Objective To evaluate the feasibility of using a low concentration of contrast medium (Visipaque 270 mgI/mL), low tube voltage, and an advanced image reconstruction algorithm in head and neck computed tomography angiography (CTA). Methods Forty patients (22 men and 18 women; average age 48.7 ± 14.25 years; average body mass index 23.9 ± 3.7 kg/m2) undergoing CTA for suspected vascular diseases were randomly assigned into two groups. Group A (n = 20) was administered 370 mgI/mL contrast medium, and group B (n = 20) was administered 270 mgI/mL contrast medium. Both groups were administered at a rate of 4.8 mL/s and an injection volume of 0.8 mL/kg. Images of group A were obtained with 120 kVp and filtered back projection (FBP) reconstruction, whereas images of group B were obtained with 80 kVp and 80% adaptive iterative statistical reconstruction algorithm (ASiR). The CT values and standard deviations of intracranial arteries and image noise on the corona radiata were measured to calculate the contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). The beam-hardening artifacts (BHAs) around the skul base were calculated. Two readers evaluated the image quality with volume rendered images using scores from 1 to 5. The values between the two groups were statistical y compared. Results The mean CT value of the intracranial arteries in group B was significantly higher than that in group A (P < 0.001). The CNR and SNR values in group B were also statistical y higher than those in group A (P < 0.001). Image noise and BHAs were not significantly dif erent between the two groups. The image quality score of VR images of in group B was significantly higher than that in group A (P = 0.001). However, the quality scores of axial enhancement images in group B became significantly smal er than those in group A (P< 0.001). The CT dose index volume and dose-length product were decreased by 63.8% and 64%, respectively, in group B (P < 0.001 for both). Conclusion Visipaque combined with 80 kVp and 80% ASiR provided similar image quality in intracranial CTA with 64% radiation dose reduction compared with the use of Iopamidol, 120 kVp, and FBP reconstruc-tion.