{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:39:30Z","timestamp":1785451170636,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Repeated brain computed tomography (CT) scans in children may result in substantial cumulative radiation exposure, particularly in young children, who are more sensitive to ionizing radiation. The purpose of the study was to assess the dose levels of radiation in patients who receive repeated brain CT during childhood and adherence rates to pediatric imaging protocols. Methods: A retrospective cross-sectional study was conducted among 177 patients aged \u22645 years who underwent two or more brain CT examinations with a total of 514 CT examinations. The information was gathered through the hospital Picture Archiving and Communication System (PACS), which included patient demographics, scan parameters, and scanner-reported dose indicators such as volume-averaged computed tomography dose index (CTDIvol) and dose-length product (DLP). The effective dose (ED) was calculated and compared with estimated doses based on a nominal pediatric CT protocol. Results: The findings indicated a great variation in scan parameters, with CTDIvol values of 8.9 to 51.7 mGy and DLP values of 177 to 1310 mGy.cm. The number of repeated scans showed a great increase in the cumulative ED (p &lt; 0.001). The median doses in patients below the age of one year were greater than those in older children. There was also a closer relation of scanner-reported doses to adult protocols, which suggests a lack of an optimized pediatric setting. Conclusions: Children under 5 who undergo repeated brain CT scans may face excessive radiation exposure. The matter is aggravated by the fact that scans are performed repeatedly without optimization of the dose, which leads to significant cumulative ED.<\/jats:p>","DOI":"10.3390\/diagnostics16091265","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T10:10:17Z","timestamp":1776939017000},"page":"1265","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Radiation Dose Evaluation in Pediatric Patients Undergoing Repeated Brain Computed Tomography Examinations"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8255-0839","authenticated-orcid":false,"given":"Mohammad","family":"Aljamal","sequence":"first","affiliation":[{"name":"Department of Medical Imaging, Faculty of Allied Medical Sciences, Arab American University, 13 Zababdeh, Jenin P.O. Box 240, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Abuasbi","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Faculty of Allied Medical Sciences, Arab American University, 13 Zababdeh, Jenin P.O. Box 240, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7320-2795","authenticated-orcid":false,"given":"Awadia","family":"Gareeballah","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2895-2284","authenticated-orcid":false,"given":"Zuhal Y.","family":"Hamd","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Medical Imaging Department, King Abdullah bin Abdulaziz University Hospital, P.O. Box 47330, Riyadh 11552, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9156-9435","authenticated-orcid":false,"given":"Amna M.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, P.O. Box 960, Abha 61421, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8260-4083","authenticated-orcid":false,"given":"Lama","family":"Almudaimeegh","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2601-6782","authenticated-orcid":false,"given":"Areej","family":"Hamami","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Rafidia Surgical Hospital, Rafidia St., Nablus 9992200, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2583","DOI":"10.1007\/s00381-023-06041-9","article-title":"Revolutionizing pediatric neuroimaging: The era of CT, MRI, and beyond","volume":"39","author":"Ryan","year":"2023","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Shaikh, Z., Torres, A., and Takeoka, M. (2019). Neuroimaging in Pediatric Epilepsy. Brain Sci., 9.","DOI":"10.3390\/brainsci9080190"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3348\/kjr.2024.1086","article-title":"Emergency Radiology: Current Status and Recent Advances","volume":"26","author":"Kaewlai","year":"2025","journal-title":"Korean J. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Mahmoudi, G., Toolee, H., Maskani, R., Jokar, F., Mokfi, M., and Hosseinzadeh, A. (2024). COVID-19 and cancer risk arising from ionizing radiation exposure through CT scans: A cross-sectional study. BMC Cancer, 24.","DOI":"10.1186\/s12885-024-12050-x"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"024003","DOI":"10.1088\/1361-6498\/acdfd7","article-title":"The scientific basis for the use of the linear no-threshold (LNT) model at low doses and dose rates in radiological protection","volume":"43","author":"Laurier","year":"2023","journal-title":"J. Radiat. Prot."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3111","DOI":"10.1038\/s41591-023-02620-0","article-title":"Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults","volume":"29","author":"Harbron","year":"2023","journal-title":"Nat. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E575","DOI":"10.1503\/cmaj.221303","article-title":"Risks of leukemia, intracranial tumours and lymphomas in childhood and early adulthood after pediatric radiation exposure from computed tomography","volume":"195","author":"Wang","year":"2023","journal-title":"Can. Med. Assoc. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3637","DOI":"10.1118\/1.4734771","article-title":"SU-E-I-55: Cumulative Radiation Exposure and Cancer Risk Estimates in Pediatric Hydrocephalus Patients Undergoing Repeat Or Multiple CT","volume":"39","author":"Wang","year":"2012","journal-title":"Med. Phys."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Han, S., Soh, J., Nah, S., Han, K., Jung, J.