The field of atherosclerosis imaging has expanded rapidly in the last decade, and technologies such as electron-beam computed tomography (EBCT), have contributed significantly to our understanding of the prevalence of silent coronary artery disease and its consequences. Nonetheless, proper use of technology is necessary to conduct effective and cost-beneficial screening programs. Because most adverse events related to atherosclerosis occur in individuals at an intermediate risk level, it seems appropriate to concentrate screening efforts on this group of patients. This article reviews the current understanding of the value of coronary artery calcium screening in asymptomatic individuals and in symptomatic patients at low-to-intermediate risk and the use of EBCT as a tool for assessing the efficacy of therapy for atherosclerosis.