I. Anderson1, Y. Young1, N. Jayarajan1, K. Sutyak1, E. Garcia1, N. Hebballi1, M. Broussard1, T. Fisher1, B. Hegde1, N. Ghosh1, S. John2, S. Rose2, K. Lally1, K. Tsao1 1University Of Texas Health Science Center At Houston, Pediatric Surgery, Houston, TX, USA 2University Of Texas Health Science Center At Houston, Diagnostic And Interventional Imaging, Houston, TX, USA
Introduction:
Radiation used in computed tomography (CT) carries an oncogenic risk, which is heightened in children. We previously showed that 63% of pediatric patients received a preoperative CT for appendicitis diagnosis. Through a system-wide quality improvement project, CT rates have declined in recent years, but radiation dose remains unknown, especially at non-system hospitals. We aimed to compare current radiation dosing between our children’s-associated hospitals (system hospitals, SH) and referring community healthcare facilities (non-system hospitals, NSH).
Methods:
A retrospective cohort study was conducted on patients (<18 years) who underwent appendectomy at our tertiary level children’s hospital from June 2020-June 2023. Data was collected from 12 SH locations and NSH. Patient demographics and imaging details were abstracted from the electronic medical record. Size Specific Dose Estimate (SSDE), which accounts for patient diameter, and Effective Dose (ED), which accounts for patient age, were calculated from each CT. SSDE was evaluated against American College of Radiology dose benchmarks, including achievable dose (AD), median of doses analyzed, and diagnostic reference level (DRL), 75th percentile of doses analyzed. T-test and Chi-square were performed and p values <0.05 were deemed statistically significant.
Results:
Of the 1,419 patients, 410 (29%) received one or more CTs for acute appendicitis evaluation. Previously, 1128 (65%) of 1736 patients received preoperative CTs. CT usage is significantly lower than previous years (p=0.001). 352 CTs had dose data available, of which 290 (82%) were performed at SH and 62 (18%) at NSH. Patients who got CTs at SH were older (14.1+/-2.99 years) than patients at NSH (12.4+/-3.57 years). Patients who got CTs at SH had 49% Medicaid, 37% Private insurance and 8% Self-pay, while patients at NSH had 41% Medicaid, 49% Private insurance and 9% Self-pay. Both SSDE and ED were higher at NSH than at SH. Mean SSDE per CT was 13.9+/-10.1 mGy at NSH and 11.2+/-6.87 mGy at SH (p=0.047). Mean ED per CT was 9.33+/-7.04 mSv at NSH and 7.26+/-5.98 mSv at SH (p=0.029). SSDE exceeded DRLs more frequently at NSH than SH. 31.6% of CTs performed at our children’s facility (n=19), 32.5% at 11 other SH (n=271), and 50.0% at NSH (n=62) exceeded DRL (Figure).
Conclusion:
Despite significant decrease in CT utilization for appendicitis diagnosis, radiation dose remains a concern. Pediatric appendectomy patients received significantly higher radiation doses and exceeded reference levels more often at NSH when compared to SH associated with our children’s facility. CT reduction protocols in children should include evaluation of dosing and robust dose reduction guidelines.