Revolutionary developments in multidetector-row computed tomography (CT) scanner technology offer several advantages for imaging of cardiothoracic disorders. As a result, expanding applications of CT now account for >85 million CT examinations annually in the United States alone. Given the large number of CT examinations performed, concerns over increase in population-based risk for radiation-induced carcinogenesis have made CT radiation dose a top safety concern in health care. In response to this concern, several technologies have been developed to reduce the dose with more efficient use of scan parameters and the use of "newer" image reconstruction techniques. Although iterative image reconstruction algorithms were first introduced in the 1970s, filtered back projection was chosen as the conventional image reconstruction technique because of its simplicity and faster reconstruction times. With subsequent advances in computational speed and power, iterative reconstruction techniques have reemerged and have shown the potential of radiation dose optimization without adversely influencing diagnostic image quality. In this article, we review the basic principles of different iterative reconstruction algorithms and their implementation for various clinical applications in cardiothoracic CT examinations for reducing radiation dose.