The purpose of this article is to review the basic techniques of cardiac MDCT including the most recent 64-slice scanner generation. Besides the technical developments of different MDCT generations within recent years, the basic principles of ECG-related CT algorithms are discussed. Retrospective ECG-gated data acquisitions are considered as a prerequisite for reliable and reproducible calcium scoring as well as for volumetric assessment of the coronary artery tree. While data acquisition itself is rather straightforward, the optimization of image quality, the knowledge of adequate scan protocols and especially knowledge of possibly arising artefacts is mandatory for a stable high image quality. As data acquisition is becoming faster with the most recent advent of 64-slice MDCT, protocols have to be adapted to this new scanner generation. On the other hand, the improvement in spatial as well as in temporal resolution shows impact on the accuracy and stability of coronary CT angiography. However, the use of dose-reducing technical improvements is strongly recommended.