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Diagnostic Performance on Low Dose Computed Tomography For Acute Appendicitis Among Attending and Resident Radiologists

View Article: PubMed Central - PubMed

ABSTRACT

Background: Low-dose computed tomography (LDCT) techniques can reduce exposure to radiation. Several previous studies have shown that radiation dose reduction in LDCT does not decrease the diagnostic performance for appendicitis among attending radiologists. But, the LDCT diagnostic performance for acute appendicitis in radiology residents with variable training levels has not been well discussed.

Objectives: To compare inter-observer and intra-observer differences of diagnostic performance on non-enhanced LDCT (NE-LDCT) and contrast-enhanced standard dose CT (CE-SDCT) for acute appendicitis among attending and resident radiologists.

Patients and methods: This retrospective study included 101 patients with suspected acute appendicitis who underwent NE-LDCT and CE-SDCT. The CT examinations were interpreted and recorded on a five-point scale independently by three attending radiologists and three residents with 4, 1 and 1 years of training. Diagnostic performance for acute appendicitis of all readers on both examinations was represented by area under receiver operating characteristic (ROC) curves. Inter-observer and intra-observer AUC values were compared using Jackknife FROC software on both modalities. The diagnostic accuracy of each reader on NE-LDCT was compared with body mass index (BMI) subgroups and noise using independent T test.

Results: Diagnostic performances for acute appendicitis were not statistically different for attending radiologists at both examinations. Better performance was noted on the CE-SDCT with a borderline significant difference (P = 0.05) for senior radiology resident. No statistical difference of AUC values was observed between attending radiologists and fourth year resident on both examinations. Statistically significant differences of AUC values were observed between attending radiologists and first year residents (P = 0.001 ~ 0.018) on NE-LDCT. Diagnostic accuracies of acute appendicitis on NE-LDCT for each reader were not significantly related to BMI or noise.

Conclusion: Attending radiologists could diagnose acute appendicitis accurately on NE-LDCT. Performance of senior residents on NE-LDCT is better than junior residents and comparable to attending radiologists.

No MeSH data available.


Related in: MedlinePlus

A, Coronal NE-LDCT and B, Coronal CE-SDCT images of a 64-year-old woman with acute appendicitis show dilated appendix (white arrows), wall thickening, and surrounding fat stranding (black arrows). Reader 1 and reader 6 assigned a score of 5 and 1 (definitely not appendicitis) for the diagnosis of appendicitis on NE-LDCT and a score of 5 and 5 on CE-SDCT. The BMI was 23.6 kg/m2. The dose-length product was 239.6 and 647.9 mGy cm, respectively.
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fig26117: A, Coronal NE-LDCT and B, Coronal CE-SDCT images of a 64-year-old woman with acute appendicitis show dilated appendix (white arrows), wall thickening, and surrounding fat stranding (black arrows). Reader 1 and reader 6 assigned a score of 5 and 1 (definitely not appendicitis) for the diagnosis of appendicitis on NE-LDCT and a score of 5 and 5 on CE-SDCT. The BMI was 23.6 kg/m2. The dose-length product was 239.6 and 647.9 mGy cm, respectively.

Mentions: At the end of the case collection, NE-LDCT and CE-SDCT images were interpreted independently by three board-certified attending emergency radiologists (readers 1, 2, and 3) with 20, 12, and 10 years of experience, respectively, and three resident radiologists (readers 4, 5, and 6) with 4, 1, and 1 year of training in radiology, respectively. All readers were blinded to the demographics, BMI, noise, clinical information, official CT report, and final diagnosis. NE-LDCT examinations were read prior to CE-SDCT examinations with a 1 month interval between the two interpretation sessions. During each interpretation session, readers were asked to record whether the appendix was visualized, and to record the presence or absence of each of the following signs (8, 10): dilatation of the appendix (> 7 mm diameter), appendicolith, periappendiceal fat stranding, periappendiceal abscess, extraluminal air, and extraluminal appendicolith (Figures 1, 2 and 3). When CE-SDCT examinations were interpreted, readers were further asked to assess whether wall enhancement of the appendix was stronger than that of the adjacent colonic walls, and whether the appendiceal wall was thicker than 2 mm.


