In this systematic review of the literature, we reviewed the evidence for maintaining the current recommendation that a routine CT scan should be performed in first-episode psychotic patients (Danish National Board of Health). We identified eight papers comprising 625 CT and 214 MRI scans. The share of potentially causal brain abnormalities was 0.8% with CT and 3.3% with MRI, but the findings had limited clinical consequences. We concluded that there is no evidence in support of performing routine CT scans of first-episode psychotic patients. If intracranial pathology is suspected clinically, an MRI scan should be performed.