Cardiac CT Training & Certification

How to get there: Level 1, Level 2, Level 3, CBCCT board eligibility and ACR accreditation, explained for radiology and cardiology trainees and for practicing physicians.

Last verified October 2026. Requirements change, and each certifying body has the final word. Confirm with SCCT, CBCCT/Inteleos, ACR or your program before you count on a number. Items marked ⚑ unverified could not be checked against the live source page.

Based on our AJR Expert Panel Narrative Review of training and verification requirements¹, updated against the current SCCT, ACC, CBCCT and ACR documents.

The short version

Level 1 is basic literacy. It is not enough to read independently. About 50 mentored cases, 15 of them at the scanner.
Level 2 (Independent Practitioner) lets you read on your own. 250 cases within 36 months, including 65 “direct” cases where you take part in prep, acquisition and reconstruction, plus 20 CME hours.
Level 3 (Advanced Practitioner) is for lab directors and teachers. 450 cases within 48 months, with 150 direct cases and 40 CME hours.
CBCCT is the cardiovascular CT board exam. You qualify through Level 2 (any specialty) or, for radiologists, through the ACR cardiac CT route.
Up to about 185 of the 250 Level 2 cases can be done online, if the course gives you a real interactive workstation, a mentor, and feedback against an expert read. Details below.

Pick your track

Track A

Radiology resident or fellow

Get Level 1 exposure during residency: about 50 mentored cases, 15 at the scanner³. The ABR curriculum covers cardiac imaging but sets no case numbers¹.
Use your 4th-year elective or mini-fellowship, or a cardiothoracic/cardiovascular fellowship, to build Level 2 volume (250 cases, 65 direct)⁴.
For CBCCT, you can go through Level 2 or the ACR route⁶. Trainees who finished ACGME training within the past 36 months are exempt from the CME requirement⁶.
Keep a de-identified case log from day one, with date, indication, diagnosis and how you were involved.

Track B

Cardiology fellow

Level 1 is required of all fellows (COCATS 4): about 1 month, 50 mentored cases, 15 at the scanner². ACGME now requires at least 1 month of CT during general fellowship¹.
Level 2 can be reached in a standard fellowship with dedicated time, or in an advanced imaging fellowship. The 2025 ACC statement sets 250 cases, 65 direct, with a defined case mix⁵.
CBCCT eligibility for cardiologists is Level 2 per COCATS 2015⁶.
Need the cases outside fellowship? Online workstation courses can fill most of the non-direct cases (see below).

Track C

Practicing physician

Radiologists: ACR accreditation asks board-certified radiologists for 40 h of cardiac CT CME. Those certified before 2008 also need 75 cases in 36 months⁸. For CBCCT via the ACR route, you need 75 recent contrast cases (last 12 months), which can be completed on a workstation in a supervised course⁶.
Cardiologists: complete Level 2 (SCCT Verification is one way to document it)⁴, then CBCCT. The 65 direct cases still have to happen at a scanner.
If your training was more than 36 months ago, CBCCT asks for 150 contrast cases in the last 36 months⁶.

Requirements at a glance

A simplified summary. “Direct” means you took part in patient prep, acquisition and reconstruction. “Workstation” means library or online cases you manipulated yourself in 3D and compared with an expert read. “Observation” means watching a case or presentation without manipulating it.

