CT Cardiac Function and Morphology — Dictation, Appropriateness, and Dose for Residents

Stat pre-TAVR (Transcatheter Aortic Valve Replacement) workup on the list. The interventional cardiologist and surgeon are waiting for your measurements: aortic annulus area and perimeter, coronary ostial heights, sinus of Valsalva dimensions, and a full iliofemoral access map. Your attending expects every key measurement in a clean, structured format, and they want it before the heart team meeting in an hour. You have a 4D dataset with 20 phases, and getting it right the first time is the only option.

This isn’t just about calculating an ejection fraction. This is about providing the precise anatomical map that determines device selection and procedural success. Let’s walk through how to nail this report every time. For more guides like this, check out our free residents and fellows resource hub with calculators, references, and templates.

What a CT Cardiac Function and Morphology Study Covers and What Attendings Look For

A cine ECG-gated CT of the heart is a powerful study that generates a 4D dataset, allowing you to watch the heart beat in any plane. It’s the go-to for pre-procedural planning when echo is insufficient or MRI is contraindicated. While it’s not the first choice for suspected myocarditis (that’s MRI’s turf) or routine function checks (echo is king there), it excels at answering specific, high-stakes questions.

Your attending is looking for a comprehensive report that methodically addresses:

• Global Function: Left and Right Ventricular (LV/RV) end-diastolic volumes (EDV), end-systolic volumes (ESV), and calculated Ejection Fraction (EF).
• Regional Function: A qualitative assessment of regional wall motion abnormalities.
• Valvular Morphology: Detailed assessment of the aortic valve, including calcium scoring and measurements for valve area (AVA). Also, comments on the mitral, tricuspid, and pulmonic valves.
• Anatomic Measurements for TAVR: This is the core of a pre-TAVR study. It requires precise measurements of the aortic annulus, sinuses of Valsalva, sinotubular junction, and the height of the coronary ostia from the annulus.
• Vascular Access: A full workup from the subclavian arteries down to the common femoral arteries, noting minimal luminal diameters, calcification, and tortuosity.
• Ancillary Findings: Evaluation for cardiac masses (myxoma, thrombus), pericardial disease (effusion, thickening, constriction), and any relevant extracardiac findings.

Radiology Report Template for CT Cardiac Function and Morphology (Cine ECG-Gated)

Here’s a solid starting point for your dictation macro. The key is to be systematic. For TAVR planning, the measurements are everything, so list them clearly.

Technique

Retrospectively ECG-gated helical CT of the heart was performed with intravenous administration of [e.g., 80] mL of [e.g., Isovue-370] contrast. Multiplanar reformatted images and 4D cine reconstructions were created and reviewed on a dedicated 3D workstation. ECG dose modulation was utilized.

Findings

CARDIAC FUNCTION:
– LV End-Diastolic Volume (EDV): [___] mL
– LV End-Systolic Volume (ESV): [___] mL
– LV Ejection Fraction (EF): [___]%
– RV End-Diastolic Volume (EDV): [___] mL
– RV End-Systolic Volume (ESV): [___] mL
– RV Ejection Fraction (EF): [___]%
– Regional Wall Motion: [No regional wall motion abnormalities detected. OR Describe hypokinesis, akinesis, or dyskinesis by segment.]

VALVES:
– Aortic Valve: [Trileaflet/Bicuspid]. [Severe, moderate, mild] calcification. Aortic valve area by planimetry is [___] cm².
– Mitral Valve: [Structurally normal. OR Describe findings like prolapse, calcification.]
– Tricuspid and Pulmonic Valves: Unremarkable.

