title: Appendicitis in children: low-dose CT with a phantom-based simulation technique--initial observations.
abstract: OBJECTIVE
  To retrospectively determine the accuracy of low-dose (20-mAs) computed tomography (CT) in the diagnosis of acute appendicitis in children by using a technique that enables the simulation of human CT scans acquired at a lower tube current given the image acquired at a standard dose.
  
  
  METHODS
  Institutional review board approval was obtained, informed consent was not required, and the study was HIPAA compliant. The authors reviewed 100 standard-dose pediatric abdominal-pelvic CT scans (50 positive and 50 negative scans) obtained in 100 patients and corresponding simulated low-dose (20-mAs) scans. The standard-dose scans were obtained for evaluation in patients suspected of having appendicitis. Scans were reviewed in randomized order by four experienced pediatric radiologists. The patients with positive findings included 21 girls (mean age, 9.2 years) and 29 boys (mean age, 8.4 years). The patients with negative findings included 28 girls (mean age, 9.2 years) and 22 boys (mean age, 8.4 years). Simulation was achieved by adding noise patterns from repeated 20-mAs scans of a pediatric pelvis phantom to the original scans obtained with a standard tube current. Observers recorded their confidence in the diagnosis of appendicitis by using a six-point scale. Dose-related changes were analyzed with generalized estimating equations and the nonparametric sign test.
  
  
  RESULTS
  There was a statistically significant (P < .001, sign test) decrease in both sensitivity and accuracy with a lower tube current, from 91.5% with the original tube current to 77% with the lower tube current. A low dose was the only statistically significant (P < .001) risk factor for a false-negative result. The specificity was unchanged at 94% for both the images obtained with the original tube current and the simulated low-dose images. The overall accuracy decreased from 92% with the original dose to 86% with the low dose.
  
  
  CONCLUSIONS
  Preliminary findings indicate that it is feasible to optimize the CT dose used to evaluate appendicitis in children by using phantom-based computer simulations.
authors.affiliation: Department of Radiology, Pediatric Radiology Division, New York University Medical Center, New York, NY 10016, USA. nancy.fefferman@nyumc.org
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Fefferman
authors.forename: Elan
authors.initials: E
authors.lastname: Bomsztyk
authors.forename: Angela M
authors.initials: AM
authors.lastname: Yim
authors.forename: Rafael
authors.initials: R
authors.lastname: Rivera
authors.forename: John B
authors.initials: JB
authors.lastname: Amodio
authors.forename: Lynne P
authors.initials: LP
authors.lastname: Pinkney
authors.forename: Naomi A
authors.initials: NA
authors.lastname: Strubel
authors.forename: Marilyn E
authors.initials: ME
authors.lastname: Noz
authors.forename: Henry
authors.initials: H
authors.lastname: Rusinek
mesh_terms: D000293:Adolescent; D001064:Appendicitis / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008297:Male; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*