The introduction of helical single-detector row computed tomography (CT) and, more recently, multi-detector row CT has greatly increased the clinical indications for CT. Correspondingly, CT examinations now account for greater than one-half of the radiation dose due to medical procedures in the population of North America. The level of CT radiation dose, especially in the pediatric population, is of concern to radiologists, medical physicists, government regulators, and the media. This review addresses this problem with particular reference to radiation dose in chest CT. Specifically it outlines the topics of measurement units used to quantify radiation exposure, factors affecting CT scanner dose efficiency, scanner settings that determine the administered radiation dose, and radiation dose reduction in chest CT. A table of reference dose values is provided. Given the wide variation documented in chest CT radiation exposure, the authors suggest that reference standards be promoted to minimize excessive CT radiation exposure. In addition, further research into the complex relationship between radiation exposure, image quality, and diagnostic accuracy should be encouraged in order to establish the minimum radiation dose necessary to provide adequate diagnostic information for standard clinical questions.