In many clinical applications, it is necessary to tilt the gantry of an X-ray CT system with respect to the patient. Tilting the gantry introduces no complications for single-slice fan-beam systems; however, most systems today are helical multislice systems with up to 16 slices (and this number is sure to increase in the future). The image reconstruction algorithms used in multislice helical CT systems must be modified to compensate for the tilt. If they are not, the quality of reconstructed images will be poor with the presence of significant artifacts produced by the tilt. Practical helical multislice algorithms currently incorporated in today’s systems include helical fan-beam, ASSR (Advanced single-slice rebinning), and Feldkamp algorithms. This paper presents the modifications necessary to compensate for gantry tilt for the helical cone-beam Feldkamp algorithm implemented by Toshiba (referred to as TCOT for true cone-beam tomography). Unlike some of the other algorithms, gantry tilt compensation is simple and straightforward to implement with no significant increase in computational complexity. It will be shown that the effect of the gantry tilt is to introduce a lateral shift in the isocenter of the reconstructed slice of interest, which is a function of the tilt, couch speed, and view angle. This lateral shift is easily calculated and incorporated into the backprojection algorithm. The tilt-compensated algorithm is called T-TCOT. Experimental tilted-gantry data has been obtained with 8- and 16 slice Toshiba Aquilion systems, and examples of uncompensated and tilt compensated images are presented.