PMID- 25539280
OWN - NLM
STAT- MEDLINE
DCOM- 20150224
LR  - 20161125
IS  - 1546-3141 (Electronic)
IS  - 0361-803X (Linking)
VI  - 204
IP  - 1
DP  - 2015 Jan
TI  - Pediatric CT dose reduction for suspected appendicitis: a practice quality 
      improvement project using artificial Gaussian noise--part 1, computer 
      simulations.
PG  - W86-94
LID - 10.2214/AJR.14.12964 [doi]
AB  - OBJECTIVE: The purpose of this study was to develop a departmental practice 
      quality improvement project to systematically reduce CT doses for the evaluation 
      of suspected pediatric appendicitis by introducing computer-generated gaussian 
      noise. MATERIALS AND METHODS: Two hundred MDCT abdominopelvic examinations of 
      patients younger than 20 years performed with girth-based scanning parameters for 
      suspected appendicitis were reviewed. Two judges selected 45 examinations in 
      which the diagnosis of appendicitis was excluded (14, appendix not visualized; 
      31, normal appendix visualized). Gaussian noise was introduced into axial image 
      series, creating five additional series acquired at 25-76% of the original dose. 
      Two readers reviewed 270 image series for appendix visualization (4-point Likert 
      scale and arrow localization). Volume CT dose index (CTDIvol) and size-specific 
      dose estimate (SSDE) were calculated by use of patient girth. Confidence ratings 
      and localization accuracy were analyzed with mixed models and nonparametric 
      bootstrap analysis at a 0.05 significance level. RESULTS: The mean baseline SSDE 
      for the 45 patients was 16 mGy (95% CI, 12-20 mGy), and the corresponding CTDIvol 
      was 10 mGy (95% CI, 4-16 mGy). Changes in correct appendix localization 
      frequencies were minor. There was no substantial trend with decreasing simulated 
      dose level (p = 0.46). Confidence ratings decreased with increasing dose 
      reduction (p = 0.007). The average decreases were -0.27 for the 25% simulated 
      dose (p = 0.01), -0.17 for 33% (p = 0.03), and -0.03 for 43% (p = 0.65). 
      CONCLUSION: Pediatric abdominal MDCT can be performed with 43% of the original 
      dose (SSDE, 7 mGy; CTDIvol, 4.3 mGy) without substantially affecting 
      visualization of a normal appendix.
FAU - Callahan, Michael J
AU  - Callahan MJ
AD  - 1 Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, 
      MA 02115.
FAU - Kleinman, Patricia L
AU  - Kleinman PL
FAU - Strauss, Keith J
AU  - Strauss KJ
FAU - Bandos, Andriy
AU  - Bandos A
FAU - Taylor, George A
AU  - Taylor GA
FAU - Tsai, Andy
AU  - Tsai A
FAU - Kleinman, Paul K
AU  - Kleinman PK
LA  - eng
PT  - Journal Article
PL  - United States
TA  - AJR Am J Roentgenol
JT  - AJR. American journal of roentgenology
JID - 7708173
SB  - IM
MH  - Absorption, Radiation
MH  - Adolescent
MH  - Appendicitis/*diagnostic imaging
MH  - Child
MH  - Child, Preschool
MH  - Computer Simulation
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - *Models, Biological
MH  - *Models, Statistical
MH  - Normal Distribution
MH  - Quality Improvement
MH  - *Radiation Dosage
MH  - Radiation Protection/*methods
MH  - Radiographic Image Enhancement/methods
MH  - Radiographic Image Interpretation, Computer-Assisted/*methods
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Signal-To-Noise Ratio
MH  - Tomography, X-Ray Computed/*methods
MH  - Young Adult
OTO - NOTNLM
OT  - CT
OT  - appendicitis
OT  - pediatrics
OT  - radiation dose reduction
OT  - size-specific dose estimate
EDAT- 2014/12/30 06:00
MHDA- 2015/02/25 06:00
CRDT- 2014/12/25 06:00
PHST- 2014/12/25 06:00 [entrez]
PHST- 2014/12/30 06:00 [pubmed]
PHST- 2015/02/25 06:00 [medline]
AID - 10.2214/AJR.14.12964 [doi]
PST - ppublish
SO  - AJR Am J Roentgenol. 2015 Jan;204(1):W86-94. doi: 10.2214/AJR.14.12964.