Longitudinal trends in cardiac CT utilization by institutional academic status: insights from the MR/CT registry

Objectives To characterize longitudinal changes in coronary CT angiography (CCTA) utilization patterns across academic and non-academic centers. Materials and methods Submissions to the MR/CT Registry of the European Society of Cardiovascular Radiology from 2011 to 2025 were analyzed. Outcomes were stratified by academic status and assessed longitudinally using joinpoint regression. Evaluated outcomes included the proportion of CCTA indications among cardiac CTs, the rate of pre-CCTA functional testing, and pre-test probability (PTP) distribution. Results A total of 236,432 cardiac CT (academic 44.8%, non-academic 55.2%) examinations, including 155,975 CCTAs, were analyzed. Academic centers demonstrated a more balanced distribution of cardiac CT indications, with CCTA for suspected CAD showing an initial dip followed by gradual growth, without overall change in the study period (65.6% vs 51.2%, p = 0.62). Non-academic centers demonstrated a linear increase in CCTA proportions over the study period (74.6% vs 80.9%, p < 0.001). Pre-CCTA functional testing decreased in both settings, remaining low at academic centers (2.4% vs 2.3%, p = 0.01) but higher at non-academic sites (63.0% vs 39.5%, p = 0.04). PTP distributions shifted toward intermediate-risk referrals, predominantly at academic centers (40.4% vs 87.1%, p < 0.001), while non-academic centers demonstrated no significant net change (47.0% vs 57.0%, p = 0.58). High-PTP referrals consistently remained lower at academic centers (2.0% vs 3.0%, p = 0.42) than at non-academic sites (16.7% vs 12.9%, p = 0.71). Conclusion CCTA utilization patterns demonstrate distinct differences between academic and non-academic sites. The refinement of pathways and targeted capacity building among institutions may further enhance the clinical utility of CCTA. Key Points Question How have indications for cardiac CT, pre-coronary CTA functional testing use, and PTP profiles evolved over time at academic vs non-academic cardiac imaging centers ? Findings Academic centers demonstrated broader CT indications and increasing intermediate-risk referrals, while pre-coronary CTA functional testing declined in both settings, yet remained higher at non-academic sites . Relevance statement Differences in cardiac CT utilization between academic and non-academic centers highlight opportunities to improve referral pathways, reduce redundant pre-coronary CTA testing, and support more efficient and equitable deployment of cardiac CT resources across diverse healthcare settings .