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Cho J, Kim Y, Lee S, Min HD, Ko Y, Chee CG, Kim HY, Park JH, Lee KH. Appendiceal Visualization on 2-mSv CT vs. Conventional-Dose CT in Adolescents and Young Adults with Suspected Appendicitis: An Analysis of Large Pragmatic Randomized Trial Data. Korean J Radiol 2022; 23:413-425. [PMID: 35289144 PMCID: PMC8961010 DOI: 10.3348/kjr.2021.0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngjune Kim
- Aerospace Medical Group, Air Force Education and Training Command, Jinju, Korea
| | - Seungjae Lee
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Hooney Daniel Min
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | | | - Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Altunkas A, Aktas F, Ozmen Z, Albayrak E, Demir O. The normal vermiform appendixin adults: its anatomical location, visualization, and diameter at computed tomography. J ANAT SOC INDIA 2022. [DOI: 10.4103/jasi.jasi_135_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Park SB, Kim MJ, Ko Y, Sim JY, Kim HJ, Lee KH. Structured Reporting versus Free-Text Reporting for Appendiceal Computed Tomography in Adolescents and Young Adults: Preference Survey of 594 Referring Physicians, Surgeons, and Radiologists from 20 Hospitals. Korean J Radiol 2019; 20:246-255. [PMID: 30672164 PMCID: PMC6342761 DOI: 10.3348/kjr.2018.0109] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To survey care providers' preference between structured reporting (SR) and free-text reporting (FTR) for appendiceal computed tomography (CT) in adolescents and young adults. MATERIALS AND METHODS An ethical committee approved this prospective study. The requirement for participant consent was waived. We distributed the Likert scale-based SR form delivering the likelihood of appendicitis across 20 hospitals through a large clinical trial. In the final phase of the trial, we invited 706 potential care providers to participate in an online survey. The survey questions included usefulness in patient management, communicating the likelihood of appendicitis, convenience, style and format, and overall preference. Logistic regression analysis was performed for the overall preference. Three months after the completion of the trial, we checked if the use of the SR was sustained. RESULTS Responses were analyzed from 594 participants (175 attendings and 419 trainees; 225 radiologists, 207 emergency physicians, and 162 surgeons). For each question, 47.3-64.8% of the participants preferred SR, 13.1-32.7% preferred FTR, and the remaining had no preference. The overall preference varied considerably across the hospitals, but slightly across the departments or job positions. The overall preference for SR over FTR was significantly associated with attendings, SR experience for appendiceal CT, hospitals with small appendectomy volume, and hospitals enrolling more patients in the trial. Five hospitals continued using the SR in usual care after the trial. CONCLUSION Overall, the care providers preferred SR to FTR. Further investigation into the sustained use of the SR is needed.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Min Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea.
| | - Yousun Ko
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Ji Ye Sim
- Department of Radiology, Hanil General Hospital, Seoul, Korea
| | - Hyuk Jung Kim
- Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Kyoung Ho Lee
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Visibility of Normal Appendix on CT, MRI, and Sonography: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:W140-W150. [PMID: 30040469 DOI: 10.2214/ajr.17.19321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of the present study is to assess the visibility of the normal appendix on CT, MRI, or ultrasound (US) images of a healthy population. MATERIALS AND METHODS The MEDLINE and EMBASE databases were searched to identify articles on the rates of detection of a normal appendix on CT, MRI, or US that appeared in the literature published up to January 20, 2017. Pooled detection rates were assessed using random-effects modeling, and rates associated with different imaging modalities were compared. Meta-regression analyses were performed to assess factors influencing detection rates and heterogeneity. RESULTS Thirty-two studies (21 CT studies with 5296 patients, 7 MRI studies with 600 patients, and 4 US studies with 1221 patients) were included in our meta-analysis. The overall normal appendix detection rate tended to be highest for CT (84%), followed by US (71%) and MR (69%), but no statistically significant differences were noted (for CT vs MRI, p = 0.16; for CT vs US, p = 0.23; and for MRI vs US, p = 0.91). Meta-regression analyses of the appendix detection rate with CT revealed that the year of publication of the study, the number of CT channels, and slice thickness affected study heterogeneity. CONCLUSION Normal appendixes seemed to be more visible on CT than on MRI or US, although this finding did not have statistical significance. With respect to CT, detection of normal appendixes was significantly better when more channels and thinner slices were used.
