The help describes this tool as:
Exports an existing PDF file to a Tagged Image File Format (TIFF). If the PDF has georeference information, the TIFF can be a GeoTIFF. These TIFFs can be used as a source for heads-up digitizing and viewing in ArcMap. Both GeoPDF and ISO standards of georeferenced PDFs are supported.
It is very straight forward to use:
import arcpy arcpy.PDFToTIFF_conversion(in_pdf_file="C:/temp/sample.pdf", out_tiff_file="C:/temp/sample.tif", pdf_password="", pdf_page_number="1", pdf_map="Layers", clip_option="NO_CLIP", resolution="250", color_mode="RGB_TRUE_COLOR", tiff_compression="LZW", geotiff_tags="GEOTIFF_TAGS")
For this sample, I just created a map with one of the AGOL imagery layers in a blank ArcMap layout and exported it to PDF with the GeoReference information embedded. This creates a TIFF that can be used for additional spatial data in the ArcMap session.