This article on x-ray cone-beam CT (CBCT) acquisition provides an overview of the fundamental principles of operation of this technology and the influence of geometric and software parameters on image quality and patient radiation dose. Advantages of the CBCT system and a summary of the uses and limitations of the images produced are discussed. All current generations of CBCT systems provide useful diagnostic images. Future enhancements most likely will be directed toward reducing scan time; providing multimodal imaging; improving image fidelity, including soft tissue contrast; and incorporating task-specific protocols to minimize patient dose.