Rapid technological advances in hardware and post-processing techniques have increased the use of computed tomography (CT) of the heart in multiple clinical scenarios. Coronary computed tomography angiography (CCTA) is commonly accepted as a clinically useful noninvasive imaging modality for the diagnosis and exclusion of obstructive coronary artery disease (CAD), particularly in patients with intermediate pretest probability of coronary artery disease. However, CCTA is technically complex. In this chapter, we review technical and patient-related factors that may adversely affect the image quality and discuss potential measures that can be taken to avoid or mitigate these artifacts. In addition, future improvements in cardiac CT are described.