Related Experiment Video
Updated: Jul 25, 2025
Whole-body PET/MRI of Pediatric Patients: The Details That Matter
Published on: December 19, 2017
Quality Improvement Campaign Improved Utilization of Rapid Sequence MRI for Diagnosis of Pediatric Appendicitis
Bailey D Lyttle1, Marina L Reppucci2, Connor Prendergast3
1General Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Introduction:
Appendicitis is the most common indication for emergency general surgery in the pediatric population. Computed tomography (CT) or magnetic resonance imaging (MRI) may be used for diagnosis when ultrasound findings are equivocal. However, CT involves unnecessary radiation exposure if MRI is available. After introducing a rapid sequence MRI (rsMRI) appendicitis protocol at our institution, CT was still preferentially used. We therefore implemented a quality improvement (QI) campaign to reduce the rate of CTs and increase the rate of rsMRI. Here, we assess the effectiveness of the QI campaign while evaluating potential barriers to using rsMRI.
Methods:
We conducted a mixed methods study, first performing stakeholder interviews which informed the design of a QI campaign initiated in May 2021 and a midway feedback survey in December 2021. A retrospective cohort study was then performed of children evaluated for appendicitis at our institution between January 1, 2016, and April 30, 2022. CT and rsMRI rates were compared before and after QI campaign implementation.
Results:
There was a significant decrease in rate of CTs and increase in rate of rsMRIs performed following the initiation of the QI campaign (p < 0.0001). The rate of CT scans decreased by a factor of 0.4 while the rate of rsMRI increased by a factor of 9.5.
Conclusion:
A successful QI campaign was initiated at our institution, resulting in decreased utilization of CT and increased use of rsMRI for the evaluation of suspected appendicitis. These results highlight the potential impact of QI projects.
Level Of Evidence:
III.
Insights
A quality improvement campaign successfully reduced CT scans and increased rapid sequence MRI use for pediatric appendicitis diagnosis. This highlights the impact of QI initiatives in optimizing imaging practices.
Area of Science:
- Pediatric Surgery
- Radiology
- Quality Improvement
Background:
- Appendicitis is a common surgical emergency in children.
- Computed tomography (CT) and magnetic resonance imaging (MRI) are used for diagnosis, but CT involves radiation.
- A rapid sequence MRI (rsMRI) protocol was introduced, yet CT remained preferred.
Purpose of the Study:
- To assess the effectiveness of a quality improvement (QI) campaign aimed at reducing CT use and increasing rsMRI use for pediatric appendicitis.
- To evaluate potential barriers to rsMRI adoption.
Main Methods:
- A mixed-methods study combining stakeholder interviews and a retrospective cohort analysis.
- QI campaign initiated in May 2021 with a feedback survey in December 2021.
- Comparison of CT and rsMRI rates before and after QI implementation (January 2016 - April 2022).
Main Results:
- Significant decrease in CT utilization (by a factor of 0.4) post-QI campaign.
- Significant increase in rsMRI utilization (by a factor of 9.5) post-QI campaign.
- Statistical significance achieved (p < 0.0001).
Conclusions:
- The QI campaign was effective in reducing CT scans and increasing rsMRI use for suspected appendicitis in children.
- QI projects demonstrate potential for optimizing medical imaging practices.
- Further evaluation of barriers may enhance rsMRI adoption.
Related Concept Videos
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
01:24Magnetic Resonance Imaging