For over two decades, coronary and cardiac CT have evolved into essential tools for diagnosing cardiovascular disease, but recent advancements in fractional flow reserve technology (CTFFR / HeartFlow) have dramatically increased the demand for pristine image quality. Because advanced physiological modeling relies heavily on accurate structural data adhering strictly to the "good data in, good data out" rule the debate between prospective and retrospective gating is more relevant than ever.

In this episode of Rethink Imaging, host Chris St. John sits down with Dr. Ari Goldberg to analyze the core tension between minimizing radiation exposure and maximizing diagnostic confidence. Dr. Goldberg explains the mechanics of prospective gating, capturing a narrow snapshot of the cardiac cycle versus retrospective gating acquiring continuous data across the full cardiac cycle with dose modulation. They explore the real-world impact of heart rate variability, motion artifacts, radiologist reading efficiency, and how next-generation technologies like photon-counting CT are redefining protocol selection.