Pathway	Total cases	Contrast / non-contrast	Direct (live)	Online workstation	Observation-only cap	CME	Timeframe	Case mix
Level 1COCATS 4 (2015); SCCT Level 1 (2015)^2,3	50 mentored	Not specified	15 at the scanner	Up to 35 (SCCT requires a 3D workstation)	None allowed (SCCT)	None required	About 1 month / 4 weeks	Correlative imaging data should be available
Level 2 / Independent PractitionerSCCT 2020 + SCCT Verification; COCATS 4^2,4	250 mentored	≥200 contrast; up to 50 non-contrast (can be the same patients)	≥65: ≥50 physically present + up to 15 with acquisition watched on a recording	85–135	≤50, and only from CME-accredited material	20 h	36 months; 8 weeks recommended	COCATS: ≥20 function, ≥20 structural/congenital, ≥15 grafts, ≥40 with cath or perfusion correlation
Level 2 “core” (advanced imaging fellows)2025 ACC/AHA/ASE/ASNC/SCCT/SCMR statement⁵	250	CAC: only 20 count	65	No fixed cap. Archived cases are for case mix and “should not be a main source”	—	—	Within fellowship	CCTA 150, structural 40 (incl. TAVR), other anatomy/function 20, adult congenital 10, vascular 20
Level 3 / Advanced PractitionerSCCT 2020 + Verification⁴	450 mentored	≥300 contrast; ≥100 non-contrast	≥150 (≥100 physically present)	About 150	Not allowed	40 h	48 months; 24 weeks recommended	Structural 100, congenital 50. Also peer recognition and a second imaging modality
CBCCT — cardiology / nuclear medicineInteleos 2026⁶	Level 2 (COCATS 2015)	250 contrast + 50 non-contrast (may overlap)	65	Same categories as SCCT	≤50 (must carry CME)	20 h AMA PRA Cat 1 in 36 months	If trained >36 months ago: 150 contrast cases in the last 36 months ⚑ unverified	As for Level 2
CBCCT — radiology (ACR route)Inteleos 2026; AJR 2025^1,6	50 contrast cardiac CT + 300 thoracic CT (or 500 CT incl. 50 thoracic) in 36 months	Calcium-score-only exams don’t count	Not specified	If the above was done >12 months ago: 75 contrast cases in the last 12 months, which may come from a supervised workstation course ⚑ unverified	—	30 h cardiac CT in 36 months (200 h if not thoracic-qualified)	36 months / 12 months	—
ACR CT accreditation — cardiac moduleACR, revised Dec 2025⁸	Board-certified radiologist: 40 h CME (+75 cases in 36 months if certified before 2008). Cardiologist: Level 2 = 150 exams	Calcium scoring doesn’t count toward CCTA	Cardiologists: 50 physically present	Not addressed	—	Radiologists 40 h; cardiologists 30 h	Renewal: radiologists 50 cases in 24 months; cardiologists 50 a year	—

The ACR–NASCI–SPR practice parameter for cardiac CT was revised in 2026 and no longer lists specific case or CME numbers. Earlier versions asked for 50 cases and 30 h of CME in 36 months⁷. Some older summaries, including CBCCT’s own forms, still quote those numbers.

Maximize your online cases

You can’t do everything online. The direct cases have to happen at a scanner. But most of the remaining volume can come from a well-built online course, and that’s usually the hardest part to accumulate.

Level 135 of 50All on an interactive workstation. 15 must be live at the scanner.

Level 2 / CBCCT (cardiology)135 + 50135 contrast cases (≥85 on a workstation; ≤50 observation-only, which must carry CME) + up to 50 non-contrast. The 65 direct cases still have to be done in person.

CBCCT (radiology, ACR route)75The 75 recent contrast cases (last 12 months) can be documented by a course certificate: “on a workstation in a supervised teaching environment.” ⚑ unverified

Level 3~150Workstation cases only. Observation-only cases don’t count.

For an online case to count, look for:

A real interactive workstation for every case: you scroll, reformat (MPR, curved MPR, MIP, 3D) and measure the dataset yourself, including non-cardiac structures. Static images and videos count only as observation cases.
Your own read first, then comparison with the expert read.
A mentor: a chance to ask a Level 2 or Level 3 trained faculty member about every case.
CME accreditation (AMA PRA Category 1 Credit™), which is required for observation-only cases and useful toward your 20 or 30 h CME requirement.
A certificate and log: course name, dates, number and type of cases, signed by the course director. Keep an anonymized logbook with indication and diagnosis, because SCCT and CBCCT can audit it.
A realistic pace: SCCT won’t accept more than 30 cases logged in one day.

Grey zones: whether a recorded scan acquisition (SCCT “A1”) counts toward the direct cases for remote learners, and whether all 150 recent cases for CBCCT can come from courses, aren’t clearly settled. Ask before you rely on either.

From Dr. GhoshhajraOnline Cardiac CT Case Course — workstation-based, mentored, CME planned Coming soon
From Dr. GhoshhajraLive case review sessions — recurring small cohorts (virtual or in person) reading with a Level 3 expert, each learner on their own interactive workstation; CME planned; attendance logged automatically to the Case Log after attending verification Coming soon
Free toolCardiac CT Case Log — track direct, workstation and observation cases against each pathway Open

Courses

From Dr. Ghoshhajra

Congenital Heart Disease CT CasesOpen
Online, de-identified congenital heart disease CT cases. Free self-registration with an emailed sign-in link. More courses coming.
Online Cardiac CT Case Course (toward Level 2)Coming soon
Designed around the online-case conditions above.
Live case review sessionsComing soon
Recurring cohorts reading with a Level 3 expert on interactive workstations. Intended to count as SCCT workstation (Category B) cases. Cases count toward the direct requirement only if the actual scan acquisition is part of the session, and that’s still to be confirmed with SCCT and CBCCT.

Other reputable options

This is not an endorsement, and no prices are shown. Dates and formats change, so check each provider. “Workstation” means each learner manipulates cases themselves. Whether cases count toward Level 2 depends on the provider’s documentation and the category rules above.

