Introduction & Background: The rapid development of spiral (helical) computed tomography (CT) has resulted in exciting new applications for CT. One of these applications, three-dimensional (3D) CT with volume ren-dering, is now a major area of clinical and academic interest. One of the greatest advantages of spiral CT with 3D volume rendering is that it provides all the necessary information in a single radiologic study (and there-fore at the lowest possible price) in cases that previously required two or more studies. Three-dimensional vol-ume rendering generates clinically accurate and immediately available images from the full CT data set with-out extensive editing. It allows the radiologist and clinician to address specific questions concerning patient care by interactively exploring different aspects of the data set. Three-dimensional images integrate a series of axial CT sections into a form that is often easier to interpret than the sections themselves and can be made to appear similar to other more familiar images such as catheter angiograms. The data are organized into a 3D matrix of volume elements (voxels). The screen of the computer monitor is a 2D-surface composed of discrete picture elements (pixels). Presenting what is stored in memory (ie, floating within the monitor) on a 2D-screen is a challenge, but it is the very problem that 3D reconstruc-tion software has creatively solved. Voxel selection is usually accomplished by projecting lines (rays) through the data set that correspond to the pixel matrix of the desired 2D image. Differences in the images produced with various 3D rendering techniques are the result of variations in how voxels are selected and weighted. In this article, I compare 3D volume rendering of spiral CT data with other rendering techniques (shaded surface display, maximum intensity projection) and present a brief history of 3D volume rendering and discuss the im-plementation of this promising technology in terms of strategies for volume data management, selection of rendering parameters, and features of data display. In addition, I present recent research on the accuracy of the technique in specific medical applications and discuss a number of current clinical applications of 3D volume rendering of spiral CT data.