Prevention. Heart Disease Facts. CDC. Published October 24, 2024. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html
Mohan J, Bhatti K, Tawney A, Zeltser R. Coronary Artery Calcification. StatPearls Publishing; 2020. Accessed July 29, 2026. https://www.ncbi.nlm.nih.gov/books/NBK519037/
American Heart Association. (AHA). What Is a Stress Test? https://www.heart.org/-/media/files/health-topics/answers-by-heart/what-is-a-stress-test.pdf
