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Implementation of ultrasound and fast magnetic resonance imaging pathway reduces computed tomography utilization in

Gabrielle Steinl1, David Grabski1, Mark Fleming1

  • 1Department of Surgery, University of Virginia, Charlottesville, USA.

Pediatric Surgery International
|July 24, 2023
PubMed

Insights

A new pathway using ultrasound (US) and magnetic resonance imaging (MRI) significantly reduced computed tomography (CT) use in children with suspected appendicitis. This approach lowers radiation exposure for pediatric patients.

Area of Science:

  • Pediatric Radiology
  • Medical Imaging Techniques
  • Appendicitis Diagnosis

Background:

  • Computed tomography (CT) is a common diagnostic tool for acute appendicitis in children, leading to concerns about radiation exposure.
  • Alternative imaging modalities are sought to minimize risks associated with CT in pediatric populations.

Purpose of the Study:

  • To implement and evaluate an imaging pathway utilizing ultrasound (US) and fast magnetic resonance imaging (MRI) for suspected appendicitis in children.
  • To reduce radiation exposure in pediatric patients by decreasing reliance on CT scans.

Main Methods:

  • A retrospective review of children under 18 who underwent appendectomy between January 2011 and July 2021.
  • Implementation of a new imaging pathway in December 2015, prioritizing US followed by rapid MRI for equivocal cases, with CT reserved for MRI intolerance.
  • Comparison of CT utilization rates before and after the pathway implementation.

Main Results:

  • After pathway initiation, US use increased from 87% to 97%, and MRI use increased from 0% to 30%.
  • Computed tomography (CT) utilization decreased dramatically from 32% to 2% post-implementation.
  • These changes were statistically significant (p < 0.0001).

Conclusions:

  • The combined US and rapid MRI pathway effectively reduced CT utilization in pediatric appendicitis diagnosis.
  • This strategy significantly lowers radiation exposure for children, offering a safer diagnostic alternative.
Abstract

Keywords:
Acute appendicitisCTFast MRIRadiation exposure

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