Cardiovascular computed tomography (CT) is at the center of the risk-benefit debate about ionizing radiation exposure to the public from medical procedures. Although the risk has been sensationalized, the cardiovascular CT community has responded to the scrutiny by increasing efforts to ensure the responsible use of this young technology. Efforts to date have primarily included the development of appropriateness criteria and the implementation of dose-lowering techniques. Still needed is the development of standards that incorporate radiation exposure optimization into scan protocol selection. Such standards must consider applied radiation in the context of the clinical indication as well as the characteristics of the patient and provide guidance with regard to specific parameter settings. This editorial viewpoint demonstrates the need for comprehensive, individualized review of the clinical scenario before performing a cardiovascular CT, as well as the need for standards. If cardiovascular CT is the appropriate test and scan parameters are optimized with respect to radiation exposure, benefit should necessarily outweigh potential risk. However, efforts to promote responsible cardiovascular CT imaging must continue to ensure this is true for every patient.