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August 2015

Campaigns Against Ionizing Radiation and Changed Practice Patterns for Imaging Use in Pediatric Appendicitis

Author Affiliations
  • 1Division of General and Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington
  • 2Division of Surgery, University of Washington, Seattle
JAMA Pediatr. 2015;169(8):720-721. doi:10.1001/jamapediatrics.2015.0912

Physicians strive to provide the best care for their patients, but defining the best care can be challenging. The diagnosis of pediatric appendicitis requires reconciling many factors often in conflict with one another. In this setting, imaging has taken on a prominent role. Computed tomography (CT) has higher sensitivity and specificity and is less operator dependent compared with ultrasonography (US).1 Computed tomography is not without risk, however, because it uses ionizing radiation and requires an intravenous contrast load. At face value, CT imaging is more expensive than US or no imaging, but a missed diagnosis, negative appendectomy (the finding of a normal appendix at operation), admission for observation, or repeated imaging study also increases health care costs. Ultrasonography does not involve the risks of ionizing radiation or renal damage from intravenous contrast, but its lower accuracy may be associated with other risks, including a greater chance of a missed diagnosis or a negative appendectomy.1 Two national campaigns, Image Gently and Choosing Wisely, have emerged that emphasize reducing the dose of radiation used in CT scans and eliminating unnecessary pediatric imaging studies.2,3 How have the competing agendas of ensuring an accurate diagnosis while managing cost and patient risk affected physician practices regarding imaging for pediatric appendicitis? In this issue, Bachur et al4 evaluate the changing trend of the use of imaging modalities in freestanding pediatric hospitals.

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