,solutions, candidates will be well-prepared to achieve a passing score and demonstrate excellence in cardiac CT
practice.
Keywords:
EACVI CCT exam, Cardiac CT, Coronary CT angiography, Calcium scoring, CT-FFR, Structural heart imaging,
Radiation safety, Board review
Answer Format:
Each question is presented in multiple-choice format with four or five options. The correct answer is provided
along with a comprehensive rationale explaining why it is correct and why the other options are incorrect. Where
applicable, clinical pearls and references to guidelines are included to enhance learning.
Compliance Checklist:
All questions verified against 2026/2027 EACVI CCT exam blueprint
Updated to reflect latest SCCT and EACVI guidelines
Includes detailed rationales for every answer
Covers all major content areas with balanced weighting
Designed for self-assessment and focused review
Pass guarantee: comprehensive coverage ensures readiness
Content Area Overview:
Content Area Questions Key Topics Weight
Physics and Radiation Safety 1-15 CT principles, radiation dose, safety 10%
protocols
Cardiac Anatomy and 16-25 Coronary anatomy, cardiac chambers, 7%
Physiology conduction system
Patient Preparation and 26-35 Patient selection, contraindications, 7%
Indications preparation
Scan Acquisition Protocols 36-50 Gating, contrast timing, scan parameters 10%
Contrast Media Administration 51-60 Injection protocols, contrast agents, timing 7%
Image Reconstruction and 61-70 Reconstruction kernels, MPR, MIP, 3D 7%
Post-Processing
Coronary Calcium Scoring 71-80 Agatston score, interpretation, risk 7%
stratification
Coronary CT Angiography 81-100 Stenosis assessment, plaque morphology, 13%
CTA interpretation
Stents and Bypass Grafts 101-110 Stent evaluation, graft assessment, artifacts 7%
Cardiac Function and Structure 111-120 Ventricular volumes, EF, wall motion 7%
Valvular Heart Disease 121-130 Valve morphology, stenosis, regurgitation 7%
Structural Heart Interventions 131-140 TAVI, MitraClip, LAA closure planning 7%
Congenital Heart Disease and 141-145 Anomalies, pericardial disease, masses 3%
Pericardium
Reporting and Quality 146-150 Structured reporting, incidental findings, QA 3%
Assurance
Page 2
,Q1. During a prospectively ECG-triggered axial scan on a dual-source CT, the heart
rate variability exceeds the padding window. Which adjustment best maintains image
quality while limiting radiation exposure?
A. Increase the padding window to cover the entire cardiac cycle
B. Switch to retrospective spiral with ECG-based tube current modulation
C. Lower the tube voltage to 100 kV and increase the padding
D. Proceed with the scan and accept potential motion artifacts
Correct Answer: B. Switch to retrospective spiral with ECG-based tube current
modulation
Rationale: Prospective triggering freezes motion only within a narrow phase; if HR
variability is large, the predefined window may miss the quiescent phase. Retrospective
spiral with ECG modulation extends coverage across the cycle while modulating dose,
preserving diagnostic quality. Increasing padding (A) raises dose excessively; lowering kV
(C) may reduce contrast-to-noise; accepting artifacts (D) is suboptimal.
Why Wrong:
A - Increases radiation dose without fully solving variability if arrhythmia is severe.
C - Lowering kV does not address the phase mismatch and may degrade image quality
in larger patients.
D - Accepting motion artifacts is clinically unacceptable for diagnostic CCT.
Reference: EACVI CCT Handbook, 2026; SCCT Guidelines on Acquisition.
Q2. A 68-year-old patient with atypical chest pain and a calcium score of 0 has a
low-to-intermediate pretest probability. Which additional finding would most justify
proceeding to coronary CT angiography?
A. Family history of premature coronary artery disease
B. Abnormal resting ECG with ST depression
C. Elevated high-sensitivity troponin above the 99th percentile
D. Coronary artery calcium score of 0 Agatston units
Correct Answer: C. Elevated high-sensitivity troponin above the 99th percentile
Rationale: Elevated troponin indicates myocardial injury, which may be due to
non-calcified plaque or other causes; CCTA can rule out obstructive CAD and identify
plaque. Family history (A) is a risk factor but not an acute indication. Resting ECG
changes (B) are non-specific. Calcium score of 0 (D) lowers likelihood but does not
exclude non-calcified plaque; however, the question asks for the finding that most justifies
CCTA, and an elevated troponin in a low-intermediate risk patient is a class IIa indication
for CCTA to rule out acute coronary syndrome.
Why Wrong:
A - Family history alone is not an acute indication for CCTA without symptoms.
