Cardiac SPECT-CT is a new hybrid technique that simultaneously produces non-invasive functional information (SPECT) and anatomical information about the coronary arteries (CT). Both types of information are crucial for optimal decision making regarding coronary revascularisation. The hybrid SPECT-CT scanner is very suitable for individual patient-tailored algorithms in which SPECT based ischaemia detection can be complemented with CT coronary angiography or vice-versa. In such approaches CT corrects the limitations of SPECT and SPECT corrects the limitations of CT. Initial studies report high diagnostic performance. The SPECT-CT technique is fast, comprehensive, efficient and even financially advantageous. SPECT-CT probably contributes to a more efficient use of invasive diagnostic coronary angiography.