An appropriate balance between risk (radiation dose) and benefit (based on image quality) for computed tomography (CT) in children is essential. This balance comes through an understanding of CT dose, why we do pediatric CT, and how we do pediatric CT. The following material, then, will approach radiation dose in the context of a larger safety program, and address the challenges with determining radiation dose in contemporary CT technology. Unique considerations with respect to study quality, those factors which influence CT use, and strategies for dose reduction (that is, optimization) will also be reviewed.