|EuroSafe Imaging 2019 / ESI-0082|
|CT imaging for appendicitis - nationwide survey|
Numerous studies are reporting increasing radiation exposure from medical imaging, in adults as well as in children who are more sensitive to radition induced cancer (1,2). In developed countries, the average per capita dose is already almost as large as radiation exposure from natural sources. E.g. in Germany, radiation exposure from natural sources is estimated at 2,1 mSv/year/person, whereas exposure from medical imaging is estimated at 1,8 mSv/year/person (3). In Switzerland, exposure from medical imaging has been estimated at 1,4 mSv/Year/person in 2013, of which approximately two thirds are resulting from computed tomography (CT) (4).
This is resulting fom many factors, as defensive medicine and development and refinement of new indications for CT, e.g. cardiac imaging.
Alternative imaging methods without ionizing radiation, namely ultrasound (US) and Magnetic Resonance Imaging (MRI), although also increasing in frequency, have not been able to substitute the increase of CT imaging (5).
Also, in contrast to US examinations, CT examinations are relatively easy to standardize and therefore are the most often transmitted imaging modality in the framework of teleradiology, the use of which is increasing worldwide (6,7). In Austria, radiation protection law limits the application of teleradiology to trauma imaging, certain dislocated emergency medicine outpatient wards or for providing a nicht and weekend service.
A frequent indication for emergency imaging is appendicitis. As the sensitivity and specificity of only clinical and laboratory testing is suboptimal, diagnostic imaging for confirmation or ruling out appendicitis has been established as a standard preoperatively (8). Therefore, graded compression ultrasound is recommended as a first line method especially in younger patients. However, because of its somewhat superior accuracy, CT is used in unclear cases. The use of CT versus ultrasound depends also on the level of expertise in ultrasound available, and therefore, children are much more likely to undergo a CT scan if they are treated in a community hospital compared with a pediatric hospital (9).
The rate of CT examinations for preoperative imaging in suspected appendicitis in Austria has not yet been determined. Our concern was, that with the nationwide saturation with CT equipment, an increasing shortage of radiologists (who are - although not exclusively - a group of medical professionals with relatively high expertise in US diagnosis of appendicitis), and political pressure to reduce costs of health services, there might be a tendency to replace ultrasound with CT examinations.
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