Objective To evaluate the effect of forward projected model-based iterative reconstruction solution (FIRST) on head and neck CTA image quality at 100 kVp. Methods Thirty-three patients undergoing head and neck CTA were analyzed. Three sets of images were reconstructed from the raw data, which were filtered back projection (FBP), adaptive iterative dose reduction 3D (AIDR- 3D) and FIRST. The effect of different reconstruction modes in head and neck CTA image quality from both objective measurement and subjective scoring were evaluated. Results Objective measurement: CT values of aortic arch were statistically different among the three sets’ images (P<0.001), while there was no significant difference in other parts (P>0.05). The SD value, signal to noise ratio and noise ratio of the three sets were statistically different in each blood vessel (P<0.05). Subjective scoring: Different reconstructed images of the three sets could meet the diagnostic requirements. There was no statistical difference between the scores of the FBP group and the AIDR-3D group (P>0.05), and the scores of the FIRST group were statistically different from those of the FBP group and THE AIDR-3D group (P<0.05). Conclusion In terms of image quality of head and neck CTA examination, compared with FBP and AIDR-3D reconstruction algorithms, FIRST can significantly reduce image noise and improve image signal to noise ratio. FIRST has better performance on displaying small intracranial blood vessels. It can be used in clinical examination.