Spiral CT, venous ultrasound, ventilation-perfusion scanning, and D-dimer tests are routinely used in the diagnosis of venous thromboembolic disease. Advances in multidetector spiral CT and the combination of CT pulmonary angiography and venography as a one-step evaluation of venous thromboembolic disease have markedly improved detection of subsegmental emboli and deep pelvic venous thrombi and decreased the role of conventional pulmonary angiography. As CT has improved, many have questioned what "gold standard" CT should be compared with. Recent clinical outcome studies suggest that CT results are as good as pulmonary angiography and conventional imaging algorithms. Because the sensitivity of CT pulmonary angiography now exceeds 85%, it also appears that it is also more cost effective than other diagnostic approaches. (C) 2003 Lippincott Williams Wilkins.