The coronary artery calcium (CAC) score above which it is recommended that coronary computerized tomographic angiography (CTA) not be performed has been steadily increasing. Currently, calcium scores > 1000 are thought to prohibit CTA accurate interpretation. However, a reasoned approach suggests that there is no absolute upper limit that applies to all patients and imaging centers. To anticipate the problems posed by calcium, a CAC scan must be obtained before CTA. Understanding the clinical goals of the CTA and the source and recognition of CAC-based imaging artifacts can enable accurate clinical CTA examinations even in the setting of high calcium scores.