CT for appendicitis diagnosis in children gains popularity

CT is making rapid inroads in pediatric appendicitis diagnosis, even though concerns about radiation exposure in children continue to dog the modality, according to a two-year follow-up survey of North American Society for Pediatric Radiology members.

The survey was conducted to determine how much current appendicitis imaging practices may deviate from those prevalent during 2000, said Dr. Kimberley Applegate, a professor of radiology at the Indiana University School of Medicine. She presented the study results Thursday at the Society for Pediatric Radiology annual meeting.

Applegate and colleagues surveyed 126 U.S. members and three Canadian members, querying them on which modality they used for initial diagnosis, as well as what imaging techniques they used.

The survey found that 56% of the U.S. respondents currently use CT for diagnosis, compared with 36% in 2000.

"In 2002, the numbers had almost completely flipped," Applegate said.

Geography also played a large role in which modality was used for diagnosis: 70% of the Midwestern physicians turned to CT compared with only 36% in California. CT use was broken down by region:
· Northeast: 50%
· Southeast: 58%
· Midwest: 70%
· Northwest: 50%
· California: 36%
· Southwest: 30%

Applegate postulated that the geographic variation related to differences in training and reflected real trends in staffing shortages. The time of day of diagnosis also affected which modality was used, with ultrasound use increasing at night.

In 2000, the survey members reported 14 different CT techniques, including complete abdomen and pelvis CT with IV and oral contrast, no IV contrast, and rectal contrast. The number of CT techniques reported in 2002 had dropped to 10, an indication that the modality use in this application was beginning to mature, Applegate said.

By far, the most common CT technique used was complete abdomen and pelvis CT, with IV and oral contrast. This was preferred by 78% of the survey respondents, compared with 69% in 2000.

The Canadian respondents differed from their counterparts across the border. The survey found that they used ultrasound almost exclusively as their primary modality for diagnosis.

For more information from the Diagnostic Imaging archives:

CT as effective at pegging appendicitis in children as in adults, but indications vary
http://www.dimag.com/db_area/onlinenews/2000/2000052501.shtml

What should CT's role be in pediatric appendicitis?
http://www.dimag.com/db_area/archives/2000/0001disup8.shtml