Purpose To investigate whether reduced radiation dose liver computed tomography (CT) images reconstructed with model-based iterative reconstruction (MBIR) might compromise depiction of clinically relevant findings or might have decreased image quality when compared with clinical standard radiation dose CT images reconstructed with adaptive statistical iterative reconstruction (ASIR). Materials and Methods With institutional review board approval, informed consent, and HIPAA compliance, 50 patients (39 men, 11 women) were prospectively included who underwent liver CT. After a portal venous pass with ASIR images, a 60% reduced radiation dose pass was added with MBIR images. One reviewer scored ASIR image quality and marked findings. Two additional independent reviewers noted whether marked findings were present on MBIR images and assigned scores for relative conspicuity, spatial resolution, image noise, and image quality. Liver and aorta Hounsfield units and image noise were measured. Volume CT dose index and size-specific dose estimate (SSDE) were recorded. Qualitative reviewer scores were summarized. Formal statistical inference for signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), volume CT dose index, and SSDE was made (paired t tests), with Bonferroni adjustment. Results Two independent reviewers identified all 136 ASIR image findings (n = 272) on MBIR images, scoring them as equal or better for conspicuity, spatial resolution, and image noise in 94.1% (256 of 272), 96.7% (263 of 272), and 99.3% (270 of 272), respectively. In 50 image sets, two reviewers (n = 100) scored overall image quality as sufficient or good with MBIR in 99% (99 of 100). Liver SNR was significantly greater for MBIR (10.8 ± 2.5 [standard deviation] vs 7.7 ± 1.4, P < .001); there was no difference for CNR (2.5 ± 1.4 vs 2.4 ± 1.4, P = .45). For ASIR and MBIR, respectively, volume CT dose index was 15.2 mGy ± 7.6 versus 6.2 mGy ± 3.6; SSDE was 16.4 mGy ± 6.6 versus 6.7 mGy ± 3.1 (P < .001). Conclusion Liver CT images reconstructed with MBIR may allow up to 59% radiation dose reduction compared with the dose with ASIR, without compromising depiction of findings or image quality. © RSNA, 2014.