Low vs. standard dose computed tomography in suspected acute appendicitis: Is it time for a change?

• Clinical diagnosis is accurate in 80% of patients with suspected appendicitis with negative appendectomy rates of up to 21%.
• In the UK the use of standard-dose CT (SDCT) is conservative due to concerns over radiation exposure and cost.
• The use of low dose computer tomography (LDCT) instead of SDCT may partially address these concerns.
• This review illustrates that LD CT is not inferior to SD CT in the diagnosis of acute appendicitis.

BackgroundClinical diagnosis is accurate in only 80% of patients with suspected appendicitis with negative appendectomy rates of up to 21%. In the UK the use of standard-dose CT (SDCT) is conservative due to concerns over radiation exposure and resource implications. The use of low dose computer tomography (LDCT) instead of standard dose computer tomography (SDCT) may partially address these concerns.AimTo compare LDCT and SDCT in the diagnosis of appendicitis.MethodsA literature search of the EMBASE and MEDLINE databases in July 2015 was conducted using the keywords ‘low dose CT’ and ‘appendicitis’. Data were analysed and p values calculated using the Chi-square test. P values less than 0.05 were considered to be significant.ResultsLDCT (1.2–5.3 mSv) was not inferior to SDCT (5.2–10.2 mSv) in the diagnosis of acute appendicitis and proposing alternative diagnoses. SDCT was superior to LDCT in the negative predictive value of diagnosis of appendiceal perforation. There was no significant difference between LDCT and SDCT in negative appendectomy rate, appendiceal perforation rate and the need for additional imaging.ConclusionLDCT is not inferior to SDCT in the diagnosis of acute appendicitis and proposing alternative diagnoses. Further studies are recommended to further assess the potential role of LDCT & its cost effectiveness. Its use may improve the current management of patients with suspected acute appendicitis.