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Projection data from 83 patients undergoing unenhanced spiral head CT for suspected neurologic deficits were collected. A routine dose was obtained using 250 effective mAs and iterative reconstruction. Lower-dose configurations were reconstructed (25-effective mAs iterative reconstruction, 50-effective mAs filtered back-projection and iterative reconstruction, 100-effective mAs filtered back-projection and iterative reconstruction, 200-effective mAs filtered back-projection). Three neuroradiologists circled findings, indicating diagnosis, confidence, and image quality. The routine-dose jackknife alternative free-response receiver operating characteristic figure of merit was 0.87. Noninferiority was shown for 100-effective mAs iterative reconstruction and 200-effective mAs filtered back-projection, but not for100-effective mAs filtered back-projection. The authors conclude that substantial opportunity exists for dose reduction using spiral nonenhanced head CT and that the dose level might potentially be reduced to 40% of routine dose levels or a volume CT dose index of approximately 15mGy if slight decreases in performance are acceptable. The beneficial effect of iterative reconstrution was most pronounced at this 15-mGy dose level.