Purpose:This paper introduces a new strategy for simulating low‑dose computed tomography (CT) scans using real scans of a higher dose as an input. The tool is verified against simulations and real scans and compared to other approaches found in the literature.Methods:The conditional variance identity is used to properly account for the variance of the input high‑dose data, and a formula is derived for generating a new Poisson noise realization which has the same mean and variance as the true low‑dose data. The authors also derive a formula for the inclusion of real samples of detector noise, properly scaled according to the level of the simulated x‑ray signals.Results:The proposed method is shown to match real scans in number of experiments. Noise standard deviation measurements in simulated low‑dose reconstructions of a 35 cm water phantom match real scans in a range from 500 to 10 mA with less than 5% error. Mean and variance of individual detector channels are shown to match closely across the detector array. Finally, the visual appearance of noise and streak artifacts is shown to match in real scans even under conditions of photon‑starvation (with tube currents as low as 10 and 80 mA). Additionally, the proposed method is shown to be more accurate than previous approaches (1) in achieving the correct mean and variance in reconstructed images from pure‑Poisson noise simulations (with no detector noise) under photon‑starvation conditions, and (2) in simulating the correct noise level and detector noise artifacts in real low‑dose scans.Conclusions:The proposed method can accurately simulate low‑dose CT data starting from high‑dose data, including effects from photon starvation and detector noise. This is potentially a very useful tool in helping to determine minimum dose requirements for a wide range of clinical protocols and advanced reconstruction algorithms.