Appendicitis often presents as an emergency, and whether you’re old or young, the belly pain can be extreme. Typically, it’s diagnosed using a CT scan, and a new study indicates that this evaluation should be performed differently for adults and for children.
As published in the New England Journal of Medicine, the research shows that exposure to the radiation in a CT scan is of concern particularly for children and young adults. Such scans can employ different levels of radiation, and it appears that low-dose CT scans are just as effective in diagnosing appendicitis in teens and young adults as standard doses.
Because the effects of radiation exposure can be dire—an increased risk of cancer, primarily—the lower the dose the better. (See our article, “Radiation Overdose Injuries”.) But these lower levels haven’t been accepted widely, according to analysis of the NEJM study by MedPage Today, because of the quality of the images rendered was suspect.
So the researchers conducted a randomized trial of 879 patients ages 15 to 44 suspected of having appendicitis. About half received a low-dose CT scan and half received the standard-dose scan.
About 4 in 10 patients in each group had an appendectomy after the scan. Afterward, it was determined that six patients in each group did not have inflammation, and had undergone the operation unnecessarily.
The difference between the two groups was so negligible that using the low-dose CT instead of the standard dose would have resulted in only one additional unnecessary operation in 330 patients. That risk, researchers noted, is favorably weighed against the potentially higher cancer risk with the standard dose.
"However, it is highly debatable whether the radiation levels used in our two groups can actually induce cancer and whether use of the low dose instead of the standard dose can actually reduce the carcinogenic risk," they added.
The rate of perforated appendix, which indicates that the diagnosis was delayed, also was similar between the two dosage groups.
The welcome performance of the lower dose scan was attributed to superior imaging capability of modern equipment and the fact that it’s fairly simple to interpret CT images of an appendix.
Cells that divide rapidly are more susceptible to cancer. Because the active growth of children signifies rapid cell turnover; because gastrointestinal tract cells continually turn over; and because children have a longer life span and are therefore more vulnerable to all forms of radiation exposure for a longer period, it just makes sense to limit their radiation exposure when you can.
If your child’s doctor prescribes a CT scan to diagnose possible appendicitis, request a low-dose procedure. And if it’s prescribed for other diagnostic reasons, discuss the options. Sometimes, care providers embrace the more-is-more solution out of habit, and that’s not always the best medicine.
