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This review explores the establishment of diagnostic reference levels (DRLs) for pediatric brain computed tomography (CT) examinations in Saudi Arabia and compares them with nine other countries. An extensive search strategy was employed across various databases, resulting in the inclusion of 9 studies. The studies included patient-based and phantom-based investigations into DRLs, highlighting variations across age groups and countries. Findings suggest notable differences in CT dose index (CTDI mGy) and dose length product (DLP mGy.cm) values. There was a difference in the classification of age group between Saudi food and drug administration (SFDA) and literature. For the age groups 0-5 years and 6-15 years, the DRLs for the SFDA were as follows: CTDI (28 and 42 mGy) and DLP (482 and 697 mGy cm). The discussion emphasizes the importance of age-specific DRLs to optimize radiation doses while ensuring patient safety and diagnostic efficacy. Recommendations include adopting globally accepted standards for dose optimization and continued research into factors influencing DRL variations. Limitations include varying age groupings among studies and limited access to some relevant literature. Overall, this study underscores the importance of standardizing DRLs for pediatric CT to improve patient care and safety., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)