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The diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients: A systematic review and diagnostic meta-analysis. Eur Radiol 2018; 28:2537-2548. [PMID: 29327290 DOI: 10.1007/s00330-017-5231-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 11/05/2017] [Accepted: 12/01/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of reduced-dose CT for suspected appendicitis. METHODS A systematic search of the MEDLINE and EMBASE databases was carried out through to 10 January 2017. Studies evaluating the diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients were selected. Pooled summary estimates of sensitivity and specificity were calculated using hierarchical logistic regression modelling. Meta-regression was performed. RESULTS Fourteen original articles with a total of 3,262 patients were included. For all studies using reduced-dose CT, the summary sensitivity was 96 % (95 % CI 93-98) with a summary specificity of 94 % (95 % CI 92-95). For the 11 studies providing a head-to-head comparison between reduced-dose CT and standard-dose CT, reduced-dose CT demonstrated a comparable summary sensitivity of 96 % (95 % CI 91-98) and specificity of 94 % (95 % CI 93-96) without any significant differences (p=.41). In meta-regression, there were no significant factors affecting the heterogeneity. The median effective radiation dose of the reduced-dose CT was 1.8 mSv (1.46-4.16 mSv), which was a 78 % reduction in effective radiation dose compared to the standard-dose CT. CONCLUSION Reduced-dose CT shows excellent diagnostic performance for suspected appendicitis. KEY POINTS • Reduced-dose CT shows excellent diagnostic performance for evaluating suspected appendicitis. • Reduced-dose CT has a comparable diagnostic performance to standard-dose CT. • Median effective radiation dose of reduced-dose CT was 1.8 mSv (1.46-4.16). • Reduced-dose CT achieved a 78 % dose reduction compared to standard-dose CT.
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Park JH, Jeon JJ, Lee SS, Dhanantwari AC, Sim JY, Kim HY, Lee KH. Can We Perform CT of the Appendix with Less Than 1 mSv? A De-escalating Dose-simulation Study. Eur Radiol 2017; 28:1826-1834. [DOI: 10.1007/s00330-017-5159-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/13/2017] [Accepted: 10/27/2017] [Indexed: 12/19/2022]
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Leelakanok N, Phelps AS, Zapala MA, Kato K, Ohliger M, Li Y, Courtier J. Assessing 3D T2 FSE sequence for identification of the normal appendix: working toward a single-sequence MR appendicitis protocol. Emerg Radiol 2017; 24:653-660. [DOI: 10.1007/s10140-017-1538-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/11/2017] [Indexed: 12/29/2022]
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Park HR, Park SB, Lee ES, Park HJ, Lee JB, Kim YS. Unenhanced computed tomography for normal appendix detection: comparison of low-dose with statistical iterative reconstruction and regular-dose with filtered back projection. Clin Imaging 2017; 43:117-121. [PMID: 28282598 DOI: 10.1016/j.clinimag.2017.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/09/2017] [Accepted: 02/24/2017] [Indexed: 01/07/2023]
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Park JH, Kim B, Kim MS, Kim HJ, Ko Y, Ahn S, Karul M, Fletcher JG, Lee KH. Comparison of filtered back projection and iterative reconstruction in diagnosing appendicitis at 2-mSv CT. Abdom Radiol (NY) 2016; 41:1227-36. [PMID: 27315093 DOI: 10.1007/s00261-015-0632-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare radiologists' diagnostic performance and confidence, and subjective image quality between filtered back projection (FBP) and iterative reconstruction (IR) at 2-mSv appendiceal CT. METHODS The institutional review board approved this retrospective study and waived the requirement for informed consent. We included 107 adolescents and young adults (age, 29.8 ± 8.5 years; 64 females) undergoing 2-mSv CT for suspected appendicitis. Appendicitis was pathologically confirmed in 42 patients. Seven readers with different experience levels independently reviewed the CT images reconstructed using FBP and IR (iDose(4), Philips). They rated both the likelihood of appendicitis and subjective image quality on 5-point Likert scales. Diagnostic confidence was assessed using the likelihood of appendicitis, proportion of indeterminate interpretations, and 3-point normal appendix visualization score. We used receiver operating characteristic analyses, Wilcoxon's signed-rank tests, and McNemar's tests. RESULTS The pooled area under the receiver operating characteristic curve (AUC) was 0.96 for both FBP and IR (95% CI for the difference, -0.02, 0.02; P = 0.73). The AUC difference was not significant in any of the individual readers (P ≥ 0.21). For the majority of the readers, the diagnostic confidence was not significantly different between the two reconstruction methods. Subjective image quality tended to be higher with IR for all readers (P ≤ 0.70), showing significant differences for four readers (P ≤ 0.040). CONCLUSION When diagnosing appendicitis at 2-mSv CT in adolescents and young adults, FBP and IR were comparable in radiologists' diagnostic performance and confidence while IR exhibited higher subjective image quality than FBP.
