We are at an inflection point with many aspects of medicine, not the least of which concerns choosing the correct tool to discover and manage coronary artery disease.  The American landscape of clinical and imaging service providers is going through a major reshuffle. Coronary computed tomography angiography (CTA) is growing in utilization, taking its place as an established modality with AHA, ACC and ACR society-derived appropriate use standards. However, this growth in CT utilization and the resultant growth in per capita radiation exposure have elevated a public debate about the risk of causing cancer versus the value of its information.

Hospitals that have built multimillion-dollar, specialized cardiovascular hybrid operating rooms (ORs) are hoping to make a return on investment (ROI) by attracting more referrals with the latest technology. However, many hospitals with hybrid rooms say it takes more than new, cutting-edge technology to be successful — the real secret is collaboration of several specialties to decide what is best for the patient.