•Technological developments in CT have led to an increased number of processes for protocol optimization.•Many acquisition and reconstruction parameters are interrelated, making them more complicated to adjust individually.•Adjusting CT parameters is as slotted dials: An adjustment will have an influence on image quality and radiation dose due to their interrelation.•Within the optimization process, the user's influence has increased, while automated tools were integrated to assist in optimization.•Technological improvements combined with attention to the human side by the radiographer will lead to the optimal scanning procedure. Since the introduction of Computed Tomography (CT), technological improvements have been impressive. At the same time, the number of adjustable acquisition and reconstruction parameters has increased substantially. Overall, these developments led to improved image quality at a reduced radiation dose. However, many parameters are interrelated and part of automated algorithms. This makes it more complicated to adjust them individually and more difficult to comprehend their influence on CT protocol adjustments. Moreover, the user’s influence in adapting protocol parameters is sometimes limited by the manufacturer’s policy or the user’s knowledge. As a consequence, optimization can be a challenge. A literature search in Embase, Medline, Cochrane, and Web of Science was performed. The literature was reviewed with the objective to collect information regarding technological developments in CT over the past five decades and the role of the associated acquisition and reconstruction parameters in the optimization process.