Introduction: This study evaluates the role of dual-energy ct in musculoskeletal surgery in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a retrospective diagnostic accuracy analysis. Materials and Methods: A retrospective diagnostic accuracy study was conducted on 360 patients from January 2017 to August 2023 at a tertiary care center. Patients were divided into DECT evaluated (n=180) and Conventional CT (n=180) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The DECT evaluated group demonstrated significantly improved primary outcomes compared to Conventional CT (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.