-H., Park, J., Hwang, Y.J., Lee, C., and Hong, J.Y. (2025). Pediatric computed tomography scan and subsequent risk of malignancy: A nationwide population-based cohort study in Korea using National Cancer Institute dosimetry system for computed tomography (NCICT). BMC Med., 23.","DOI":"10.1186\/s12916-025-04235-3"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e12282","DOI":"10.1002\/pul2.12282","article-title":"Associated radiation exposure from medical imaging and excess lifetime risk of developing cancer in pediatric patients with pulmonary hypertension","volume":"13","author":"Mahendra","year":"2023","journal-title":"Pulm. Circ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"110271","DOI":"10.1016\/j.radphyschem.2022.110271","article-title":"Evaluation of paediatric computed tomography imaging for brain, and abdomen procedures","volume":"200","author":"Almujally","year":"2022","journal-title":"Radiat. Phys. Chem."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1001\/jamapediatrics.2013.3180","article-title":"Image Gently: Child-Sizing Radiation Dose for Children","volume":"167","author":"Goske","year":"2013","journal-title":"JAMA Pediatr."},{"key":"ref_13","first-page":"e85284","article-title":"Pediatric Local Diagnostic Reference Levels for CT Examinations: A Study Based on the European Guidelines on Diagnostic Reference Levels for Pediatric Imaging","volume":"17","author":"Syrgiamiotis","year":"2025","journal-title":"Cureus"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1038\/nrn.2018.1","article-title":"Imaging structural and functional brain development in early childhood","volume":"19","author":"Gilmore","year":"2018","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00247-020-04803-0","article-title":"Early life ionizing radiation exposure and cancer risks: Systematic review and meta-analysis","volume":"51","author":"Abalo","year":"2021","journal-title":"Pediatr. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.radmp.2020.01.005","article-title":"Aging and age-related health effects of ionizing radiation","volume":"1","author":"Tong","year":"2020","journal-title":"Radiat. Med. Prot."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1088\/1361-6498\/ab3ee2","article-title":"Diagnostic reference levels for paediatric CT in Jordan","volume":"39","author":"Rawashdeh","year":"2019","journal-title":"J. Radiol. Prot."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1093\/rpd\/ncz056","article-title":"Local Drls for Paediatric CT Examinations Based on Size-specific dose Estimates in Kermanshah, Iran","volume":"186","author":"Mohammadbeigi","year":"2019","journal-title":"Radiat. Prot. Dosim."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.3390\/tomography9060159","article-title":"Reporting Diagnostic Reference Levels for Paediatric Patients Undergoing Brain Computed Tomography","volume":"9","author":"Alhailiy","year":"2023","journal-title":"Tomography"},{"key":"ref_20","first-page":"e64646","article-title":"Radiation Doses in Routine CT Examinations for Adult Patients in Saudi Arabia: A Systematic Review","volume":"16","author":"Alenazi","year":"2024","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Al-Othman, A.Y., Al-Sharydah, A.M., Abuelhia, E.I., Mohtasib, R., Dahmash, A.B., Hegazi, T.M., Tajaldeen, A.A., Alshehri, S.S., Al-Malki, F.M., and Alghamdi, S. (2022). Radiation Dose Optimization Based on Saudi National Diagnostic Reference Levels and Effective Dose Calculation for Computed Tomography Imaging: A Unicentral Cohort Study. Appl. Sci., 12.","DOI":"10.3390\/app122211504"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1051\/radiopro\/2022027","article-title":"Assessment of pediatric radiation doses in brain CT procedures","volume":"57","author":"Bawazeer","year":"2022","journal-title":"Radioprotection"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kamdem, F.E., Ngano, S.O., Takam, C.A., Fotue, A.J., Abogo, S., and Fai, C.L. (2021). Optimization of pediatric CT scans in a developing country. BMC Pediatr., 21.","DOI":"10.1186\/s12887-021-02498-2"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1559325820985660","DOI":"10.1177\/1559325820985660","article-title":"A Preliminary Study of Personalized Head CT Scan in Pediatric Patients","volume":"19","author":"Bingyang","year":"2021","journal-title":"Dose Response"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s00234-025-03893-7","article-title":"Radiation dose of computed tomography in pediatric head trauma imaging","volume":"68","author":"Rosok","year":"2026","journal-title":"Neuroradiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1186\/s43055-024-01396-8","article-title":"Establishment of baseline size-specific dose estimate (SSDE) for paediatric head computed tomography (CT) examinations","volume":"55","author":"Sulemana","year":"2024","journal-title":"Egyp. J. Radiol. Nucl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bouchareb, Y., Al Kharusi, M., Al Maqbali, A., Al Maimani, A., Al Maskari, H., Sirasanagandla, S.R., Al Jabri, A., Al Kindi, F., Al Shabibi, S., and Baawain, S. (2025). Establishing Diagnostic Reference Levels for Paediatric CT Imaging: A Multi-Centre Study. Healthcare, 13.","DOI":"10.3390\/healthcare13141728"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1051\/radiopro\/2024044","article-title":"Evaluating the knowledge of radiation exposure parameters among CT technologists in Saudi Arabia: A survey-based study on adherence to ALARA principles and dose optimization","volume":"60","author":"Alashban","year":"2025","journal-title":"Radioprotection"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1148\/radiol.2019181753","article-title":"Radiation Dose for Pediatric CT: Comparison of Pediatric versus Adult Imaging Facilities","volume":"291","author":"Strauss","year":"2019","journal-title":"Radiology"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1265\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T10:21:10Z","timestamp":1776939670000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1265"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":29,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091265"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091265","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]}}}