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Yang HK, Ko Y, Lee MH, Woo H, Ahn S, Kim B, Pickhardt PJ, Kim MS, Park SB, Lee KH. Initial Performance of Radiologists and Radiology Residents in Interpreting Low-Dose (2-mSv) Appendiceal CT. AJR Am J Roentgenol 2015; 205:W594-W611. [PMID: 26587949 DOI: 10.2214/ajr.15.14513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE The objective of our study was to prospectively evaluate the initial diagnostic performance and learning curve of a community of radiologists and residents in interpreting 2-mSv appendiceal CT. SUBJECTS AND METHODS We included 46 attending radiologists and 153 radiology residents from 22 hospitals who completed an online training course of 30 2-mSv CT cases. Appendicitis was confirmed in 14 cases. Most of the readers had limited (≤ 10 cases, n = 32) or no (n = 118) prior experience with low-dose appendiceal CT. The order of cases was randomized for each reader. A multireader multicase ROC analysis was performed. Generalized estimating equations were used to model the learning curves in diagnostic performance. RESULTS Diagnostic performance gradually improved with years of training. The average AUC was 0.94 (95% CI, 0.90-0.98), 0.92 (0.88-0.96), 0.90 (0.85-0.96), and 0.86 (0.80-0.92) for the attending radiologists, senior residents, 2nd-year residents, and 1st-year residents, respectively. We did not observe any notable intrareader learning curves over the training course of the 30 cases except a decrease in reading time. Diagnostic accuracy and sensitivity were significantly affected by the reader training level and prior overall experience with appendiceal CT but not by the prior specific experience with low-dose appendiceal CT. CONCLUSION The learning curve is likely prolonged and forms gradually over years by overall radiology training and clinical experience in general rather than by experience with low-dose appendiceal CT specifically.
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Affiliation(s)
- Hyun Kyung Yang
- 1 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Yousun Ko
- 1 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Min Hee Lee
- 2 Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Korea
| | - Hyunsik Woo
- 3 Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Soyeon Ahn
- 4 Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Bohyoung Kim
- 1 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Perry J Pickhardt
- 5 Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mi Sung Kim
- 6 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Bin Park
- 7 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyoung Ho Lee
- 1 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- 8 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Bolger JC, Kelly ME, Barry K. Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach. J Gastrointest Surg 2015; 19:2249-57. [PMID: 26361771 DOI: 10.1007/s11605-015-2934-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/31/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Acute appendicitis represents the commonest cause of acute intra-abdominal pathology. Appendectomy and antibiotics are the mainstay of therapy for appendicitis. Evidence is emerging that antibiotics alone may adequately treat most cases of appendicitis. Decision analysis is a quantitative method of examining alternate treatment strategies. This study describes a modelled decision analysis comparing operative and conservative management of appendicitis. METHODS The base case patient is a healthy, 23-year-old male presenting with migratory pain to the right iliac fossa (RIF) and elevated inflammatory markers. A decision tree was constructed comparing operative and conservative treatment. Rates of complications, failure of conservative therapy, recurrence and utilities were calculated via a systematic literature review. Variables were tested for sensitivity. RESULTS Overall, conservative management gives a significantly better outcome (51.51 vs 49.87 QALYs). Three variables proved sensitive. Once operative complication rates are lower than 11.5 %, surgical treatment becomes the optimal strategy. If rates of failure of conservative management exceed 12.9 %, surgery becomes optimal. If the utility assigned to a post-operative complication exceeds 0.44, surgery becomes optimal. CONCLUSIONS This decision analysis supports a conservative strategy, albeit with caveats. If operative complications are low or rates of failure of conservative management remain high, surgery is the preferable strategy.
