## 4 Discussion  
Our aim in this work is to correlate between dose and image quality metrics in pediatric while implementing CT optimization protocols. Among radiation dose metrics, organ equivalent dose is considered one of the best indicators for characterizing patient radiation burden [10,32]. Several researchers have been inspired to reduce the risk by altering the variable of scan parameters, including growing the pitch factor, increasing slice collimation, choosing tube voltage, and utilizing automatic tube current modulation (ATCM) feature [33, 34, 35]. Figure 4: The mean organ-absorbed doses from the modification of standard pediatric CT CAP protocols in: (**a**) Thyroid, (**b**) lungs, (**c**) liver, (**d**) stomach, (**e**) gonads, and (**f**) skin. In this work, we have measured organ-absorbed dose in pediatric patients by inserting a TL dosimeter into the hole designed at the slab of the one-year-old anthropomorphic phantom to represent specific radiosensitive organ parts. The CT CAP protocol was selected because of the high frequency performed amongst pediatric patients and the rise in repetitive scans due to the standard protocol used for cancer staging. Nevertheless, patients with early detection of malignancy can have multiple follow-up CT scans with elevated combined sensitivity to radiation, contributing to a possibility of radiation-related illness. Consequently, there is the concern as scan length that includes more than one part of the body may lead to the pediatric patient's over-exposure if CT parameter optimization has not been implemented. The highest organ-absorbed dose was presented in the liver, skin, stomach, and lungs as the site of these organs was situated in the primary beam. As CT CAP is often applied as a routine CT examination in the pediatric population due to its benefit in revealing diseases in the lungs, liver, stomach, and deliberately for cancer staging, this can contribute to a rise in cancer incidence. The modification in CT parameter by lowering the tube voltage and tube current results in substantially different organ equivalent dose. Another research found that small adjustments in tube voltage might significantly reduce the radiation exposure and raise the quantum mottle resulting in increased image noise [36; 37]. However, lowering the capacity of the X-ray tube is an acceptable operation to evaluate iodine structures as a consequence of the rise in iodine attenuation energy due to the proximity of the K-edge of iodine and the photoelectric influence. The optimum kilovoltage for a CT analysis should be selected depending on the imaging task and patient habitus [32]. Furthermore, the practice of low tube potential technique with a proper selection of mAs value will improve contrast resolution in a patient with a smaller body thickness. The decrease in tube voltage from 120 to 100 kVp and 80 kVp is the best range tube potential in pediatric CT chest, abdominal and pelvic examination without deteriorating CNR and SNR consistency index. The alteration of CT scan parameter by reducing the pitch factor from 1.4 to 1.2 slightly increased the organ-absorbed dose without affecting image quality. This was supported by [PERSON] et al. [38], where the increased pitch factor on selected pediatric CT parameter may decrease the radiation output. As presented in P8, there is no significant difference (\(p>0.05\)) in organ-absorbed dose albeit it was slightly increased compared to the routine protocol (P1) and also image diagnostic quality in terms of image noise and SNR value in this study. However, the CNR was found to be varied. Studies have shown that high-pitch CT is not only effective for cardiac imaging, but also for routine chest and abdominal CT analysis by minimizing radiation sensitivity while retaining diagnostic image consistency [33; 39]. Moreover, the efficient high pitch value was found along with the iterative reconstruction algorithm for decreased radiation exposure and image noise, while tube current (mAs) stayed unchanged [40; 41].