C ardiovascular disease remains the number 1 killer of women and men of all races and ethnicities in the United States. Coronary artery disease (CAD) accounts for more than half of all cardiovascular diseases. Nearly 2,400 Americans die of cardiovascular disease each day, an average of one death every 37 seconds.1 Unfortunately, many diagnostic technologies have low sensitivity and specificity and may fail to identify CAD in its earliest stages. However, because of its high sensitivity, cardiac computed tomographic angiography (CCTA) is becoming the first-line imaging study for the evaluation of chest pain or the anginal equivalent to rule out CAD in patients with a low-to-moderate probability of myocardial ischemia. CCTA is better than invasive coronary angiography because it can detect disease before the patient develops significant lesions (defined as those causing greater than 50% stenosis). Coronary segment-based sensitivity, specificity, and positive and negative predictive values of CCTA are 95%, 98%, 87%, and 99%, respectively.2 And for patients at low-to-moderate risk of CAD, disease can be ruled out in a single study with 99% probability.