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PURPOSE Radiation dose reduction is critical to the success of x-ray computed tomography (CT). Many advanced reconstruction techniques have been developed over the years to combat noise resulting from the low-dose CT scans. These algorithms rely on accurate local estimation of the image noise to determine reconstruction parameters or to select inferencing models. Because of difficulties in the noise estimation for heterogeneous objects, the performance of many algorithms is inconsistent and suboptimal. In this paper, we propose a novel approach to overcome such shortcoming. METHOD By injecting appropriate amount of noise in the CT raw data, a computer simulation approach is capable of accurately estimating the local statistics of the raw data and the local noise in the reconstructed images. This information is then used to guide the noise reduction process during the reconstruction. As an initial implementation, a scaling map is generated based on the noise predicted from the simulation and the noise estimated from existing reconstruction algorithms. Images generated with existing algorithms are subsequently modified based on the scaling map. In this study, both iterative reconstruction (IR) and deep learning image reconstruction (DLIR) algorithms are evaluated. RESULTS Phantom experiments were conducted to evaluate the performance of the simulation-based noise estimation in terms of the standard deviation and noise power spectrum (NPS). Quantitative results have demonstrated that the noise measured from the original image matches well with the noise estimated from the simulation. Clinical datasets were utilized to further confirm the accuracy of the proposed approach under more challenging conditions. To validate the performance of the proposed reconstruction approach, clinical scans were used. Performance comparison was carried out qualitatively and quantitatively. Two existing advanced reconstruction techniques, IR and DLIR, were evaluated against the proposed approach. Results have shown that the proposed approach outperforms existing IR and DLIR algorithms in terms of noise suppression and, equally importantly, noise uniformity across the entire imaging volume. Visual assessment of the images also reveals that the proposed approach does not endure noise texture issues facing some of the existing reconstruction algorithms today. CONCLUSION Phantom and clinical results have demonstrated superior performance of the proposed approach with regard to noise reduction as well as noise homogeneity. Visual inspection of the noise texture further confirms the clinical utility of the proposed approach. Future enhancements on the current implementation are explored regarding image quality and computational efficiency. Because of the limited scope of this paper, detailed investigation on these enhancement features will be covered in a separate report. This article is protected by copyright. All rights reserved.