Pediatric CT dose reduction for suspected appendicitis: a practice quality improvement project using artificial...

Area of Science:

• Medical Imaging
• Pediatric Radiology
• Radiation Dose Reduction

Background:

• Computed tomography (CT) is crucial for diagnosing acute appendicitis in children.
• Reducing radiation exposure in pediatric imaging is a significant concern.
• Previous studies suggest potential for dose reduction in abdominal CT without compromising diagnostic quality.

Purpose of the Study:

• To evaluate the impact of a 50% nominal reduction in median absorbed radiation dose on CT scan performance for diagnosing acute appendicitis in children.
• To assess the effect of dose reduction on the sensitivity, specificity, and negative appendectomy rate.
• To determine if reduced radiation dose affects the accuracy of CT in pediatric appendicitis diagnosis.

Main Methods:

• A retrospective study of 494 children who underwent CT for suspected appendicitis.
• Comparison of diagnostic performance before and after implementing a 50% nominal dose reduction using computer-generated noise.
• Analysis included sensitivity, specificity, and negative appendectomy rates, with histologic diagnosis as the gold standard.

Main Results:

• A 39% actual decrease in median absorbed radiation dose was achieved.
• CT sensitivity for appendicitis remained high (98% vs. 97%) and specificity was comparable (93% vs. 94%) after dose reduction.
• The negative appendectomy rate showed no significant change (4.5% vs. 4.0%).

Conclusions:

• A 39% reduction in median absorbed radiation dose for pediatric CT scans of acute appendicitis is safe.
• Diagnostic performance (sensitivity and specificity) for acute appendicitis remains unaffected by this dose reduction.
• The negative appendectomy rate was not adversely impacted by the decreased radiation dose, supporting the quality improvement initiative.