PRE-TAVR MEASUREMENTS:
– Aortic Annulus Area: [___] mm²
– Aortic Annulus Perimeter: [___] mm
– Annulus Area-Derived Diameter: [___] mm
– Annulus Perimeter-Derived Diameter: [___] mm
– Sinus of Valsalva Diameters: [___] x [___] mm (short x long axis)
– Sinotubular Junction Diameter: [___] mm
– Height of Left Coronary Ostium: [___] mm from annulus
– Height of Right Coronary Ostium: [___] mm from annulus
– Ascending Aorta Diameter (at level of pulmonary artery): [___] mm

VASCULAR ACCESS ASSESSMENT:
– Right Common Femoral Artery Minimum Diameter: [___] mm
– Left Common Femoral Artery Minimum Diameter: [___] mm
– Right External Iliac Artery Minimum Diameter: [___] mm
– Left External Iliac Artery Minimum Diameter: [___] mm
– Tortuosity and Calcification: [Mild/Moderate/Severe tortuosity and calcification of the iliofemoral vessels, as described above. No prohibitive disease.]

OTHER CARDIAC/PERICARDIAL FINDINGS:
– Myocardium: [Normal thickness. OR Note hypertrophy.]
– Pericardium: [No pericardial effusion or thickening.]
– Cardiac Chambers: [Normal in size. OR Describe enlargement.]
– Coronary Arteries: [Not a dedicated coronary CTA, but note any severe calcification or incidental high-grade stenosis.]

EXTRACARDIAC FINDINGS:
– Lungs: [Clear.]
– Pleura: [No pleural effusion.]
– Mediastinum/Hila: [No lymphadenopathy.]

– Visualized Upper Abdomen: [Unremarkable.]

Impression

1. Calculated left ventricular ejection fraction of [___]%.
2. Severe calcific aortic stenosis. Aortic valve area by planimetry is [___] cm².
3. Detailed measurements of the aortic root and iliofemoral vasculature are provided above for TAVR planning.
4. [Add any other significant findings, e.g., Moderate right ventricular enlargement.]

Free Template Sources for Your On-Call Toolkit

Building your own macros is a rite of passage, but you don’t have to start from scratch. When you need a template for a study you haven’t seen in a while, two great free repositories exist that are curated by and for radiologists.

• RadReport.org: Maintained by the RSNA, this is a comprehensive library with templates for nearly every modality and subspecialty. They are standardized and peer-reviewed.
• Radiology Templates (AU): An excellent, user-friendly site run by Australian radiologists. It’s well-organized and has practical, clean templates you can adapt quickly.

Bookmark them. They’ll save you time and help ensure you don’t miss a key reporting element when you’re busy.

The Next-Level Move: From Free-Form Dictation to Flawless Structured Report

The challenge with complex reports like a pre-TAVR CT isn’t just finding the right words; it’s organizing dozens of discrete measurements into a perfectly structured format that surgeons and cardiologists can read at a glance. Dictating every field and value one by one is slow and error-prone. When I was a resident, I’d dictate the positive findings in a block of text and then spend five minutes manually copying and pasting values into the right template fields.

This is where AI-driven tools can streamline your workflow. Instead of dictating into a rigid template, you can dictate your findings naturally—”LV ejection fraction is 45 percent, annulus area is 450 square millimeters, left coronary height is 12 millimeters”—and let the software parse that and populate the structured report automatically. GigHz Precision AI is designed for this exact workflow. It uses ACR and SIR-based templates to generate a clean report from your free-form dictation. For this specific study, there is no specific Clinical Decision Support (CDS) popup that fires, but the AI Refine feature is the main benefit, ensuring all your critical TAVR measurements are captured and correctly formatted in the final impression.

When Should You Order a CT for Cardiac Function and Morphology? ACR Appropriateness Criteria

The American College of Radiology (ACR) provides evidence-based guidelines to help clinicians choose the right test. For cardiac functional and morphologic assessment, CT is a powerful problem-solver but isn’t always the first step.

For a patient with Suspected Aortic Stenosis being evaluated for TAVR, a Cardiac CT is Usually Appropriate. It is the gold standard for providing the detailed annular, aortic root, and vascular access measurements required for procedural planning.

For an Asymptomatic Patient at Risk for Coronary Artery Disease, a Cardiac CT for morphologic evaluation May Be Appropriate, particularly when echocardiography is technically limited or non-diagnostic. However, echo remains the first-line imaging modality for initial evaluation of cardiac structure and function in most scenarios.

