In 1976, Noyek observed that the thyroid cartilage framework of the larynx could be imaged by diagnostic ultrasound; the image appeared uniquely independent of the presence or absence of calcification. It was suggested that ultrasound, with its simple, nonroentgenographic, noninvasive features, might permit screening detection of thyroid cartilage destruction. It might, therefore, give direction to better computed tomographic (CT) imaging, and, specifically, more effectively identify T4 laryngeal cancer. Since that time, with improving generations of ultrasound transducers, more than 130 clinically correlated laryngeal ultrasound examinations have been recorded. Thirty CT, ultrasound, and pathologically correlated advanced cases of laryngeal carcinoma were critically evaluated by the Departments of Otolaryngology and Radiology at Mount Sinai Hospital, Toronto. Our diagnostic imaging approach has resulted in remarkably improved thyroid cartilage imaging by CT when "directed" by preliminary ultrasound.