Carotid intima-media thickness (CIMT) is a validated predictive marker of increased plaque occurrence and the incidence of major cardiovascular events. However, due to technical issues associated with the measurement of CIMT, a well-trained and certified sonographer is needed to overcome causes of variability due to the patient, device, sonographer, and quantification tool. The recently updated Mannheim consensus defined and described how to differentiate CIMT from plaques. These definitions allow for the better analysis and quantification of early atherosclerosis. Indications for CIMT measurements largely include the detection of coronary heart disease risk among intermediate-risk patients. CIMT is frequently used in clinical trials, and recent technical recommendations have been provided to improve the quality of the procedures. The final choice of a CIMT protocol depends on the purpose of the measurement, the research question at hand, the cost effectiveness, the quality of the data and the added value provided by the additional information.