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Affiliation(s)
- Jarlath Christopher Bolger
- Department of Surgery, Mayo General Hospital, Saolta University Hospital Group, Castlebar, Co Mayo, Ireland.
| | - Michael Eamon Kelly
- Department of Surgery, Mayo General Hospital, Saolta University Hospital Group, Castlebar, Co Mayo, Ireland
| | - Kevin Barry
- Department of Surgery, Mayo General Hospital, Saolta University Hospital Group, Castlebar, Co Mayo, Ireland.,Discipline of Surgery, National University of Ireland Galway, Galway, Ireland
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Low-Dose (2-mSv) CT in Adolescents and Young Adults With Suspected Appendicitis: Advantages of Additional Review of Thin Sections Using Multiplanar Sliding-Slab Averaging Technique. AJR Am J Roentgenol 2015; 205:W485-91. [DOI: 10.2214/ajr.14.13994] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ahn SJ, Hong SH, Chai JW, Choi JY, Yoo HJ, Kim SH, Kang HS. Comparison of image quality of shoulder CT arthrography conducted using 120 kVp and 140 kVp protocols. Korean J Radiol 2014; 15:739-45. [PMID: 25469085 PMCID: PMC4248629 DOI: 10.3348/kjr.2014.15.6.739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/23/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the image quality of shoulder CT arthrography performed using 120 kVp and 140 kVp protocols. MATERIALS AND METHODS Fifty-four CT examinations were prospectively included. CT scans were performed on each patient at 120 kVp and 140 kVp; other scanning parameters were kept constant. Image qualities were qualitatively and quantitatively compared with respect to noise, contrast, and diagnostic acceptability. Diagnostic acceptabilities were graded using a one to five scale as follows: 1, suboptimal; 2, below average; 3, acceptable; 4, above average; and 5, superior. Radiation doses were also compared. RESULTS Contrast was better at 120 kVp, but noise was greater. No significant differences were observed between the 120 kVp and 140 kVp protocols in terms of diagnostic acceptability, signal-to-noise ratio, or contrast-to-noise ratio. Lowering tube voltage from 140 kVp to 120 kVp reduced the radiation dose by 33%. CONCLUSION The use of 120 kVp during shoulder CT arthrography reduces radiation dose versus 140 kVp without significant loss of image quality.
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Affiliation(s)
- Se Jin Ahn
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Jee Won Chai
- Department of Radiology, Boramae Medical Center, Seoul 156-707, Korea
| | - Ja-Young Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
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Off-site smartphone reading of CT images for patients with inconclusive diagnoses of appendicitis from on-call radiologists. AJR Am J Roentgenol 2014; 203:3-9. [PMID: 24951190 DOI: 10.2214/ajr.13.11787] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to simulate a mobile consultation in patients with inconclusive diagnosis of appendicitis made by on-call radiologists, as well as to measure the diagnostic confidence and performance of the mobile consultation. MATERIALS AND METHODS Two off-site abdominal radiologists interpreted the CT images from 68 patients (including 29 patients with confirmed appendicitis) on a smart-phone for whom the preliminary CT reports by 25 in-house on-call radiologists were inconclusive. The smartphone readings were compared with the preliminary reports by on-call radiologists and with the original final reports by in-house abdominal radiologists. Heat maps, kappa statistics, Wilcoxon signed-rank tests, and ROC curves were used for data analysis. RESULTS The heat maps and kappa statistics showed that the smartphone readings were more similar to the final reports than to the preliminary reports. In diagnosing or ruling out appendicitis, the smartphone readings were more confident than the preliminary reports (p ≤ 0.01) and did not significantly differ in diagnostic confidence from the final reports (p ≥ 0.19). The AUCs of the smartphone readings (0.91 and 0.92) did not differ significantly from those of the preliminary (0.85) or final (0.97) reports (p ≥ 0.09). CONCLUSION With the given study sample, the diagnostic performance of the off-site smartphone readings did not differ significantly from that of the in-house preliminary reports. However, the smartphone readings provided higher diagnostic confidence than the preliminary reports.
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Cystic fibrosis: unenhanced CT description of the appendix in asymptomatic adults. AJR Am J Roentgenol 2014; 202:759-64. [PMID: 24660703 DOI: 10.2214/ajr.13.11390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the unenhanced CT appearance of the appendix in adults with cystic fibrosis. SUBJECTS AND METHODS Among adults with cystic fibrosis undergoing follow-up at our hospital, 71 patients (35 women, 36 men; mean age, 33 years; range, 18-59 years) without a history of appendectomy or current abdominal pain were prospectively included in this study and underwent unenhanced abdominopelvic MDCT. Two readers coded visualization of the appendix, measured the diameter of the appendix, and described the attenuation of its contents in relation to the intestinal wall. They also coded the presence of colonic wall redundancy, pancreatic fatty replacement, and cirrhosis. Lung transplant status and CFTR gene mutations were recorded. Analysis of variance, linear regression analysis, Student t test, and Pearson test were used. RESULTS The appendix was detected in all patients. The mean diameter was recorded as 10.6 ± 3.5 mm. The mean diameter was larger when the appendix contained hyperattenuating material (p = 0.001). There was no association between diameter and the other coded CT findings (p = 0.076-0.466), transplant status (p = 0.788), or CFTR mutation (p = 0.078). In 75% of the patients, the appendix contained hyperattenuating material with a higher proportion in homozygous ΔF508 mutation (p = 0.029) without any significant effect of the other CT features (p = 0.056-0.392), or transplant status (p = 1.000). CONCLUSION The appendix is larger in adults with cystic fibrosis than in those without it and appears hyperattenuating at unenhanced CT in 75% of patients, more commonly in those with ΔF508 homozygous mutation.
