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Given the link between radiation exposure from CT in children and increased cancer risk, imaging test selection should adhere to the principle of ALARA (as low as reasonably achievable) to minimize radiation exposure. Ultrasonography is sufficiently sensitive and specific as an initial imaging test in pediatric patients with suspected urolithiasis. When ultrasound results are negative or indeterminate despite strong clinical suspicion or when proceeding with perioperative planning, CT using a low-dose protocol is an appropriate next step.