Using ultrasound as the first diagnostic imaging technique to detect appendicitis in children produces comparable outcomes to using computed tomography (CT) scans and does not increase hospital length of stay, according to research published in the December issue of the American Journal of Roentgenolgy. Investigators at The Children's Hospital at Montefiore (CHAM) conducted a retrospective study examining the efficacy of using ultrasound, which emits no radiation, to diagnose suspected appendicitis in children compared to the standard approach of using CT scans.
Appendicitis is one of the most commonly experienced conditions among children in the U.S., and its frequency has been increasing. A CT scan is the most frequently used imaging technique to evaluate patients with symptoms of the condition.
"As more people become aware of the risks of medical radiation, there are increasing efforts to utilize non-radiation emitting imaging techniques as a first approach to diagnosis," said author Jessica Kurian, M.D., attending radiologist, Division of Pediatric Radiology, The Children's Hospital at Montefiore and assistant professor, Albert Einstein College of Medicine of Yeshiva University. "Our research shows that using ultrasound first in the evaluation of appendicitis commonly produces actionable results and should be considered more frequently as clinicians try to limit medical radiation exposure in children."
Collaboration between radiologists and clinicians in the divisions of pediatric surgery and emergency medicine increased the use of ultrasound as the first imaging option from 33 percent at the beginning of the study to almost 90 percent at the study's completion. At the same time the use of a CT scan as the first and only diagnostic test decreased from 43 percent to less than 10 percent by the end of the study.
"Our study, which took place during Montefiore's transition to an "ultrasound-first" model, shows that the percentage of patients who received ultrasound first significantly increased without impacting the median hospital length of stay, which remained consistent," Dr. Kurian said. "These findings support the use of ultrasound in helping to reduce radiation exposure in kids and suggest this approach could be applied in the diagnosis of other conditions to minimize the cumulative radiation dose a child is exposed to over the course of a lifetime."
Clinicians in the Division of Pediatric Radiology at CHAM have implemented robust efforts to raise awareness for radiation protection and lower CT scan radiation dose in the imaging of children. Education and building awareness about alternate options, such as ultrasound and MRI, has resulted in a dramatic reduction in the number of CT scans carried out on pediatric patients in recent years. Efforts include educational seminars about appropriate radiation dose, reinforcement of "ALARA" -- As Low As Reasonably Achievable, encouraging technologists to use appropriate dosage, and dissemination of awareness materials to inform of the potential risks and benefits of various imaging modalities.
The extensive efforts at CHAM to reduce radiation exposure to children are aligned with the national Image Gently Campaign, which aims to change practice by increasing awareness of the opportunities to promote radiation protection in the imaging of children.
- Jenna Le, Jessica Kurian, Hillel W. Cohen, Gerard Weinberg, Meir H. Scheinfeld. Do Clinical Outcomes Suffer During Transition to an Ultrasound-First Paradigm for the Evaluation of Acute Appendicitis in Children? American Journal of Roentgenology, 2013; 201 (6): 1348 DOI: 10.2214/AJR.13.10678
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