Abstract. Monte Carlo simulation is the Gold Standard method for modelling scattering processes in medical x-ray imaging. General-purpose Monte Carlo codes, however, typically use the Independent Atom Approximation (IAA). This is known to 10 be inaccurate for Rayleigh scattering, for many materials, in the forward direction. This work addresses whether the IAA is sufficient for the typical modelling tasks in medical kilovoltage x-ray imaging. As a means of comparison we incorporate a more realistic 'interference function' model into a custom-written Monte Carlo code. First, we conduct simulations of scatter from isolated voxels of soft-tissue, adipose, 15 cortical bone and spongiosa. Then, we simulate scatter profiles from a cylinder of water and from phantoms of a patient's head, thorax and pelvis, constructed from diagnostic-quality CT data sets. Lastly, we reconstruct CT-numbers from simulated sets of projection images and investigate the quantitative effects of the approximation. We show that the IAA can produce errors of several percent of the total scatter, across 20 a projection image, for typical x-ray beams and patients. The errors in reconstructed CT-number, however, for the phantoms simulated, were small (typically < 10 HU). The IAA can therefore be considered sufficient for the modelling of scatter-correction in CT imaging. Where accurate quantitative estimates of scatter in individual projection images are required, however, the appropriate interference functions should 25 be included.