Diagnostic Performance on Low Dose Computed Tomography For Acute Appendicitis Among Attending and Resident Radiologists
A, Coronal NE-LDCT and B, Coronal CE-SDCT images of a 64-year-old woman with acute appendicitis show dilated appendix (white arrows), wall thickening, and surrounding fat stranding (black arrows). Reader 1 and reader 6 assigned a score of 5 and 1 (definitely not appendicitis) for the diagnosis of appendicitis on NE-LDCT and a score of 5 and 5 on CE-SDCT. The BMI was 23.6 kg/m2. The dose-length product was 239.6 and 647.9 mGy cm, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037579&req=5

fig26117: A, Coronal NE-LDCT and B, Coronal CE-SDCT images of a 64-year-old woman with acute appendicitis show dilated appendix (white arrows), wall thickening, and surrounding fat stranding (black arrows). Reader 1 and reader 6 assigned a score of 5 and 1 (definitely not appendicitis) for the diagnosis of appendicitis on NE-LDCT and a score of 5 and 5 on CE-SDCT. The BMI was 23.6 kg/m2. The dose-length product was 239.6 and 647.9 mGy cm, respectively.
Mentions: At the end of the case collection, NE-LDCT and CE-SDCT images were interpreted independently by three board-certified attending emergency radiologists (readers 1, 2, and 3) with 20, 12, and 10 years of experience, respectively, and three resident radiologists (readers 4, 5, and 6) with 4, 1, and 1 year of training in radiology, respectively. All readers were blinded to the demographics, BMI, noise, clinical information, official CT report, and final diagnosis. NE-LDCT examinations were read prior to CE-SDCT examinations with a 1 month interval between the two interpretation sessions. During each interpretation session, readers were asked to record whether the appendix was visualized, and to record the presence or absence of each of the following signs (8, 10): dilatation of the appendix (> 7 mm diameter), appendicolith, periappendiceal fat stranding, periappendiceal abscess, extraluminal air, and extraluminal appendicolith (Figures 1, 2 and 3). When CE-SDCT examinations were interpreted, readers were further asked to assess whether wall enhancement of the appendix was stronger than that of the adjacent colonic walls, and whether the appendiceal wall was thicker than 2 mm.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Low-dose computed tomography (LDCT) techniques can reduce exposure to radiation. Several previous studies have shown that radiation dose reduction in LDCT does not decrease the diagnostic performance for appendicitis among attending radiologists. But, the LDCT diagnostic performance for acute appendicitis in radiology residents with variable training levels has not been well discussed.

Objectives: To compare inter-observer and intra-observer differences of diagnostic performance on non-enhanced LDCT (NE-LDCT) and contrast-enhanced standard dose CT (CE-SDCT) for acute appendicitis among attending and resident radiologists.

Patients and methods: This retrospective study included 101 patients with suspected acute appendicitis who underwent NE-LDCT and CE-SDCT. The CT examinations were interpreted and recorded on a five-point scale independently by three attending radiologists and three residents with 4, 1 and 1 years of training. Diagnostic performance for acute appendicitis of all readers on both examinations was represented by area under receiver operating characteristic (ROC) curves. Inter-observer and intra-observer AUC values were compared using Jackknife FROC software on both modalities. The diagnostic accuracy of each reader on NE-LDCT was compared with body mass index (BMI) subgroups and noise using independent T test.

Results: Diagnostic performances for acute appendicitis were not statistically different for attending radiologists at both examinations. Better performance was noted on the CE-SDCT with a borderline significant difference (P = 0.05) for senior radiology resident. No statistical difference of AUC values was observed between attending radiologists and fourth year resident on both examinations. Statistically significant differences of AUC values were observed between attending radiologists and first year residents (P = 0.001 ~ 0.018) on NE-LDCT. Diagnostic accuracies of acute appendicitis on NE-LDCT for each reader were not significantly related to BMI or noise.

Conclusion: Attending radiologists could diagnose acute appendicitis accurately on NE-LDCT. Performance of senior residents on NE-LDCT is better than junior residents and comparable to attending radiologists.

No MeSH data available.


Related in: MedlinePlus