X-ray computed tomography (CT) has exhibited rapid technological advances in recent years which has made it a potential alternative to electron beam computed tomography (EBCT). In addition to the development of spiral CT, rotation times in the subsecond range and the development of multislice detectors were decisive steps. These technical developments will be sketched briefly; the necessary adaptation of image reconstruction and evaluation will be explained. Particular emphasis will be placed on the necessary steps of quality assurance and calibration in quantitative procedures, as for example coronary calcium measurements. The exposure for typical CT examinations of the heart are in the order of half to five times the natural exposure per year. With synchronous recording of the ECG, the complete heart can be imaged continuously with thin slices and high spatial resolution in less than 30 s. In spite of the very short validation phase up to now, we consider multislice spiral CT an alternative to EBCT.