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Ahn S. LOCAT (low-dose computed tomography for appendicitis trial) comparing clinical outcomes following low- vs standard-dose computed tomography as the first-line imaging test in adolescents and young adults with suspected acute appendicitis: study protocol for a randomized controlled trial. Trials 2014; 15:28. [PMID: 24438500 PMCID: PMC3903028 DOI: 10.1186/1745-6215-15-28] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/07/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Computed tomography is widely used to diagnose acute appendicitis. Many adolescents and young adults are exposed to the associated radiation. A recent single-institution trial has reported promising results for low-dose computed tomography; however, this technique has not yet been widely adopted. LOCAT (low-dose computed tomography for appendicitis trial), a multi-institution randomized controlled non-inferiority trial, aims to compare low-dose computed tomography and standard-dose computed tomography as the first-line imaging tests for adolescents and young adults, and therefore to test the generalizability of the previous single-institution trial results. METHODS/DESIGN Participants with suspected appendicitis are randomly assigned to either the low-dose group (with a typical effective dose of 2 mSv) or the standard-dose group (as used in normal practice at each participating site, typically 8 mSv). The primary end point is the negative appendectomy rate (the percentage of the number of uninflamed appendices that were removed among all non-incidental appendectomies), which is a consequence of false-positive diagnoses, with a non-inferiority margin of 4.5 percentage points. The key secondary end point is the appendiceal perforation rate, which is a consequence of delayed (or false-negative) diagnoses. Participant recruitment will be continued until the number of non-incidental appendectomies for each group exceeds 444. The total number of expected participants approximates 3,000, including those not undergoing appendectomy. DISCUSSION In addition to the study protocol, we elaborate on several challenging or potentially debatable components of the study design, including the broad eligibility criteria, choice of the primary end point, potential effect of using advanced imaging techniques on study results, determining and adjusting the radiation doses, ambiguities in reference standards, rationale for the non-inferiority margin, use of the intention-to-treat approach and difficulties in defining adverse events. TRIAL REGISTRATION ClinicalTrials.gov NCT01925014.
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Affiliation(s)
- Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
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Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, Lee HS, Ahn S, Kim T, Hwang SS, Song KJ, Kang SB, Kim DW, Park SH, Lee KH. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med 2012; 366:1596-605. [PMID: 22533576 DOI: 10.1056/nejmoa1110734] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Computed tomography (CT) has become the predominant test for diagnosing acute appendicitis in adults. In children and young adults, exposure to CT radiation is of particular concern. We evaluated the rate of negative (unnecessary) appendectomy after low-dose versus standard-dose abdominal CT in young adults with suspected appendicitis. METHODS In this single-institution, single-blind, noninferiority trial, we randomly assigned 891 patients with suspected appendicitis to either low-dose CT (444 patients) or standard-dose CT (447 patients). The median radiation dose in terms of dose-length product was 116 mGy·cm in the low-dose group and 521 mGy·cm in the standard-dose group. The primary end point was the percentage of negative appendectomies among all nonincidental appendectomies, with a noninferiority margin of 5.5 percentage points. Secondary end points included the appendiceal perforation rate and the proportion of patients with suspected appendicitis who required additional imaging. RESULTS The negative appendectomy rate was 3.5% (6 of 172 patients) in the low-dose CT group and 3.2% (6 of 186 patients) in the standard-dose CT group (difference, 0.3 percentage points; 95% confidence interval, -3.8 to 4.6). The two groups did not differ significantly in terms of the appendiceal perforation rate (26.5% with low-dose CT and 23.3% with standard-dose CT, P=0.46) or the proportion of patients who needed additional imaging tests (3.2% and 1.6%, respectively; P=0.09). CONCLUSIONS Low-dose CT was noninferior to standard-dose CT with respect to negative appendectomy rates in young adults with suspected appendicitis. (Funded by GE Healthcare Medical Diagnostics and others; ClinicalTrials.gov number, NCT00913380.).
