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Appendicitis in Children: Low-Dose CT with a Phantom-based Simulation Technique—Initial Observations¹

¹ From the Department of Radiology, Pediatric Radiology Division, New York University Medical Center, 560 First Ave, RIRM 234, New York, NY 10016. Received September 23, 2004; revision requested November 15; revision received February 25, 2005; accepted March 6. Address correspondence to N.R.F. (e-mail: nancy.fefferman{at}nyumc.org).

View larger version (57K): [in a new window]   Figure 1. Schematic illustration shows the phantom-based simulation method.

View larger version (95K): [in a new window]   Figure 2. Diagram illustrates the application of the phantom-based simulation technique.

View larger version (108K): [in a new window]   Figure 3a. Original and simulated CT scans in an 8-year-old boy with abdominal pain. (a) Transverse contrast material–enhanced helical CT scan obtained with a tube current of 180 mAs demonstrates an inflamed appendix (arrow) in the right lower quadrant. (b) Simulated low-dose (20-mAs) scan at the same z-axis level as in a also demonstrates the inflamed appendix (arrow).

View larger version (126K): [in a new window]   Figure 3b. Original and simulated CT scans in an 8-year-old boy with abdominal pain. (a) Transverse contrast material–enhanced helical CT scan obtained with a tube current of 180 mAs demonstrates an inflamed appendix (arrow) in the right lower quadrant. (b) Simulated low-dose (20-mAs) scan at the same z-axis level as in a also demonstrates the inflamed appendix (arrow).

View larger version (126K): [in a new window]   Figure 4a. Original and simulated CT scans in a 7-year-old girl with abdominal pain. (a) Transverse contrast-enhanced helical CT scan obtained with a tube current of 80 mAs demonstrates an inflamed appendix (arrow) in the lower right side of the pelvis. (b) Simulated low-dose (20-mAs) scan at the same z-axis level as in a. The inflamed appendix (arrow) is substantially less conspicuous, owing to the increased noise.

View larger version (138K): [in a new window]   Figure 4b. Original and simulated CT scans in a 7-year-old girl with abdominal pain. (a) Transverse contrast-enhanced helical CT scan obtained with a tube current of 80 mAs demonstrates an inflamed appendix (arrow) in the lower right side of the pelvis. (b) Simulated low-dose (20-mAs) scan at the same z-axis level as in a. The inflamed appendix (arrow) is substantially less conspicuous, owing to the increased noise.

View larger version (34K): [in a new window]   Figure 5. Graph shows the ROC curves (pooled for four readers) in the diagnosis of appendicitis at standard-dose and simulated low-dose (20-mAs) CT. There is a decrease in sensitivity with the low-dose images.