Key alternatives include:

• Echocardiography: The first-line, go-to modality for assessing LV function and valvular disease. It’s radiation-free and widely available.
• Cardiac MRI: Considered the gold standard for quantifying ventricular volumes, function, and myocardial tissue characterization (e.g., viability, infiltration, myocarditis).
• Cardiac Catheterization: The invasive gold standard for measuring hemodynamics and coronary anatomy.

These ACR criteria primarily guide initial imaging decisions. The choice of follow-up imaging depends on the specific clinical context and prior findings.

How Much Radiation Does a Cine ECG-Gated Cardiac CT Deliver?

This is a relatively high-dose study, and for good reason. Acquiring data throughout the entire cardiac cycle requires continuous scanning. The estimated effective dose for a retrospectively gated cardiac CT is typically in the range of 10-25 mSv.

To put that in perspective, this is equivalent to several years of natural background radiation. The dose is justified when the detailed functional and anatomical information is critical for major therapeutic decisions like TAVR. Dose reduction techniques are always used, primarily ECG-based tube current modulation, which lowers the mA during phases of the cardiac cycle that are less critical for diagnosis (e.g., diastole), reducing the overall dose by 30-50%.

If only anatomical information is needed (e.g., a coronary CTA without functional assessment), a prospectively gated “step-and-shoot” technique can be used, which dramatically lowers the dose to the 2-5 mSv range. However, this technique does not provide the cine data needed to calculate ejection fraction or evaluate wall motion.

CT Cardiac Function and Morphology Imaging Protocol — Phases, Contrast, and Reconstructions

A successful cardiac CT hinges on a meticulously executed protocol. The key is retrospective gating, which acquires data continuously through the R-R interval, allowing for reconstruction of any phase of the cardiac cycle. This requires excellent ECG tracing and patient cooperation with breath-holding. Heart rate control (ideally <65 bpm) is crucial.

The protocol generally consists of a non-contrast calcium score followed by a contrast-enhanced, retrospectively gated helical acquisition from the tracheal carina through the cardiac base.

Common protocol pitfalls:

• Arrhythmia: Irregular heart rhythms can cause severe stair-step artifacts. Good ECG lead placement and monitoring are essential.
• Streak Artifact: Contrast injected in a left arm IV can cause dense streak artifact from the left brachiocephalic vein, obscuring the ascending aorta. Always advocate for a right antecubital IV.
• Motion: Poor breath-hold or patient motion degrades image quality. Practice the breath-hold with the patient before scanning.

The 3-Months-Free Offer for Radiology Residents and Fellows

3+ months free for radiology residents and fellows

Look like a rockstar on your reports — dictate positive findings in free form, and our AI generates a structured report using ACR + SIR templates with the appropriate clinical decision support firing automatically. This lets you focus on the images, not on copy-pasting measurements or hunting for template fields.

All we ask is feedback so we can keep improving the product for trainees. The signup is simple. No credit card, no long forms. Just provide three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or specific fellowship)
3. Your training program / hospital name

To get started, apply for the residents free-access program and we’ll get you set up.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Frequently Asked Questions

Is it HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. It processes the clinical content of your dictation without requiring Protected Health Information (PHI), ensuring compliance with privacy rules.

Do I need my hospital’s IT department to set this up?

No. GigHz Precision AI is browser-based and requires no local software installation or special IT permissions. It works on any modern computer, including the PACS workstation or your personal laptop/iPad in the call room.

Does it work with PowerScribe or other dictation systems?

Yes. It works alongside any existing dictation system. You dictate as you normally would, and the tool works in your browser to help you structure the report. You can then copy and paste the final, clean report back into your PACS/RIS.

Can I use this on my phone or iPad?

Absolutely. The platform is fully responsive and works well on mobile devices, making it a useful tool for reviewing or finalizing reports when you’re away from your primary workstation.

Can I customize the templates?

Yes. While the system comes pre-loaded with standard ACR and society-based templates, you can create, modify, and save your own custom templates to match your personal or institutional preferences.

What happens after my residency or fellowship ends?

Trainee accounts transition to standard access after graduation. We offer discounts for early-career radiologists who wish to continue using the platform in their practice.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026