# Monitoring Pediatric Head CT Scan Dose Levels:
## 1 Introduction  
The role of diagnostic imaging in the diagnosis and treatment of disease is very important. Different techniques and tools are used in radiology in order to provide information and visualize the inner body of a patient [1, 2]. Nevertheless, the human body may suffer harm from exposure to the radiation used in X-rays, specifically in children, due to their underdeveloped organs and tissues. For the last twenty years, several international standards have supported radiation dose optimization in medical exposure, especially in computed tomography (CT) scans. These include the International Atomic Energy Agency (IAEA), the International Basic Safety Standards (BSS), the European Basic Safety Standards, as well as the International Commission on Radiological Protection [2, 3, 4, 5]. The primary goal of these standards is to reduce the risks associated with radiation exposure while ensuring that the necessary diagnostic information is obtained. Therefore, the use of appropriate imaging protocols and dose-reduction techniques is essential to minimize radiation exposure in pediatric patients. Due to the technological advances in CT scanners, they are considered essential diagnostic tools by many medical practitioners [6]. CT scanning is an essential medical imaging technique that has significantly contributed to the diagnosis and treatment of various medical conditions. CT scans provide detailed images of internal body structures, making it possible to identify abnormalities and injuries that may not be visible throughother diagnostic tests. They are particularly useful in emergency situations, where quick diagnosis and treatment are crucial for saving lives. CT scanning is a popular diagnostic tool used to identify various medical conditions such as cancer, trauma, cardiovascular disease, and infectious diseases [7; 8; 9]. It plays a key role in diagnosing and staging cancer and evaluating trauma patients. However, CT scanning involves a higher radiation dose than conventional radiography, which poses a significant public health concern. To minimize radiation exposure, it is important to monitor radiation exposure and implement appropriate safety measures, especially during pediatric CT imaging [7; 10]. The establishment of a diagnostic reference level (DRL) is an essential optimization strategy for ensuring that the benefits of CT scans outweigh their risks [11]. In 1996, the International Commission on Radiological Protection (ICRP) introduced diagnostic reference levels (DRLs) as tools to optimize and monitor the radiation levels to which patients are exposed during medical imaging procedures [7]. DRLs play a crucial role in managing radiation doses in medical imaging procedures, particularly in pediatric CT imaging. By establishing and following DRLs, medical facilities can help to ensure that radiation doses are kept as low as reasonably achievable while still providing the necessary diagnostic information, ultimately protecting the health and safety of patients. In addition, the official guidelines recently published by the European Commission report the methodology to be followed to establish DRLs exclusively for pediatric patients [12]. According to the guidelines' standards, the national DRL should be based on patient dose surveys involving samples from a large number of institutions within a country. Similar to national DRLs, the establishment of local DRLs is also based on patient dose surveys involving representative samples within a region or facility. They are based on the 3 rd quartile or the 75 th percentile of the median values of the distribution of patient doses. Following these guidelines, different DRLs have been established in several countries or regions. This variety of DRLs is mainly due to variations in equipment, procedural protocols, and the size and weight of the patients in the corresponding countries or regions [13]. Furthermore, DRLs are set using standard CT parameters, including the CT dose index volume (CTDIvol) and dose-length product (DLP).