title: Diagnostic Performance on Low Dose Computed Tomography For Acute Appendicitis Among Attending and Resident Radiologists.
abstract: BACKGROUND
  Low-dose computed tomography (LDCT) techniques can reduce exposure to radiation. Several previous studies have shown that radiation dose reduction in LDCT does not decrease the diagnostic performance for appendicitis among attending radiologists. But, the LDCT diagnostic performance for acute appendicitis in radiology residents with variable training levels has not been well discussed.
  
  
  OBJECTIVE
  To compare inter-observer and intra-observer differences of diagnostic performance on non-enhanced LDCT (NE-LDCT) and contrast-enhanced standard dose CT (CE-SDCT) for acute appendicitis among attending and resident radiologists.
  
  
  METHODS
  This retrospective study included 101 patients with suspected acute appendicitis who underwent NE-LDCT and CE-SDCT. The CT examinations were interpreted and recorded on a five-point scale independently by three attending radiologists and three residents with 4, 1 and 1 years of training. Diagnostic performance for acute appendicitis of all readers on both examinations was represented by area under receiver operating characteristic (ROC) curves. Inter-observer and intra-observer AUC values were compared using Jackknife FROC software on both modalities. The diagnostic accuracy of each reader on NE-LDCT was compared with body mass index (BMI) subgroups and noise using independent T test.
  
  
  RESULTS
  Diagnostic performances for acute appendicitis were not statistically different for attending radiologists at both examinations. Better performance was noted on the CE-SDCT with a borderline significant difference (P = 0.05) for senior radiology resident. No statistical difference of AUC values was observed between attending radiologists and fourth year resident on both examinations. Statistically signiﬁcant differences of AUC values were observed between attending radiologists and first year residents (P = 0.001 ~ 0.018) on NE-LDCT. Diagnostic accuracies of acute appendicitis on NE-LDCT for each reader were not significantly related to BMI or noise.
  
  
  CONCLUSIONS
  Attending radiologists could diagnose acute appendicitis accurately on NE-LDCT. Performance of senior residents on NE-LDCT is better than junior residents and comparable to attending radiologists.
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
authors.forename: Chih-Chen
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
authors.forename: Yon-Cheong
authors.initials: YC
authors.lastname: Wong
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
authors.forename: Huan-Wu
authors.initials: HW
authors.lastname: Chen
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Wang
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
authors.forename: Yu-Hsien
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
authors.forename: Patricia Wanping
authors.initials: PW
authors.lastname: Wu
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
authors.forename: Wiwan
authors.initials: W
authors.lastname: Irama
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
authors.forename: Wei Yuan
authors.initials: WY
authors.lastname: Chen
authors.affiliation: Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
keywords: Appendicitis; Computed Tomography; Education; Emergencies; Radiation Dose