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Background: Coronary CT angiography (CCTA) is a relatively new technique whose role has yet to be fully defined. The initial appropriateness criteria (AC) guidelines published in 2006 have already been revised. There is paucity of data on the effect of the AC on the use of CCTA at academic centers and none for the private sector., Methods: All CCTA studies ordered at one institution (a large community hospital with internal medicine and cardiovascular training programs) from 2006 to 2008 were retrospectively evaluated, and the ordering indications were categorized per the published AC for both 2006 and 2010., Results: There were 384 studies, of which 243 were included in this study. The majority of the studies were ordered for chest pain (67.1% of patients). A significant proportion of studies (43.2%) were classified as inappropriate on the basis of the 2006 published criteria. Uncertain indications made up 39.1%, and appropriate indications were a minority. There was a significant regrading of appropriateness using the 2010 guidelines. Inappropriate testing remained similar at 48.1%, but uncertain cases decreased to only 2.8%, while appropriateness increased to 49.0% (P = .0001 for trend)., Conclusions: The updated 2010 AC guidelines for CCTA resulted in a significant reclassification of the indications for ordering CCTA from the previous 2006 guidelines. This shift in the AC reflects increased familiarity and confidence with this new technology across the imaging community. A large proportion of CCTA studies were ordered for inappropriate indications using both sets of criteria. Further research and enhanced education are needed to disseminate the appropriate role of CCTA in cardiovascular imaging., (Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.)