Multidetector-row computed tomography (MDCT) has rapidly developed into a powerful tool for noninvasive measurement of calcified plaque in the coronary arteries over the past decade. Identification and quantification of coronary artery calcifications (CAC) with X-ray devices is well established in the literature with chest radiographs, fluoroscopy, computed tomography (CT without electrocardiogram [ECG] gating) and cardiac CT (electron beam CT [EBCT], helical CT, and MDCT with cardiac gating) (1–6). Calcified plaque is an established component of coronary atherosclerosis, and radiographic techniques are highly sensitive to calcified atherosclerotic plaque (1,7). The presence of calcified plaque documents the presence of subclinical atherosclerosis in the coronary artery. Calcified plaque is an active and regulated process occurring in the vessel wall, with pathways similar to those of bone metabolism (8,9). As of 2003, two consensus documents (1,10) concerning cardiac CT and the recommendations of the Prevention V Conference (11) are available to guide clinical application. The results of several large epidemiological studies, as well as pharmaceutical trials, will become available during the next five years and will provide new information to guide the medical community and society at large as to the appropriate utilization of CAC screening in the population.