Recent advances in CT technology have led to the advent of the photon-counting detector CT (PCD-CT). The technology has shown significant improvements in CT image quality with high spatial resolution, more accurate differentiation of coronary plaque components, and radiation reductions compared to the energy-integrating detector-CT (EID-CT). However, limited experience exists, and little has been published, on the decision-making process for PCD-CT coronary scanning protocols and parameters in clinical practice. In this pictorial review, we showcase our experience in the use of PCD-CT coronary CT angiogram through a step-by-step guide in the form a decision tree, a series of clinical cases and detailed discussion of each scanning protocol to aid the operator in making their decision in commonly encountered clinical scenarios. The guide should also help the operator in setting up a PCD-CT cardiac imaging service.