There are several techniques for assessing arterial health, including carotid ultrasound, endothelial function, and magnetic resonance imaging. Each has pros and cons, but which technique is best? Quantitative intima medial thickness (QIMT) is safe, validated, portable, has a reference database, is inexpensive, and can be used in multicenter studies. Magnetic resonance imaging may be useful clinically, but it is still considered experimental and remains a costly procedure. Flow-mediated dilation (FMD) is a good surrogate measure, reflecting initial risk, indicating very early disease, and demonstrating rapid response to change. All the imaging methods require standardization of tools, operator training, specification of populations studied, and other considerations to be of use in the clinical setting.