## 4 Discussion  
CT diagnostic procedures are considered one of the highest sources of ionizing radiation, posing risks to both patients and medical personnel. Therefore, it is essential to assess radiation dose to reduce the effects of ionizing radiation while maintaining acceptable CT image quality for precise diagnoses. A simple and straightforward method to assess radiation dose for CT procedures is to multiply the DLP by a CF to obtain the ED. This allows for estimating the possible risks of CT radiation and can take a step forward to optimize radiation exposure levels and minimize its risks. The results for EDs and DRLs were computed and shown in Tables 2 and 3. Then, the results were compared with the values for EDs and DRLs found in the literature, as shown in Tables 4-6. In this study, the maximum ED values were found in head and abdominal CT procedures for patients aged <1 year, whereas the minimum values were found in chest CT procedures. The values of the CTDI\({}_{\text{vol}}\) and DLP for head CT procedures were higher than the other CT procedures among all pediatric age groups. The high EDs for head CT procedures were reported by [PERSON] and [PERSON] (2007) and [PERSON] et al. (2014) [40; 41] for patients aged <1 year compared to older or adult patients. These reports highlighted a concern for the importance of radiation dose optimization for young patients, as they are more radiosensitive and have a longer life expectancy, which increases the probability of radiation-induced cancers. In this study, the results of EDs for head CT procedures for patients aged <5 years were higher than that reported by the USA (1) [26], Malaysia [27], and the USA (3), but the results for older age groups were comparable with these studies [28]. The DRLs of the DLP for head CT procedures for patients aged <1 year were found to be higher than the DRLs mentioned in USA (2) [29], European [20], and German [34] reports but lower than the Japanese DRLs [33]. On the other hand, the DRLs of CTDI\({}_{\text{vol}}\) appeared to be comparable with those reported in the previous studies. Similarly, high EDs for abdomen CT procedures for patients aged <5 years were noticed when they were compared with EDs reported by the USA (4), Turkey, and the USA (1). The DRLs of the DLP and the CTDI\({}_{\text{vol}}\) for abdominal CT procedures for patients aged <5 years were found to be lower than those reported in the international [36] and Chinese [37] DRL reports but higher than those reported in Franch DRLs [35]. However, the difference could be related to the CT protocol setting (axial or helical scan), parameter settings, and type of the CT machine. Thus, the results obtained in this study for EDs and DRLs were found to be the same, lower, or higher than the values found in the literature. Nevertheless, the results for abdominal and head EDs and DRLs, when compared with the values found in the literature, show the necessity for radiation dose optimization for patients aged <1 year. In addition, the assessed radiation dose and the proposed DRLs can be guidelines for the optimization of pediatric CT procedures. Even though most of the assessed EDs and DRLs were found to be low or the same compared to the values found in the literature, radiation dose optimization should continue to reduce radiation dose received by pediatric patients undergoing CT procedures. This can be achieved by the optimization of EDs and establishment of DRLs for these procedures. Moreover, the revision of CT protocols and parameters is recommended. However, setting an optimal CT protocol with high image quality was reported as a demanding technique due to the variation in pediatric patients' size [42]. In addition, deep investigations could be valuable to find the effect of different pediatric genders on EDs and DRLs results. There are some important caveats to the study that deserve mentioning.