SCCT Advanced Cardiac CT On-demand Training Toward Level 2Online
225 cases on cloud workstations (TeraRecon), compared with faculty reads. Up to 20 AMA PRA Category 1 credits and case credit. Next cohort listed for Nov 2, 2026. SCCT store page.
SCCT virtual hands-on workshopLive virtual
Two days, about 50 cases on individual workstations with real-time faculty. 15.25 CME credits and 50 case credits (listed for Oct 17–18, 2026).
SCCT Annual Scientific MeetingIn person
The main cardiovascular CT meeting, with CME. SCCT2027: Washington, DC, July 8–11, 2027. SCCT also runs a CBCCT board review course (see Credentialing).
Cardiac CT training with Matthew Budoff, MD (Harbor-UCLA, Torrance, CA)In person
Long-running hands-on program: one workstation per attendee, proctored live cases, and options designed around Level 2 and Level 3 numbers. CME commensurate with the course.
ACR Education Center — Coronary CTACheck format
Two-day supervised case review on TeraRecon workstations, nearly 100 cases, most with cath correlation. ACCME-accredited. ACR says the Education Center is now fully virtual, so check the current calendar.
Medality Cardiac CT (toward Level 2)Online
10-week virtual program. Lists 50 SCCT Category B workstation cases (scheduled cohort), 50+ Category B1 video cases, and up to 70.25 CME hours. Describes itself as SCCT-endorsed.
NASCI Annual MeetingIn person
North American Society for Cardiovascular Imaging, cardiovascular CT and MRI, with CME. Recent meetings included vendor-sponsored hands-on workshops.
RSNA Annual MeetingIn person
Broad radiology meeting with cardiac imaging sessions and CME. Check the program for hands-on cardiac CT workshops.
European Society of Cardiovascular Radiology (ESCR)Online / Europe
Annual congress plus an online, case-based Cardiac CT Course (2026 edition: 50 cases for independent review, aligned with European Level 1–2 curricula; for ESR/ESCR members).
EACVI Congress (ESC)Europe
Multimodality imaging congress with hands-on workshops (EACVI 2026: Milan, Dec 3–5). EACVI also endorses workstation courses such as the Athens Cardiac CT Course (Oct 31–Nov 1, 2026) that prepare for EACVI CCT certification.

Where the sources disagree

50 or 65 direct cases for Level 2? COCATS 4 says 65 in its table and 50 in its text. SCCT 2020 and CBCCT use 65 (≥50 physically present + up to 15 by recording). ACR accreditation uses 150 cases with 50 present for cardiologists.
250 “contrast” or 250 total? CBCCT’s letter template says 250 contrast + 50 non-contrast. SCCT says 250 total with ≥200 contrast. Plan for the stricter version.
Recent cases from courses (CBCCT). Inteleos accepts course certificates for recent cases, but an older CBCCT case sheet suggests a minimum of live cases even then. ⚑ unverified The Inteleos pages block automated checks, so confirm directly with CBCCT.

Sources

Rajiah PS, Budoff M, Ghoshhajra B, Morris MF, Ocazionez-Trujillo D, Ordovas K, Patel AR, Ranganath P, Vargas D, Woodard PK, Choi AD. Training and Verification Requirements for Interpretation of Cardiac CT and MRI: AJR Expert Panel Narrative Review. AJR 2025;224(3):e2431524. doi:10.2214/AJR.24.31524 · PMID 38984783
Garcia MJ, et al. COCATS 4 Task Force 7: Training in Cardiovascular Computed Tomographic Imaging. JACC 2015;65:1810–21. PDF
Maroules CD, et al. SCCT curriculum guidelines for general (Level 1) cardiovascular CT training. JCCT 2015;9:81–88. PDF · SCCT training requirements table
Choi AD, et al. 2020 SCCT Guideline for Training Cardiology and Radiology Trainees as Independent Practitioners (Level II) and Advanced Practitioners (Level III) in Cardiovascular CT. PMC · SCCT Verification Program · Level 2 case categories (rev. 2021) · Level 3
Baldassarre LA, Mendes LA, et al. 2025 ACC/AHA/ASE/ASNC/SCCT/SCMR Advanced Training Statement on Advanced Cardiovascular Imaging. PMC (Table 3)
Certification Board of Cardiovascular Computed Tomography (Inteleos). CBCCT Eligibility and Resources · CBCCT exam (2026 cycle) ⚑ some details unverified
ACR–NASCI–SPR Practice Parameter for the Performance and Interpretation of Cardiac CT, revised 2026. ACR
ACR Accreditation Support. Interpreting Physician: CT (revised Dec 18, 2025; cardiac CT module)