B - Abnormal resting ECG is non-specific and not a strong standalone indication.
D - A zero calcium score reduces but does not eliminate the need for CCTA if clinical
Page 3
, suspicion remains.
Reference: 2026 ESC Guidelines on Chronic Coronary Syndromes; EACVI CCT
Curriculum.
Q3. In a patient with a bicuspid aortic valve undergoing pre-TAVI CT, which
measurement is most critical for determining the risk of annular rupture?
A. Coronary ostia height
B. Annular perimeter-derived diameter
C. Sinotubular junction diameter
D. Left ventricular outflow tract calcification
Correct Answer: D. Left ventricular outflow tract calcification
Rationale: Heavy LVOT calcification is a known predictor of annular rupture after
balloon-expandable valve implantation. While annular sizing (B) is essential for valve
selection, the question specifically asks about rupture risk. Coronary height (A) relates to
coronary occlusion; STJ diameter (C) affects supra-annular sealing, not rupture primary.
Why Wrong:
A - Coronary ostia height is crucial for coronary occlusion, not annular rupture.
B - Annular sizing is needed for valve selection but not the best predictor of rupture.
C - STJ diameter is more relevant to valve anchoring and coronary access.
Reference: EACVI/SCCT Pre-TAVI CT Guidelines, 2026.
Q4. Which statement accurately compares the advantages of CT-derived fractional
flow reserve (CT-FFR) versus invasive FFR?
A. CT-FFR requires additional radiation exposure and contrast administration.
B. CT-FFR provides a functional assessment without additional radiation or invasive
risk.
C. Invasive FFR is superior for assessing lesion-specific ischemia in serial stenoses.
D. CT-FFR has higher spatial resolution than invasive FFR.
Correct Answer: B. CT-FFR provides a functional assessment without additional
radiation or invasive risk.
Rationale: CT-FFR is computed from standard CCTA data using computational fluid
dynamics, thus no extra radiation or contrast. It provides functional significance
non-invasively. Invasive FFR is invasive and carries risk, but may be more accurate in
complex serial lesions; however, CT-FFR has shown good correlation. Spatial resolution is
not the primary comparison.
Why Wrong:
A - CT-FFR uses existing CCTA data; no additional radiation or contrast is needed.
C - Invasive FFR remains the reference standard, but CT-FFR is non-invasive and can
assess serial lesions reasonably.
Page 4
practice.
Keywords:
EACVI CCT exam, Cardiac CT, Coronary CT angiography, Calcium scoring, CT-FFR, Structural heart imaging,
Radiation safety, Board review
Answer Format:
Each question is presented in multiple-choice format with four or five options. The correct answer is provided
along with a comprehensive rationale explaining why it is correct and why the other options are incorrect. Where
applicable, clinical pearls and references to guidelines are included to enhance learning.
Compliance Checklist:
All questions verified against 2026/2027 EACVI CCT exam blueprint
Updated to reflect latest SCCT and EACVI guidelines
Includes detailed rationales for every answer
Covers all major content areas with balanced weighting
Designed for self-assessment and focused review
Pass guarantee: comprehensive coverage ensures readiness
Content Area Overview:
Content Area Questions Key Topics Weight
Physics and Radiation Safety 1-15 CT principles, radiation dose, safety 10%
protocols
Cardiac Anatomy and 16-25 Coronary anatomy, cardiac chambers, 7%
Physiology conduction system
Patient Preparation and 26-35 Patient selection, contraindications, 7%
Indications preparation
Scan Acquisition Protocols 36-50 Gating, contrast timing, scan parameters 10%
Contrast Media Administration 51-60 Injection protocols, contrast agents, timing 7%
Image Reconstruction and 61-70 Reconstruction kernels, MPR, MIP, 3D 7%
Post-Processing
Coronary Calcium Scoring 71-80 Agatston score, interpretation, risk 7%
stratification
Coronary CT Angiography 81-100 Stenosis assessment, plaque morphology, 13%
CTA interpretation
Stents and Bypass Grafts 101-110 Stent evaluation, graft assessment, artifacts 7%
Cardiac Function and Structure 111-120 Ventricular volumes, EF, wall motion 7%
Valvular Heart Disease 121-130 Valve morphology, stenosis, regurgitation 7%
Structural Heart Interventions 131-140 TAVI, MitraClip, LAA closure planning 7%
Congenital Heart Disease and 141-145 Anomalies, pericardial disease, masses 3%
Pericardium
Reporting and Quality 146-150 Structured reporting, incidental findings, QA 3%
Assurance
Page 2
,Q1. During a prospectively ECG-triggered axial scan on a dual-source CT, the heart
rate variability exceeds the padding window. Which adjustment best maintains image
quality while limiting radiation exposure?
