Preface to the 4th Edition
We are now living in the era of cardiovascular CT! Coronary CTA now carries a Class I recommendation in international guidelines, where it is considered the test of choice in patients without known coronary artery disease. These guidelines are broadly accepted and practiced based on the remarkable, unparalleled ability of coronary CTA to not only accurately diagnose coronary artery lumen stenosis, but to assess total coronary plaque burden, plaque risk features, and CT-derived fractional flow reserve, while imaging patients using low radiation and contrast doses. Coronary artery calcium scoring, long known to be superior to traditional risk factor-based scores for informing patient and provider decision-making, is increasingly performed as patients and providers demand more individualized, accurate approaches to prevention in a world with increasingly prevalent preventive therapies beyond just statins and aspirin. In just the past few years, cardiac CT has become a prerequisite test to guide the optimal performance of virtually all transcatheter and many surgical cardiac interventions, and is increasingly being utilized to evaluate the left atrial appendage and patients with suspected or confirmed endocarditis.
This thrilling pace of scientific discovery and technological advancement, that has shaped the contemporary practice of cardiovascular CT, is a triumphant tribute to the collective efforts of researchers, clinicians, industry, and especially patients, all of whom knew that we could and must do better than the previous status quo. It is also a testament to the enduring efforts of the Society of Cardiovascular Computed Tomography(SCCT), whose mission is to improve health outcomes through effective use of cardiovascular CT. At the core of this patient-centered mission is a dedication to education and ensuring clinical excellence in the worldwide use of cardiovascular CT. That is why this book exists and it was with mission in mind that the we embarked during the tumultuous year of 2020 to update this edition.
The editors have significantly updated the SCCT board prep book with the latest guidelines, contemporary CT applications, and terminology, and worked to improve the quality of every question, explanation, and image. To this end, 170 new questions were written and all previous questions and images were reviewed, edited and rewritten to conform to the format of current board questions, using contemporary CT terminology and updated references. Many outdated questions and references were deleted. A new chapter dedicated to congenital heart disease and expanded content covering structural heart disease was added. Finally, we utilized a panel of peer-reviewers who practice cardiovascular CT. They evaluated each and every question and explanation and provided feedback that undoubtedly made this book better.
I would like to thank the authors and editors of the first 3 editions of this book, especially Stephan Achenbach, Ricardo Cury, Michael Poon, Guy Weigold and Armin Arbab-Zadeh. These master educators, thought leaders, and clinician-scientists, along with SCCT staff and leadership, helped to make the SCCT Board Prep book synonymous with excellence from its inception. This remarkably comprehensive book has served as the “go to” resource for those studying for cardiovascular CT board or wishing to refresh their knowledge in this increasingly complex field. Lastly, I would like to thank my family (Tammy, Elle, Dax, Jack and Boomer)for their steadfast love, support and patience throughout this project and always.
I hope that you enjoy the 4th edition!
Todd C. Villines, MSCCT
Editor-in-Chief of the 4th Edition
SCCT Board Prep Book