PURPOSE: The purpose of this work was to assess the utility of low-dose spiral CT for three-dimensional imaging of the central airways. METHOD: Spiral CT was performed in 15 patients using two tube currents (50 and 240 mA), producing 30 CT data sets. Surface-rendered virtual bronchoscopy (VB) and shaded surface display (SSD) images were assessed by three radiologists for image quality. The radiologists were also asked to compare 15 matched pairs each of 50 and 240 mA VB and SSD images, blindly select the 240 mA image, and record differences in diagnostic quality between the matched images. RESULTS: No significant difference in image quality was noted with 50 or 240 mA. Only 51.1% of 240 mA SSD and 51.1% of 240 mA VB images were correctly identified. Differences in diagnostic quality, noted in 84.4% of SSD and 33% of VB image pairs, were not ascribed to image noise. CONCLUSION: Image quality of surface-rendered three-dimensional images of the central airways is preserved using a lower tube current.