Radiology Residents' Independent Diagnosis of Appendicitis Using 2-mSv Computed Tomography: A Secondary Analysis of a Large Pragmatic Randomized Trial

Jungheum Cho; Hae Young Kim; Seungjae Lee; Ji Hoon Park; Kyoung Ho Lee

doi:10.3348/kjr.2023.0015

Radiology Residents' Independent Diagnosis of Appendicitis Using 2-mSv Computed Tomography: A Secondary Analysis of a Large Pragmatic Randomized Trial

Korean J Radiol. 2023 Jun;24(6):529-540. doi: 10.3348/kjr.2023.0015.

Authors

Jungheum Cho¹, Hae Young Kim², Seungjae Lee³, Ji Hoon Park^{1

3

4

5}, Kyoung Ho Lee^{1

3

4

5

6}

Affiliations

¹ Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
² Department of Radiology, Asan Medical Center, Seoul, Korea. khysjsh19@gmail.com.
³ Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
⁴ Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
⁵ Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea.
⁶ Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea.

Abstract

Objective: To compare the diagnostic performance and clinical outcomes of 2-mSv computed tomography (CT) and conventional-dose CT (CDCT), following radiology residents' interpretation of CT examinations for suspected appendicitis.

Materials and methods: Altogether, 3074 patients with suspected appendicitis aged 15-44 years (28 ± 9 years, 1672 females) from 20 hospitals were randomly assigned to the 2-mSv CT (n = 1535) or CDCT (n = 1539) groups in a pragmatic trial from December 2013 and August 2016. Overall, 107 radiology residents participated in the trial as readers in the form of daily practice after online training for 2-mSv CT. They made preliminary CT reports, which were later finalized by attending radiologists via addendum reports, for 640 and 657 patients in the 2-mSv CT and CDCT groups, respectively. We compared the diagnostic performance of the residents, discrepancies between preliminary and addendum reports, and clinical outcomes between the two groups.

Results: Patient characteristics were similar between the 640 and 657 patients. Residents' diagnostic performance was not significantly different between the 2-mSv CT and CDCT groups, with a sensitivity of 96.0% and 97.1%, respectively (difference [95% confidence interval {CI}], -1.1% [-4.9%, 2.6%]; P = 0.69) and specificity of 93.2% and 93.1%, respectively (0.1% [-3.6%, 3.7%]; P > 0.99). The 2-mSv CT and CDCT groups did not significantly differ in discrepancies between the preliminary and addendum reports regarding the presence of appendicitis (3.3% vs. 5.2%; -1.9% [-4.2%, 0.4%]; P = 0.12) and alternative diagnosis (5.5% vs. 6.4%; -0.9% [-3.6%, 1.8%]; P = 0.56). The rates of perforated appendicitis (12.0% vs. 12.6%; -0.6% [-4.3%, 3.1%]; P = 0.81) and negative appendectomies (1.9% vs. 1.1%; 0.8% [-0.7%, 2.3%]; P = 0.33) were not significantly different between the two groups.

Conclusion: Diagnostic performance and clinical outcomes were not significantly different between the 2-mSv CT and CDCT groups following radiology residents' CT readings for suspected appendicitis.

Keywords: Abdomen; Appendicitis; Radiation dosage; Tomography, X-ray computed.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Appendectomy
Appendicitis* / diagnostic imaging
Female
Humans
Radiation Dosage
Radiology*
Sensitivity and Specificity
Tomography, X-Ray Computed / methods