Cardiac computed tomography (CT) and coronary CT angiography represent a breakthrough in cardiac diagnostic power and are already making an impact on clinical practice. Yet, technical limitations remain and patients must be appropriately selected for this new and exciting examination. An understanding of those limitations will help guide patient selection and maximize the clinical yield of the test. The most significant issues to deal with are those of inherently increased image noise, vulnerability to cardiac and respiratory motion and arrhythmia, and image artifacts that result from the presence of coronary calcification and stents. Fortunately, there are methods to overcome all of these limitations. These predominantly involve diligent and attentive patient preparation before the scan, focusing on clinical, hemodynamic, and basic eletrocardiographic parameters. With proper premedication to optimize heart rate, simple patient coaching, attention to detail during the acquisition, and the use of software tools to optimize the axial image reconstruction, cardiac CT should consistently yield very satisfying results.