The U.S. has experienced significant growth in national health expenditures, averaging 4.8% per year from 1960 to 2006 (1). Today, much of the growth in spending is not only related to coronary heart disease but to most chronic conditions including diabetes, arthritis, hypertension, and kidney disease (2). The growth in spending for imaging parallels an increase in spending for chronic conditions including payments to orthopedic surgeons, radiologists, and cardiologists, to name a few (2). As is illustrated in (Figure 1), payments for imaging services to cardiologists represent a small proportion of payments for all of imaging and reflects the diverse needs of the Medicare population (3). In the year 2000, the total payment to cardiologists was $1.6 billion and increased by more than 200% to $5.1 billion in 2006. In 2006, only 36% of total Medicare Part B revenues were paid to cardiologists for in-office imaging services (3). This payment to cardiologists for imaging services represents 8.7% of total payments for all physician services in 2006 (4). When including estimates of payments by private health insurance, the total expenditures related to CV imaging are estimated to approach $17 billion (5).