Beyond the surface: A review of current and potential micro-CT applications in paleopathology

We assess the current use and future potential of micro-computed tomography (micro-CT) in bioarchaeology and paleopathology, identifying areas of underuse and offering recommendations for effective, standardized application.

We reviewed articles published 2015-2025 in the International Journal of Paleopathology and International Journal of Osteoarchaeology, supplemented by the Journal of Archaeological Science and Journal of Archaeological Science: Reports (2015-2025) and five frequently cited mummy studies (2010-2025).

Articles were categorized by how micro-CT was used (active use versus referencing or recommending it) and by anatomical and pathological focus; reporting of acquisition and reconstruction parameters was also evaluated.

Across all journals, micro-CT was used predominantly to image bone, with little application to soft tissue, infectious disease, or malignancy, and parameter reporting was inconsistent across studies.

Micro-CT is underused for soft-tissue, infectious, and neoplastic pathologies; its diagnostic value would expand with standardized parameter reporting and closer collaboration with radiologists.

This review maps current micro-CT use in paleopathology and offers practical guidance, a reporting checklist, and parameter recommendations to support broader, more reproducible adoption of this potentially diagnostic imaging modality.

The review focused on a defined set of journals and a non-exhaustive selection of mummy studies.

Future work should develop consensus reporting protocols by tissue type and explore AI-assisted analysis of micro-CT data.