[The challenging patient-recommendations and solutions].

backgroundThe continuous technical development of cardiac computed tomography (CT) over the last decades has led to an improvement in image quality and diagnostic accuracy, while simultaneously reducing radiation exposure. Despite these advancements, certain patient-related factors remain a challenge to conduct a high-quality diagnostic examination. QUESTION: What factors can negatively affect the image quality of cardiac CT and how can these be addressed? MATERIALS AND

methodsAnalysis of the available literature on cardiac CT and identification of the quality-limiting factors, discussion, and possible solutions.

resultsTachycardia, arrhythmias, high coronary calcification, the presence of stents and coronary artery bypasses, as well as obesity and anxiety were identified as primary factors that limit image quality and diagnostic accuracy. These issues primarily arise from a lack of response or the presence of contraindications to premedication, blooming artifacts, variations in postoperative anatomy, as well as other personal factors. Suggested solutions include optimizing premedication, scanner modifications, the selection of the most suitable acquisition mode, new scanner technologies, and innovative image reconstruction methods including artificial intelligence.

conclusionsCertain factors continue to pose a major challenge for cardiac CT. Knowledge of alternative premedication, scanner modifications, as well as the use of postprocessing software and new technologies can help overcome these limitations, enabling successful and safe cardiac CTs even in challenging patients.