Radiologic imaging has been clearly shown to be useful for the evaluation of patients clinically suspected of having appendicitis with CT and ultrasound being the most frequently recommended modalities. However, controversy still exists as to which modality is the technique of choice for appendiceal imaging. Our experience has led us to conclude that a standard helical abdominopelvic CT is the initial test of choice for the evaluation of the adult patient suspected of having acute appendicitis. Focused appendiceal CT with colonic contrast is then utilized as a problem solving technique for equivocal cases after this initial assessment.