X‐ray computed tomography (CT) is widely available in the world and has the ability to provide high definition, thin section imaging of any body part. In particular, CT over the past decade has been shown in numerous publications to allow for quantitation of coronary calcification, a proven surrogate for coronary artery atheromatous plaque. Electron beam tomography (EBT) and multi‐detector CT (MDCT) have been studied for these purposes; although the majority of the data has been derived from EBT studies.

This chapter details the patho‐biology of atherosclerotic disease, the basis of using EBT (and/or CT in general) to define atherosclerotic plaque including the technical and engineering pitfalls and promises, and details issues of clinical application.