Don't forget the dose: Improving computed tomography dosing for pediatric appendicitis.
BACKGROUND
A pediatric computed tomography (CT) radiation dose reduction program was implemented throughout our children's associated hospital system in 2010. We hypothesized that the CT dose received for evaluation of appendicitis in children would be significantly higher among the 40 referral, nonmember hospitals (NMH) than the 9 member hospitals (MH).


METHODS
Preoperative CTs of pediatric (<18years) appendectomy patients between April 2012 and April 2015 were reviewed. Size specific dose estimate (SSDE), an approximation of absorbed dose incorporating patient diameter, and Effective Dose (ED) were calculated for each scan.


RESULTS
1128 (65%) of 1736 appendectomy patients underwent preoperative CT. 936 patients seen at and 102 children evaluated at NMH had dosing and patient diameter data for analysis. SSDE and ED were significantly higher with greater variance at NMH across all ages (all p<0.05, Figure). NMH's SSDE and ED also exceeded reference levels.


CONCLUSIONS
Radiation exposure in CT scans for evaluation of pediatric appendicitis is significantly higher and more variable in NMH. A proactive approach to reduce dose, in addition to frequency, of CT scans in pediatric patients is essential.


METHODS
Level III.
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
K Tinsley
KT
Anderson
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Susan
S
Greenfield
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Luke R
LR
Putnam
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Emma
E
Hamilton
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Akemi
A
Kawaguchi
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Mary T
MT
Austin
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Lillian S
LS
Kao
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Susan D
SD
John
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Kevin P
KP
Lally
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX. Electronic address: Kuojen.Tsao@uth.tmc.edu.
KuoJen
K
Tsao
D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011829:Radiation Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
ALARA; Appendicitis; Ct; Pediatrics