Computed Tomography Scanning for Diagnosing Appendicitis

Bushong (2000) maintained that there are at least five advantages offered by computed tomography over conventional radiography: (1) better contrast resolution, (2) no superposition of tissue, (3) less scatter radiation, (4) 3D imaging capability, and (5) capability for bone mineral assay.The standard practice at the Khalifa Medical City (SKMC) in Abu Dhabi is that a CT scan of the abdomen is requested after initial clinical examination and blood works have been performed in the Emergency Room. However, if the patient is either very young or an adult female, the ultrasound is the modality of choice. When the prior ultrasound yields inconclusive results, it is only then that a CT scan is performed on these two groups of patients. From the proponents’ observation, though, all patients ultimately undergo a CT scan for diagnosis of appendicitis, whether clinical examination and blood works find the symptoms typical or atypical.As imaging science advanced considerably through the last three decades, contrasts have been used with CT scans, particularly the oral, rectal and intravenous types. As a CT radiographer in SKMC, the proponent observed that some radiologists prefer non-contrasted examinations for the diagnosis of appendicitis, while others prefer contrasted CT examinations. To date, no standard protocol is in place at the SKMC regarding the use of IV contrasted and non-contrasted or plain CT scans. The non-existence of such protocol is believed to stirring some confusion among the emergency room (ER) doctors. Hence, the proponent’s decision to undertake a study on this area.According to Perkins, Kahan and McCue (2008), a CT scan with oral and IV contrast is recommended for diagnosis of appendicitis. Some practitioners prefer the use of rectal contrast to avoid unnecessary delays in appendicitis diagnosis and treatment intervention.