This study aims to investigate the effect of iterative reconstruction (IR) on MDCT image quality and radiologists' ability to diagnose and grade blunt solid organ injuries. One hundred (100) patients without and 52 patients with solid organ injuries were scanned on a 64-slice MDCT scanner using reference 300 mAs, 120 kVp, and fixed 75 s delay. Raw data was reconstructed using filtered back projection (FBP) and three levels of iterative reconstruction (Philips iDose levels 2, 4, and 6). Four emergency radiologists, blinded to the reconstruction parameters and original interpretation, independently reviewed each case, assessed image quality, and assigned injury grades. Each reader was then asked to determine if they thought that IR was used and, if so, what level. There was no significant difference in diagnostic accuracy between FBP and the various IR levels or effect on the detection and grading of solid organ injuries (p > 0.8). Images reconstructed using iDose level 2 were judged to have the best overall image quality (p < 0.01). The radiologists had high sensitivity in detecting if IR was used (80 %, 95 % CI 76-84 %). IR performed comparably to FBP with no effect on radiologist ability to accurately detect and grade blunt solid organ injuries.