Noninvasive visualization of the coronary arteries is the holy grail of cardiac imaging.Cardiac catheterization, the historic gold standard for coronary imaging, is invasive,costly, and often performed unnecessarily. Cardiac computed tomographic angiography(CCTA) is a widely available, cost-effective imaging modality that effectively imagesthe coronary arteries. The most appropriate patient for a CCTA-guided approach tothe evaluation of chest pain is the symptomatic patient at low to intermediate risk.Data are rapidly evolving to further validate the accuracy, prognostic ability, andcost-effectiveness of this technique. The current landscape of the American medicalsystem and the rising cost of United States health care have led to skepticism concerningCCTA and its potential misuse. Technological misunderstanding and concernabout excessive radiation exposure also threaten its growth. When used properly byappropriately trained physicians, CCTA adds significant value to the evaluation ofchest pain and to the diagnosis of coronary artery disease.