Introduction: Imaging of the cervical spine in general radiography is most frequently performed using an anti-scatter grid. The purpose of this study was to investigate the effects of a gridless setting on image quality and radiation dose during digital radiography of the anteroposterior (AP) and lateral (LAT) cervical spine. Methods: A phantom study was performed with a variety of tube voltages (63e75 kV) with and without an anti-scatter grid. The tube current time product (mAs) and dose area product (DAP) were recorded and used to calculate effective dose (ED) and individual organ dose using PCXMC 2.0 software, as well as entrance surface dose (ESD) and objective image quality: signal-to-noise ratio (SNR) and contrast-tonoise ratio (CNR). Subjective visual image quality grading characteristics (VGC) was performed by five qualified radiographers. Results: In a gridless setting, the AP and LAT positions showed significantly lower DAP (1.6 mGym2; 61.3 % and 1.6 mGym2; 51.2%), ESD (27.6 mGy; 57.3% and 77.2 mGy; 47.2%) and ED (4.2 mSv; 61.3% and 2.3 mSv; 48.9%). In a gridless setting in the AP position, there is a slight significant deterioration in image quality. In the lateral projection, on the other hand, the image quality without the use of grid was only significantly reduced in three of six criteria and there was no difference in the objective image quality between the two settings examined. Conclusion: The results of this study show that gridless setting significantly decreases radiation dose and image quality, but the quality in the lateral projection is still acceptable for diagnostic purpose. Implications for practice: The protocol without the use of the anti-scatter grid in cervical spine radiography leads to a reduction in the radiation dose in both projections, but the image quality in the AP is significantly reduced for all criteria examined, with a slight deterioration in image quality in the lateral projection.