PMID- 34304094
OWN - NLM
STAT- MEDLINE
DCOM- 20211220
LR  - 20211220
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 50
DP  - 2021 Dec
TI  - Effect of focused protocol on reducing radiation dose for children who require 
      computed tomography for suspected appendicitis.
PG  - 76-79
LID - S0735-6757(21)00566-0 [pii]
LID - 10.1016/j.ajem.2021.07.005 [doi]
AB  - BACKGROUND: Despite efforts to incorporate ultrasound into the evaluation of 
      children for appendicitis, computed tomography (CT) is often used to aid in its 
      diagnosis. CT scans, however, expose children to a considerable amount of 
      radiation. In 2017, our institution began using a height-based Focused CT 
      protocol for children with suspected appendicitis in need of CT. OBJECTIVE: To 
      compare the radiation dose received by children with suspected appendicitis who 
      underwent a Standard CT of the abdomen and pelvis (CTAP) with that of a Focused 
      CT. METHODS: We conducted a retrospective study of children <18 years who 
      underwent a CT scan for suspected appendicitis (2014-2020). We included all 
      patients whose indication for CT was "appendicitis" or "right lower quadrant 
      pain" and excluded those whose CT scan record lacked a radiation dose report. The 
      effective radiation dose delivered was calculated using the dose-length product 
      from the dose report. We compared the effective dose of those who received a 
      Standard CTAP to those who received a Focused CT. To account for differences in 
      radiation dose over time and by CT scanner, analyses were adjusted for CT dose 
      index volume (CTDI(vol)) and size-specific dose estimate (SSDE) using quantile 
      regression. RESULTS: A total of 474 patients who underwent CT were included. 
      Prior to CT, 362(76%) had received an ultrasound. In total, 309(65%) patients 
      underwent a Standard CTAP and 165(35%) underwent a Focused CT. The appendix was 
      identified in 259(84%) Standard CTAPs compared to 151(92%) Focused CTs (p = 
      0.02). Compared to the Standard CTAP, children who received a Focused CT were 
      exposed to a significantly lower effective dose (relative difference: 
      CTDI-adjusted -13%[95% CI:-21,-5]; SSDE-adjusted -14%[95% CI:-24,-3]). 
      CONCLUSIONS: Our height-based Focused CT protocol reduces radiation for children 
      undergoing CT evaluation for suspected appendicitis without sacrificing 
      diagnostic accuracy. Further study is needed to validate these findings at other 
      institutions.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Roberts, Suzanne
AU  - Roberts S
AD  - Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, 
      Bronx, NY, United States of America. Electronic address: 
      suzanne.roberts@nychhc.org.
FAU - Goldwasser, Bernard
AU  - Goldwasser B
AD  - Department of Radiology, Division of Pediatrics, Jacobi Medical Center, Bronx, 
      NY, United States of America. Electronic address: bernard.goldwasser@nychhc.org.
FAU - Nixon, Abigail F
AU  - Nixon AF
AD  - Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, 
      Bronx, NY, United States of America. Electronic address: 
      abigail.nixon@nychhc.org.
FAU - Borkar, Deeksha
AU  - Borkar D
AD  - Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States 
      of America. Electronic address: borka015@umn.edu.
FAU - Brookman, Max
AU  - Brookman M
AD  - Department of Pediatrics, Jacobi Medical Center, Bronx, NY, United States of 
      America. Electronic address: max@brookmanenterprises.com.
FAU - Fox, Carolyn E
AU  - Fox CE
AD  - Department of Emergency Medicine, Division of Pediatrics, Oregon Health and 
      Science University, Portand, OR, United States of America. Electronic address: 
      cef5xd@virginia.edu.
FAU - Rosenfeld, Cyril
AU  - Rosenfeld C
AD  - Department of Radiology, Jacobi Medical Center, Bronx, NY, United States of 
      America. Electronic address: rosenfec1@nychhc.org.
FAU - Meltzer, James A
AU  - Meltzer JA
AD  - Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, 
      Bronx, NY, United States of America. Electronic address: 
      james.meltzer@nychhc.org.
LA  - eng
PT  - Journal Article
DEP - 20210710
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
RN  - 0 (Contrast Media)
SB  - IM
MH  - Adolescent
MH  - Appendicitis/*diagnostic imaging
MH  - Child
MH  - *Clinical Protocols
MH  - Contrast Media
MH  - Female
MH  - Humans
MH  - Male
MH  - *Radiation Dosage
MH  - Radiation Protection/*standards
MH  - Retrospective Studies
MH  - Tomography, X-Ray Computed/*standards
OTO - NOTNLM
OT  - Abdominal pain
OT  - Appendicitis
OT  - Children
OT  - Computed tomography
OT  - Focused
OT  - Limited
OT  - Radiation
OT  - Right lower quadrant
COIS- Declaration of Competing Interest The authors have no relevant conflicts of 
      interest to disclose.
EDAT- 2021/07/26 06:00
MHDA- 2021/12/21 06:00
CRDT- 2021/07/25 20:44
PHST- 2021/04/13 00:00 [received]
PHST- 2021/07/01 00:00 [revised]
PHST- 2021/07/02 00:00 [accepted]
PHST- 2021/07/26 06:00 [pubmed]
PHST- 2021/12/21 06:00 [medline]
PHST- 2021/07/25 20:44 [entrez]
AID - S0735-6757(21)00566-0 [pii]
AID - 10.1016/j.ajem.2021.07.005 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2021 Dec;50:76-79. doi: 10.1016/j.ajem.2021.07.005. Epub 2021 Jul 
      10.