There has been an exponential growth in cardiovascular imaging resulting in the requirement for guidance and appropriateness criteria. The first appropriateness criteria for cardiac CT were published in 2006 and since numerous national and international societies have published guidance specific to their country, population and health economy. These guidelines have been through multiple iterations in response to large trials in cardiac CT. This paper aims to review and compare these guidelines specifically with respect to the performing and reporting of cardiovascular CT and on the use of cardiac CT in the investigation of suspected asymptomatic coronary artery disease, stable coronary artery disease and acute coronary syndrome. The global use of cardiac CT in comparison to other non-invasive imaging modalities will also be considered.

There is a growing use of cardiac CT and this, along with updated guidelines, is likely to be secondary to the growing evidence base. Cardiac CT continues to lag behind other non-invasive cardiac imaging modalities.

Comparison of national and international guidelines remains problematic as societies update their guidelines at different times as the evidence base evolves. More recent guidelines support increased indications for CTCA which is likely in response to the increasing evidence base predicated on improved prognosis and clinical outcome.