Abstract
Intracoronary imaging (ICI) was introduced over 3 decades ago to complement conventional coronary angiography, yet its widespread uptake remains limited. This paper seeks to explore the potential causes behind low ICI utilization. The concepts of acceptability, acceptance, and adoption were applied to understand at which stage individual factors influence ICI implementation. Overall, the document aims at offering a comprehensive understanding of the challenges affecting ICI adoption, laying the foundation for effective change strategies. This approach is intended to address the broader, multifaceted nature of ICI implementation, providing a starting point for broadening its integration into clinical practice.