A new business paradigm to make coronary CT angiography (CCTA) accessible to all.

Recently, the Centers for Medicare and Medicaid proposed a classification change that, if enacted, could double reimbursement for coronary CT angiography (CCTA) in the U.S. [1]. With this comes the potential to realistically build an economically viable and sustainable model to deliver cardiac CT outside of major urban (hospital and private practice) and academic centers. The value of CCTA in reducing cardiovascular morbidity and mortality has been demonstrated in large, randomized control trials and real-world studies, but access to CCTA in rural, socially deprived, and low-resource settings (including poorer urban areas with a lack of specialist equipment and specialty-based services) remains a significant challenge. This paper discusses the end-to-end business aspects required to deliver a sustainable cardiac CT service in these areas, exploring technologist-delivered services, with remote support from physicians, and the potential to leverage developing artificial intelligence (AI) decision aid tools and mobile scanners.