The most rigorously validated protocol for achieving diagnostic-quality CT images without general anesthesia is the intravenous co-administration of Dexmedetomidine (5–20 μg/kg) and Butorphanol (0.1–0.3 mg/kg). This synergistic combination provides sufficient immobility in 92–98% of cases, effectively eliminating motion artifacts indistinguishably from general anesthesia. For workflow optimization, the Intravenous (IV) route is preferred over Intramuscular (IM) injection due to its rapid onset (2–5 minutes) and precise titratability, allowing practitioners to use lower “micro-doses” sufficient for rapid CT acquisition rather than the higher doses typically required for MRI. The operational advantage is solidified by the use of Atipamezole for reversal, which reduces post-procedure recovery time by 60–80% compared to traditional anesthesia, facilitating rapid ambulatory discharge. Protocol selection must be tailored to patient temperament and comorbidities. For highly anxious or aggressive dogs where IV access is elusive, an IM combination of Dexmedetomidine (10–25 μg/kg) with an opioid is effective, with the addition of low-dose Ketamine (1–2 mg/kg) serving as a critical adjunct to deepen sedation and prevent arousal during positioning. Conversely, for geriatric or cardiac-compromised patients (e.g., Mitral Valve Disease) where the vasoconstrictive effects of high-dose alpha-2 agonists are contraindicated, practitioners should pivot to a “neuroleptanalgesic” approach using Methadone with low-dose Dexmedetomidine (1–3 μg/kg) or an Alfaxalone/Butorphanol combination. These alternatives prioritize hemodynamic stability, though they may require supplemental manual restraint via sandbags or troughs as immobility is less absolute. Practitioners should note that while sedation is highly transferable from MRI contexts for orthopedic and head studies, thoracic imaging represents a specific limitation; unless utilizing modern high-speed multi-detector scanners, the inability to induce breath-holding under sedation may result in motion blur, necessitating general anesthesia for lung parenchyma evaluation. Furthermore, safety protocols should avoid the routine use of anticholinergics (atropine) with alpha-2 agonists to prevent myocardial stress, while the use of supraglottic airway devices (v-gels) is strongly recommended for brachycephalic breeds to maintain airway patency under deep sedation without the need for endotracheal intubation.