Imaging for Appendicitis: Should Radiation-induced Cancer Risks Affect Modality Selection?
| العنوان: | Imaging for Appendicitis: Should Radiation-induced Cancer Risks Affect Modality Selection? |
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| المؤلفون: | Laura L. Avery, Chung Yin Kong, Sorapop Kiatpongsan, Maurice S. Herring, Lesley Meng, Pari V. Pandharipande, Jonathan D. Eisenberg |
| المصدر: | Radiology. 273:472-482 |
| بيانات النشر: | Radiological Society of North America (RSNA), 2014. |
| سنة النشر: | 2014 |
| مصطلحات موضوعية: | Diagnostic Imaging, Male, Risk, medicine.medical_specialty, Neoplasms, Radiation-Induced, Cost effectiveness, Decision Making, Sensitivity and Specificity, Life Expectancy, Breast cancer, Prevalence, medicine, Medical imaging, Humans, Radiology, Nuclear Medicine and imaging, Lung cancer, Original Research, Modality (human–computer interaction), business.industry, Cancer, Middle Aged, Appendicitis, medicine.disease, Surgery, Female, Radiology, Radiation-induced cancer, business |
| الوصف: | To compare life expectancy (LE) losses attributable to three imaging strategies for appendicitis in adults-computed tomography (CT), ultrasonography (US) followed by CT for negative or indeterminate US results, and magnetic resonance (MR) imaging-by using a decision-analytic model.In this model, for each imaging strategy, LE losses for 20-, 40-, and 65-year-old men and women were computed as a function of five key variables: baseline cohort LE, test performance, surgical mortality, risk of death from delayed diagnosis (missed appendicitis), and LE loss attributable to radiation-induced cancer death. Appendicitis prevalence, test performance, mortality rates from surgery and missed appendicitis, and radiation doses from CT were elicited from the published literature and institutional data. LE loss attributable to radiation exposure was projected by using a separate organ-specific model that accounted for anatomic coverage during a typical abdominopelvic CT examination. One- and two-way sensitivity analyses were performed to evaluate effects of model input variability on results.Outcomes across imaging strategies differed minimally-for example, for 20-year-old men, corresponding LE losses were 5.8 days (MR imaging), 6.8 days (combined US and CT), and 8.2 days (CT). This order was sensitive to differences in test performance but was insensitive to variation in radiation-induced cancer deaths. For example, in the same cohort, MR imaging sensitivity had to be 91% at minimum (if specificity were 100%), and MR imaging specificity had to be 62% at minimum (if sensitivity were 100%) to incur the least LE loss. Conversely, LE loss attributable to radiation exposure would need to decrease by 74-fold for combined US and CT, instead of MR imaging, to incur the least LE loss.The specific imaging strategy used to diagnose appendicitis minimally affects outcomes. Paradigm shifts to MR imaging owing to concerns over radiation should be considered only if MR imaging test performance is very high. |
| تدمد: | 1527-1315 0033-8419 |
| DOI: | 10.1148/radiol.14132629 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e668ebe8d2501d8e28c8b6272e0ab37b https://doi.org/10.1148/radiol.14132629 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....e668ebe8d2501d8e28c8b6272e0ab37b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15271315 00338419 |
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| DOI: | 10.1148/radiol.14132629 |