Clinicians now rely heavily on the results of single-photon emission computed tomography (SPECT) myocardial perfusion imaging for diagnosing coronary disease and for planning therapy. However, the technique is imperfect for these purposes, mainly because of technical limitations, the most prominent of which is the effect of soft-tissue attenuation on apparent tracer distribution. Providers have attempted to compensate for this by a number of indirect approaches. Recently, validated hardware and software solutions for directly correcting image data for soft-tissue attenuation have become widely available commercially. Optimal application requires an understanding of the technical details that differ somewhat from system to system, the quality control prerequisites, knowledge of the importance of the transmission map quality, and how dedicated SPECT and SPECT-computed tomography systems present different challenges. In addition, the clinical literature is expanding rapidly, including studies on diagnostic accuracy, image appearances, quantitative analysis, appropriate patients for attenuation correction, clinical utility, incremental value in relation to ECG-gating, and risk stratification.