It is perhaps an exaggeration to say cardiologists are frustrated radiologists, but as radiologists have now had the opportunity to observe the heart in detail for some years (whether they actually paid any attention to it or not) it would be pleasing if the converse were a little closer to the truth. In their paper Groves and colleagues manage to close a gap between cardiology, radiology and physiological measurement by demonstrating that multidetector helical computed tomography (CT) offers an introduction to functional cardiac imaging for the general radiologist. They describe an attractively simple technique for grading tricuspid regurgitation by visually estimating the degree of contrast reflux into the inferior vena cava (ICV) and hepatic veins. This estimate seems to correlate well with invasive measurement of right heart pressures. Although the phenomenon of IVC contrast reflux has been known for some time, this is the first study to convincingly provide a semi-quantitative assessment. Other than those radiologists with privileged access to cardiac magnetic resonance imaging (MRI) or those rare individuals who have directed ultrasound probes north of the diaphragm, assessment of right ventricular function or pulmonary artery pressure was previously limited to primitive extrapolation of findings on the chest radiograph. Groves and colleagues show conclusively that the radiologist can link cross-sectional multidetector CT data with physiological phenomena occurring within the heart and pulmonary vessels. The niceties of tricuspid valve dysfunction may not immediately ring bells with the general radiologist, but these observations can prove an important indicator of elevated right heart pressure, and therefore go a long way to explain symptomatology. A criticism of this study may be that all the patients were being assessed for a single pathology, chronic thrombo-embolism. However, echocardiography tells us that the observation of reflux of blood from the right atrium into the IVC is valid for any cause of tricuspid regurgitation. It may point to unsuspected severe pulmonary hypertension, which can be primary or secondary due to parenchymal lung disease; the very patients who make poor echo subjects. Failure to register this phenomenon may lead the radiologist to miss the important diagnosis of incipient pulmonary hypertension in more exotic conditions such as scleroderma. This paper also affords a glimpse of the future of cardiac imaging using multidetector CT. Unlike echocardiography, which uses geometric assumptions, CT lends itself to accurate assessment of chamber morphology and also of physiological data including ejection fraction, regional wall motion and myocardial perfusion. In coronary artery disease CT offers the best assessment of coronary artery calcification and is also on the verge of delivering clinically useable non-invasive coronary angiography. This may herald a new turf war between radiologists and cardiologists. Radiologists suffering from cardiac ennui need to be reminded that a significant proportion of the countless thousands of patients undergoing thoracic CT will demonstrate important co-existing cardiac pathology. This paper shows that the radiologist using a deceptively simple scoring system can make a valid assessment of cardiopulmonary function, as well as anatomy. Until recently, this was only the province of specialist echocardiography or cardiac MRI. The authors rightly conclude that multidetector CT may assist radiologists to plug something of the “black hole” in cardiac imaging, which is sorely