Introduction 1 3 4 6 Materials and methods Twenty patients (13 male, mean age 60 ± 13 years old) were selected at random from patients scanned for coronary artery disease using a standard coronary artery protocol on a dual source MDCT (Definition, Siemens, Forchheim, Germany). 1 Fig. 1 Large trajectory visualisation of the right coronary artery (RCA)  Results VA could be performed semi-automatically with minor user interaction in every patient for each of the major coronary arteries using dual-source CT (DSCT). The mean (range) length of the automated fly-through was 80 (32–107) mm for the left anterior descending (LAD), 75 (21–116) mm for the left circumflex artery (LCx), and 109 (21–190) mm for the RCA. 2 3 Fig. 2 Visibility of a stenotic lesion  Fig. 3 Stent visibility  4 Fig. 4 Visibility of major side branches  The mean time required was 3 min for LAD, 2.5 min for LCx, and 2 min for the RCA. Discussion 3 1 Table 1 4-MDCT 3   EBCT (2002) 4-MDCT (2002) DSCT (2006) LAD     Percentage assessable 14/15 (93%) 14/15 (93%) 20/20 (100%)  Mean preparation time (min) 12 13 3  Mean number of key frames 13 16 n.a. LC     Percentage assessable 11/15 (73%) 10/15 (67%) 20/20 (100%)  Mean preparation time (min) 7 10 2.5  Mean number of key frames 9 * n.a. RCA     Percentage assessable 9/15 (60%) 14/15 (95%) 20/20 (100%)  Mean preparation time (min) 6 10 2  Mean number of key frames 8 14 n.a.  Total percentage assessable 34/45 (76%) 38/45 (84%) 60/60 (100%) n.a. 5 6 Fig. 5 Problems with artefacts in non-optimal reconstructed datasets  Fig. 6 Problems with motion artefacts causing apparent stenoses  1 7 Fig. 7 Visualisation is hampered by presence of surgical clips in a bypass graft  1 3 A shortcoming of our study was the lack of a “gold standard” to confirm the findings of the coronary fly-through. Conclusion Dual-source MDCT provides a high quality visualisation of the coronary artery tree, independently of the heart rate. This is clearly shown by the successful VCA in all 20 patients in this study. With recent advancements of image processing software and CT acquisition techniques, the conditions have been met for providing the technical basis for the clinical validation of VCA and the potential clinical value of VCA should be determined in the near future.