[ABSTRACT] Objective: To investigate the value of a modified position utilizing surgical shoulder pillows in optimising the quality of thyroid CT images. Methods: A total of 176 patients who intended to get a CT scan for evaluating thyroid nodules were prospectively enrolled, and divided into control group (conventional position, n=88) and experimental group (modified position, n=88). The patients in the control group were positioned in the supine position with their arms on each side of their bodies and drooping naturally. The experimental group was adopted with the shoulders elevated by the surgical shoulder pillows, shoulders parallel to the upper edge of the shoulder pillows, arms placed on each side of the body, and the head in the hyperextension position. Subjective quality scores (overall image quality, subjective noise evaluation, artefacts), objective quality scores (signal-to-noise ratio SNR, contrast-to-noise ratio CNR) and radiation doses (CT dose index CTDIvol/ mGy, dose length product DLP/ mGy·cm, effective dose ED/ mSv) of arterial-phase and venous-phase CT images were compared between two groups. Results: The experimental group outperformed the control group in subjective picture quality scores, demonstrating superiority in overall image quality (Z=-5.385, P<0.001), subjective noise (Z=-5.609, P<0.001), and artefact suppression (Z=-3.473, P=0.001). The experimental group exhibited much superior SNR and CNR than control group in both arterial (SNR: Z=-6.533; CNR: Z=-6.475; both P<0.001) and venous phases (SNR: t=-7.193; CNR: Z=-5.705; both P<0.001). No significant differences in radiation dose were observed between the experimental and control groups for arterial phase CTDIvol (Z=-0.527, P=0.598), DLP (Z=-1.493, P=0.136), ED (Z=-1.493, P=0.136), and venous phase CTDIvol (Z=-0.611, P=0.541), DLP (Z=-1.151, P=0.250), and ED (Z=-1.151, P=0.250). Conclusion: The modified position utilising surgical shoulder pillows allows patients to fully stretch their necks, and improves the quality of CT images of the thyroid gland without increasing the radiation dose.