Paper Title
How Much is too Much? The Use of Repetition Computed Tomography among Pediatric Patients in Saudi Health Care System

Abstract
Purpose: This study investigates the frequency of CT-scan exposure to quantify the rate of CT-scan repetition among pediatrics in Saudi Arabia. Methods: A cross-sectional retrospective study was conducted for six months. The age of the patients ranged from 1 day to 15 years old. This data was used to calculate the percentage of repeated CT-scan and the duration between repeated exposure. Patients were categorized based on the age into two groups: 1 day-5 years and 6-15 years. To calculate the percentage of repetition, the frequency of re-exposure was categorized into different groups, with the number of cases in the group divided by total cases of repetition. The categories of the CT-scan repetition were classified as two, three, and more than four times. The duration between multiple CT-scan has been categorized into four subgroups: within the same day, one week, one month and more than a month. Descriptive analysis and cross tabulation were performed using SPSS software version 26.0. Results: The total number of admitted patients were 6255, and 393 of whom were children. Among them 131 (33.3%) were less than 5 years old, while 262 (66.7%) were between 6 and 15 years. Overall, 32.0% (n=42) of pediatric patients had repeated CT-scan,9.2% (n=12) of them were less than 5 years, and22.9% (n=30) were between6-15 years. In addition,61.9% (n=26) of children (0-15 years) had scanned two times, whereas 21.4% (n=9) and 16.7%(n=7) of patients had scanned three and four times, respectively. The clustering of the repeated CT-scan based on the duration of exposure time showed that a half of the children (0-15 years) were exposed to a repeat radiation exposure on the same day by 50%. In addition, 25% of children (less than 5 years) and 28.6% of children (more than 5 years)have exposed to repeated CT-scan within one month. Conclusion: Despite Saudi Arabia health authorities have given this issue high priority, little is being done to reduce unnecessary CT-scan repetition among pediatrics. The safety and protection measures should be improved according to modern technologies by creating a justification model using artificial intelligence and machine learning. There is also a dire need for the authorization of medical physics specialists to participate in the decision whether to repeat the CT-scan examination in pediatrics or not.