Introduction: Exploring potential optimization strategies and developing evident practices is critical. Previous studies show that radiation dose can be reduced by increasing the source-image distance (SID). Although most studies use digital radiography, many hospitals in underdeveloped countries still use computed radiography (CR). Therefore, research will investigate the relationship between SID and Entrance surface dose (ESD) using the CR. Methods: This study involved the measurement of radiation dose and image quality of a radiological procedure performed at a reference SID; 100cm and the tested SIDs; 110cm, 120cm, and 130cm, using constant technical factors (70kVp, 25mAs, grid). A LiF; Mg Ti thermoluminescence dosimeter (TLD-100) chip was placed in the center of the radiation field of the OF10° skull radiography examination to measure ESD. Image quality was assessed using the European Commission guidelines and graded using relative visual assessment analysis (VGA). Results: Significant ESD reduction from 21% and 45% when SID was increased from 100cm to 130cm (p <0.001), where SID was negatively correlated with ESD (r= - 0.98). The VGA scores showed no statistical difference in the image quality of the OF10° skull radiography examination for the tested and reference images (p=0.21). VGA scores for 120cm images showed the highest image quality among the SIDs tested with a dose reduction of 37%. Conclusion: ESD was statically reduced when SID was increased from 100cm to 130cm, while image quality was diagnostically acceptable. The study suggests that 120cm is the optimal SID when both dose and image quality are considered.