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Affiliation(s)
- Kyuseok Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
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Kim SY, Lee KH, Kim K, Kim TY, Lee HS, Hwang SS, Song KJ, Kang HS, Kim YH, Rhee JE. Acute appendicitis in young adults: low- versus standard-radiation-dose contrast-enhanced abdominal CT for diagnosis. Radiology 2011; 260:437-45. [PMID: 21633052 DOI: 10.1148/radiol.11102247] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare low and standard radiation doses in intravenous contrast material-enhanced abdominal computed tomography (CT) for the diagnosis of acute appendicitis in young adults. MATERIALS AND METHODS The institutional review board approved this retrospective study and waived informed consent. The study included 257 patients (age range, 15-40 years) who underwent CT for suspected appendicitis performed by using a low radiation dose (n = 125) or a standard radiation dose (n = 132). Receiver operating characteristic (ROC) analysis, Fisher exact tests, and Mann-Whitney U tests were used to compare the diagnosis of appendicitis and diagnostic confidence as recorded in prospective CT reports between the two groups. RESULTS For 55 low-radiation-dose (median dose-length product, 122 mGy · cm) and 44 standard-dose (median dose-length product, 544 mGy · cm) examinations, one of two abdominal radiologists made primary reports that served as final reports. For the remaining examinations, on-call radiologists with differing levels of experience issued preliminary reports and the two abdominal radiologists then provided final reports. In the primary reports, the low- and standard-dose CT groups did not significantly differ in area under the ROC curve (0.96 vs 0.97, P = .76), sensitivity (90% [38 of 42] vs 89% [47 of 53], P > .99), or specificity (92% [76 of 83] vs 94% [74 of 79], P = .74) in the diagnosis of appendicitis. There was also no significant difference between the two groups in the confidence level when diagnosing (P = .71) or excluding (P = .20) appendicitis in the primary reports. Similar results were observed for the final reports. The two dose groups also did not significantly differ in terms of appendiceal visualization, diagnosis of appendiceal perforation, or sensitivity for alternative diagnoses. CONCLUSION Low-dose CT may have comparable diagnostic performance to standard-dose CT for the diagnosis of appendicitis in young adults.
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Affiliation(s)
- So Yeon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
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Kim SJ, Kim HH, Kim YH, Hwang SH, Lee HS, Park DJ, Kim SY, Lee KH. Peritoneal metastasis: detection with 16- or 64-detector row CT in patients undergoing surgery for gastric cancer. Radiology 2009; 253:407-15. [PMID: 19789243 DOI: 10.1148/radiol.2532082272] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To retrospectively measure the diagnostic performance of prospective computed tomographic (CT) results obtained by using 16- or 64-detector row scanners in the detection of peritoneal metastases (PMs) in patients with advanced gastric cancer. MATERIALS AND METHODS The institutional review board approved this retrospective study and waived the need to obtain patient consent. In 498 patients with gastric cancer (stage >or= T2) who were undergoing surgery, the presence of PM was prospectively rated as grade 0 (absent), grade 1 (equivocal), or grade 2 (present) on CT scans (0.67 or 2 mm thick) that were interpreted by interactively adjusting the viewing thickness and viewing plane. The CT readings were retrospectively compared with surgical and pathologic findings. In patients in whom the presence of PM was rated as grade 1 or less, factors predictive of PM were identified by testing variables, including patient and tumor characteristics, with univariate tests and multivariate logistic regression analysis. RESULTS Fifty-three patients (10.6%) had confirmed PM. When only grade 2 was considered to indicate a positive CT reading, sensitivity and specificity were 28.3% (15 of 53) and 98.9% (440 of 445), respectively. With the threshold of grade 1 or greater indicating a positive reading, sensitivity and specificity were 50.9% (27 of 53) and 96.2% (428 of 445), respectively. In the patients with grades of 1 or less, the significant factors predictive of PM were greater tumor size and T stage. CONCLUSION The sensitivity of PM detection is limited, even with modern CT techniques. In patients whose CT results are not definitely positive for PM, staging laparoscopy is still recommended if the aforementioned two predictive factors (greater tumor size and T stage) are suspected.
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Affiliation(s)
- Su Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea
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