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 patients with shoulder pull-down in order to evaluate the image quality of DO C-spine CT in patients capable of shoulder pull-down in an emergency setting. At C2/3, DO-CT vs standard-dose (SD)-CT produced similar qualitative noise and morphological features, though higher quantitative noise. At C6/7, DO-CT produced lower subjective noise and superior morphological features along with higher visibility scores for cortex and trabeculae. No variation in quantitative noise was noted. Using DO-CT, the radiation dose was 51% lower. Thus, C-spine CT with a dose decrease of 51% exhibited no image quality impairment. Supplementary pull-down of both shoulders provided superior image quality at lower C-spine segments in comparison with a standard protocol.