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Figure 1 (A) Current American College of Cardiology/American Heart Association (ACC/AHA) Guidelines contain a total of 745 recommendations on the use of imaging, with just over one-half being class I, indicating that the procedure is beneficial, useful, and effective, and only 18% class II, indicating that the procedure is not useful or effective and may be harmful. (B) The level of evidence to support the use of imaging used in the ACC/AHA Guidelines is in contrast to the class of the recommendations. The majority are level 3, indicating that the recommendation is supported only by the consensus opinion of experts, case studies, or standard-of-care, rather than representing level 1 evidence derived from multiple randomized clinical trials.