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Multi-detector CT (MDCT), in particular isotropic or nearly isotropic MDCT, changes the way in which imagers perform and interpret studies of the thorax. The speed of data acquisition enables new clinical applications of MDCT in the areas of angiography and dynamic perfusion. Cardiac gating software is available, and CT studies of the heart and coronary arteries are now feasible. This review, however, focuses on the impact of MDCT on the routine practice of thoracic imaging, rather than on newer specific MDCT applications. The topics of scan performance and interpretation are related, and MDCT changes each of these areas when compared with the era of axial CT.