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The objective of this study was to assess the usefulness of a portable CT scanner to evaluate and treat thoracic disease in patients in the intensive care unit. MATERIALS AND METHODS. Fourteen patients who were being treated in the intensive care unit underwent 20 portable CT scans. Twice a CT scan was obtained to guide an interventional chest procedure. The remaining I 8 scans were assessed for findings not evident on portable chest radiography and for findings that altered treatment. Image quality was judged in comparison with fixed CT scans. RESULTS. Unsuspected abnormalities, most relating to the pleura or chest wall, were found in 13 of the 17 available portable CT scans. Treatment was affected in four (25%) of the I 6 cases in which medical records were available for review. Two interventional procedures were performed successfully using portable CT guidance. Scan quality was judged to be comparable with that of fixed CT for mediastinal windows and somewhat inferior for lung windows. CONCLUSION. Portable CT gives images of diagnostic quality and allows confident guidance during interventional procedures in critically ill patients who therefore need not leave the intensive care unit environment.