Sixty-four multi-detector row computed tomography (64-MDCT) offers the possibility of increasing the application of CT in multitrauma imaging. 64-MDCT affords significant increases in imaging speed while allowing for subisotropic voxel slice thicknesses. We have recently installed two 64-MDCT scanners in our Level I trauma center. Our routine protocols using these new scanners are detailed. Additionally, this new technology has made possible several novel protocols. These include an increased use of CT angiography in trauma imaging. The acquisition speed and table lengths available with 64-MDCT allow for whole-body scout images. These scout images may be used to plan complex, multistep CT studies incorporating pelvic and extremity angiography, when indicated, into a single study. Imaging speeds afforded by 64-MDCT allow for imaging in any number of phases, over any area to be imaged, all with a single initial bolus of contrast. Image quality afforded by 64-MDCT allows for increasing roles of MPR and 3D reformations. These alternatives to axial images are currently used both for primary interpretation by our trauma radiologists as well as for communication and use by our clinical colleagues. Technical challenges presented by 64-MDCT include further increases in the number of images generated. Currently, datasets may exceed 4,000 images when angiography is included in routine trauma protocols. Radiation doses are also an ever present concern. With the opportunity to image from head to toe in seconds with submillimeter slice thicknesses, radiologists must be constantly vigilant in their efforts to limit radiation. Novel techniques such as automated dose modulation currently offer means of reducing radiation doses. Though several technical challenges are faced, 64-MDCT represents an evolution in multitrauma imaging.