Objective <p>Patient compliance and comfort during cardiac computed tomography (CT) are crucial for optimal imaging outcomes. Insufficient understanding or heightened anxiety can negatively impact patient experience and potentially image quality. This study evaluates the effectiveness of video-assisted informed consent in cardiac imaging (VAICICI) in improving patient satisfaction, preparedness, and anxiety during cardiac CT.</p> Materials and methods <p>In this randomized controlled trial, 205 patients scheduled for cardiac CT were assigned to Video I (<i>n</i> = 67), Video II (<i>n</i> = 69), or Control (<i>n</i> = 69). Video I featured an instructional video incorporating visuals, narration, and subtitles. Video II included audio and subtitles only. All groups received a standard physician consultation. Experiences were assessed before and after cardiac CT using patient-reported outcome measures. Statistical analyses included group comparisons and multivariate analysis of anamnestic and demographic factors.</p> Results <p>Video I and II significantly improved patient satisfaction and understanding compared to the Control (<i>p</i> &lt; 0.05). Patients with Video II placed more importance on the informed consent form for understanding than the Control (<i>p</i> = 0.02). Satisfaction was higher in both video groups (<i>p</i> = 0.02), with no significant difference between them. Anxiety and nervousness levels were low and similar across groups, but notably higher among women (<i>p</i> = 0.008) and patients with suspected coronary artery disease (<i>p</i> = 0.04). Age, prior CT/MRI, and eight other baseline demographics partially predicted responses.</p> Conclusion <p>VAICICI improves patient satisfaction and understanding of the cardiac CT examination, with only slight variations in effectiveness across demographics, suggesting it is a valuable addition to the informed consent process. No reduction in anxiety was observed.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Can video-assisted informed consent improve patients’ understanding and reduce anxiety associated with cardiac CT examinations?</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Video-assisted informed consent improves patient satisfaction and understanding of the cardiac CT examination, with both video formats significantly outperforming the standard consent</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i> Video-assisted informed consent improves patient satisfaction and understanding of cardiac CT, with only slight variation in effectiveness across baseline demographics, suggesting it to be of value in the consent process and promoting patient-centered imaging practices</i>.</p> Graphical Abstract <p></p>