A. Increase the padding window to cover the entire cardiac cycle
B. Switch to retrospective spiral with ECG-based tube current modulation
C. Lower the tube voltage to 100 kV and increase the padding
D. Proceed with the scan and accept potential motion artifacts
Correct Answer: B. Switch to retrospective spiral with ECG-based tube current
modulation
Rationale: Prospective triggering freezes motion only within a narrow phase; if HR
variability is large, the predefined window may miss the quiescent phase. Retrospective
spiral with ECG modulation extends coverage across the cycle while modulating dose,
preserving diagnostic quality. Increasing padding (A) raises dose excessively; lowering kV
(C) may reduce contrast-to-noise; accepting artifacts (D) is suboptimal.
Why Wrong:
A - Increases radiation dose without fully solving variability if arrhythmia is severe.
C - Lowering kV does not address the phase mismatch and may degrade image quality
in larger patients.
D - Accepting motion artifacts is clinically unacceptable for diagnostic CCT.
Reference: EACVI CCT Handbook, 2026; SCCT Guidelines on Acquisition.
Q2. A 68-year-old patient with atypical chest pain and a calcium score of 0 has a
low-to-intermediate pretest probability. Which additional finding would most justify
proceeding to coronary CT angiography?
A. Family history of premature coronary artery disease
B. Abnormal resting ECG with ST depression
C. Elevated high-sensitivity troponin above the 99th percentile
D. Coronary artery calcium score of 0 Agatston units
Correct Answer: C. Elevated high-sensitivity troponin above the 99th percentile
Rationale: Elevated troponin indicates myocardial injury, which may be due to
non-calcified plaque or other causes; CCTA can rule out obstructive CAD and identify
plaque. Family history (A) is a risk factor but not an acute indication. Resting ECG
changes (B) are non-specific. Calcium score of 0 (D) lowers likelihood but does not
exclude non-calcified plaque; however, the question asks for the finding that most justifies
CCTA, and an elevated troponin in a low-intermediate risk patient is a class IIa indication
for CCTA to rule out acute coronary syndrome.
Why Wrong:
A - Family history alone is not an acute indication for CCTA without symptoms.
B - Abnormal resting ECG is non-specific and not a strong standalone indication.
D - A zero calcium score reduces but does not eliminate the need for CCTA if clinical
Page 3
, suspicion remains.
Reference: 2026 ESC Guidelines on Chronic Coronary Syndromes; EACVI CCT
Curriculum.
Q3. In a patient with a bicuspid aortic valve undergoing pre-TAVI CT, which
measurement is most critical for determining the risk of annular rupture?
A. Coronary ostia height
B. Annular perimeter-derived diameter
C. Sinotubular junction diameter
D. Left ventricular outflow tract calcification
Correct Answer: D. Left ventricular outflow tract calcification
Rationale: Heavy LVOT calcification is a known predictor of annular rupture after
balloon-expandable valve implantation. While annular sizing (B) is essential for valve
selection, the question specifically asks about rupture risk. Coronary height (A) relates to
coronary occlusion; STJ diameter (C) affects supra-annular sealing, not rupture primary.
Why Wrong:
A - Coronary ostia height is crucial for coronary occlusion, not annular rupture.
B - Annular sizing is needed for valve selection but not the best predictor of rupture.
C - STJ diameter is more relevant to valve anchoring and coronary access.
Reference: EACVI/SCCT Pre-TAVI CT Guidelines, 2026.
Q4. Which statement accurately compares the advantages of CT-derived fractional
flow reserve (CT-FFR) versus invasive FFR?
A. CT-FFR requires additional radiation exposure and contrast administration.
B. CT-FFR provides a functional assessment without additional radiation or invasive
risk.
C. Invasive FFR is superior for assessing lesion-specific ischemia in serial stenoses.
D. CT-FFR has higher spatial resolution than invasive FFR.
Correct Answer: B. CT-FFR provides a functional assessment without additional
radiation or invasive risk.
Rationale: CT-FFR is computed from standard CCTA data using computational fluid
dynamics, thus no extra radiation or contrast. It provides functional significance
non-invasively. Invasive FFR is invasive and carries risk, but may be more accurate in
complex serial lesions; however, CT-FFR has shown good correlation. Spatial resolution is
not the primary comparison.
Why Wrong:
A - CT-FFR uses existing CCTA data; no additional radiation or contrast is needed.
C - Invasive FFR remains the reference standard, but CT-FFR is non-invasive and can
assess serial lesions reasonably.
Page 4
