title: Pediatric CT dose reduction for suspected appendicitis: a practice quality improvement project using artificial gaussian noise--part 2, clinical outcomes.
abstract: OBJECTIVE. The purpose of this study was to determine the effect of a nominal 50% reduction in median absorbed radiation dose on sensitivity, specificity, and negative appendectomy rate of CT for acute appendicitis in children. MATERIALS AND METHODS. On the basis of a departmental practice quality improvement initiative using computer-generated gaussian noise for CT dose reduction, we applied a nominal dose reduction of 50% to abdominal CT techniques used for bowel imaging. This retrospective study consisted of 494 children who underwent a CT for suspected acute appendicitis before (n = 244; mean age, 133 months) and after (n = 250; mean age, 145 months) the nominal 50% dose reduction. Test performance characteristics of CT for acute appendicitis and impact on the negative appendectomy rate were compared for both time periods. Primary analyses were performed with histologic diagnosis as the outcome standard. Volume CT dose index and dose-length product were recorded from dose reports and size-specific dose estimates were calculated. RESULTS. The nominal 50% dose reduction resulted in an actual 39% decrease in median absorbed radiation dose. Sensitivity of CT for diagnosis of acute appendicitis was 98% (95% CI, 91-100%) versus 97% (91-100%), and specificity was 93% (88-96%) versus 94% (90-97%) before and after dose reduction, respectively. The negative appendectomy rate was 4.5% (0.8-10.25%) before dose reduction and 4.0% (0.4-7.6%) after dose reduction. CONCLUSION. The negative appendectomy rate and performance characteristics of the CT-based diagnosis of acute appendicitis were not affected by a 39% reduction in median absorbed radiation dose.
authors.affiliation: 1 Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Callahan
authors.forename: Seema P
authors.initials: SP
authors.lastname: Anandalwar
authors.forename: Robert D
authors.initials: RD
authors.lastname: MacDougall
authors.forename: Catherine
authors.initials: C
authors.lastname: Stamoulis
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Kleinman
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bachur
authors.forename: George A
authors.initials: GA
authors.lastname: Taylor
mesh_terms: D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D016477:Artifacts; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D058996:Quality Improvement; D011829:Radiation Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards*; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: CT; appendicitis; pediatrics; radiation dose reduction; size-specific dose estimate