Despite widespread availability of imaging modalities, there exists a paucity of data to support recommendations surrounding their use. The development of appropriate use criteria (AUC) targets this gap by addressing how to decide whether a test is a reasonable choice for a particular patient. Generated by a rigorous process modeled from the Rand methodology, AUC for cardiac computed tomography were initially developed in 2006 to guide optimal patient selection, and they were revised in 2010 in an effort to guide appropriate utilization of testing. The 2010 revision rated 93 clinical scenarios, expanded from the original set of 37 scenarios, with a general increase in the proportion of appropriate clinical scenarios. Strengths of cardiac computed tomography, as reflected in the proportion of scenarios rated as appropriate, include use in chest pain and for evaluation of cardiac structure and function. Recent data suggest that education and an emphasis on AUC can improve performance in patient selection.