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Cardiothoracic diseases result in substantial morbidity and mortality. Chest computed tomography (CT) has been an imaging modality of choice for assessing a host of chest diseases, and technologic advances have enabled the emergence of coronary CT angiography as a robust noninvasive test for cardiac imaging. Technologic developments in CT have also enabled the application of dual-energy CT scanning for assessing pulmonary vascular and neoplastic processes. Concerns over increasing radiation dose from CT scanning are being addressed with introduction of more dose-efficient wide-area detector arrays and iterative reconstruction techniques. This review article discusses the technologic innovations in CT and their effect on cardiothoracic applications.