Tozakidou M, Yang SR, Kovacs BK, et al. - Dose-optimized (DO)-CT (105mAs/120 kVp) of the C-spine in trauma settings was done in individuals with shoulder pull-down if C5 was not superimposed by soft tissue on the lateral topogram, or else standard-dose (SD)-CT (195 mAs/120 kVp) was done in order to evaluate image quality of DO cervical(C)-spine CT in individuals capable of shoulder pull-down in an emergency setting. At C2/3, DO-CT vs SD-CT gave similar qualitative noise and morphological features, yet greater quantitative noise. At C6/7, DO-CT gave lower subjective noise and superior morphological features with greater visibility scores for cortex and trabeculae. Quantitative noise did not vary. The radiation dose was 51% lower using DO-CT. Hence, no image quality impairment was exhibited by C-spine CT with a dose decrease of 51%. In comparison with a standard protocol, additional pull-down of both shoulders permit better image quality at lower C-spine segments.