We describe a new method for the automatic detection of changes in repeat CT scanning with a reduced X-ray radiation dose. We present a theoretical formulation of the automatic change detection problem based on the on-line sparse-view repeat CT scanning dose optimization framework. We prove that the change detection problem is NP-hard and therefore cannot be efficiently solved exactly. We describe a new greedy change detection algorithm that is simple and robust and relies on only two key parameters. We demonstrate that the greedy algorithm accurately detects small, low contrast changes with only 12 scan angles. Our experimental results show that the new algorithm yields a mean changed region recall rate >89% and a mean precision rate >76%. It outperforms both our previous heuristic approach and a thresholding method using a low-dose prior image-constrained compressed sensing (PICCS) reconstruction of the repeat scan. The resulting changed region map may obviate the need for a high-quality repeat scan image when no major changes are detected and may streamline the radiologist's workflow by highlighting the regions of interest.