Radiation Dose from MDCT Examinations for Suspected Acute Appendicitis

  • Denis Tack
  • Caroline Keyzer
Part of the Medical Radiology book series (MEDRAD)


Multidetector computed tomography (MDCT) is frequently used in patients with right iliac fossa pain and enables confident positive and negative diagnoses of both acute appendicitis and alternative diseases. The radiation risk related to MDCT has however to be taken into account. In this chapter, we will review the background of radiation risks, dose descriptors available on CT scanners, strategies for limiting the dose per examination, and the latest technology improvements for dose optimization and reduction. We will provide dose values for optimized and low-dose acquisitions, suited for adults, adolescents, and children tending to a radiation dose delivered by MDCT reduced to that of an abdominal plain film examination with two views.


Acute Appendicitis Iterative Reconstruction Automatic Exposure Control Tube Potential Noise Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Allen BC, Baker ME, Einstein DM, Remer EM, Herts BR, Achkar JP, Davros WJ, Novak E, Obuchowski NA (2010) Effect of altering automatic exposure control settings and quality reference mAs on radiation dose, image quality, and diagnostic efficacy in MDCT enterography of active inflammatory Crohn’s disease. AJR 195:89–100PubMedCrossRefGoogle Scholar
  2. Berrington de González A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, Land C (2009) Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 169:2071–2077PubMedCrossRefGoogle Scholar
  3. Christner JA, Kofler JM, McCollough CH (2010) Estimating effective dose for CT using dose-length product compared with using organ doses: consequences of adopting International Commission on Radiological Protection publication 103 or dual-energy scanning. AJR 194:881–889PubMedCrossRefGoogle Scholar
  4. Diel J, Perlmutter S, Venkataramanan N, Mueller R, Lane MJ, Katz DS (2000) Unenhanced helical CT using increased pitch for suspected renal colic: an effective technique for radiation dose reduction? JCAT 24:795–801Google Scholar
  5. Ege G, Akman H, Sahin A, Bugra D, Kuzucu K (2002) Diagnostic value of unenhanced CT in adult patients with suspected acute appendicitis. Br J Radiol 75:721–725PubMedGoogle Scholar
  6. European Commission (1999) European guidelines on quality criteria for computed tomography, Report EUR 16262. Brussels: ECGoogle Scholar
  7. Flum DR, Morris A, Koepsell T, Dellinger EP (2001) Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 286:1748–1753PubMedCrossRefGoogle Scholar
  8. Golding SJ (2010) Radiation exposure in CT: what is the professionally responsible approach? Radiology 255:683–685PubMedCrossRefGoogle Scholar
  9. Golding SJ, Shrimpton PC (2002) Radiation dose in CT: are we meeting the challenge? (Commentary). Br J Radiol 75:1–4PubMedGoogle Scholar
  10. Guimaraes LS, Fletcher JG, Harmsen WS, Yu L, Siddiki H, Melton Z, Huprich JE, Hough D, Hartman R, McCollough CH (2010) Appropriate patient selection at abdominal dual-energy CT using 80 kV: relationship between patient size, image noise, and image quality. Radiology 257:732–742PubMedCrossRefGoogle Scholar
  11. Hamm M, Knopfle E, Wartenberg S, Wawroschek F, Weckermann D, Harzmann R (2002) Low dose unenhanced helical computerized tomography for the evaluation of acute flank pain. J Urol 167:1687–1691PubMedCrossRefGoogle Scholar
  12. Heneghan JP, McGuire KA, Leder RA, DeLong DM, Yoshizumi T, Nelson RC (2003) Helical CT for nephrolithiasis and ureterolithiasis: comparison of conventional and reduced radiation-dose techniques. Radiology 229:575–580PubMedCrossRefGoogle Scholar
  13. Hricak H, Brenner DJ, Adelstein SJ, Frush DP, Hall EJ, Howell RW, McCollough CH, Mettler FA, Pearce MS, Suleiman OH, Thrall JH, Wagner LK (2010) Managing radiation use in medical imaging: a multifaceted challenge radiology 101157; Published online 16 December 2010, doi:  10.1148/radiol.10101157
  14. ICRP (1991) Recommendations of the international commission on radiological protection. Ann ICRP 21:1–201Google Scholar
  15. Kalra MK (2007) Automatic exposure control in multidetectorrow computed tomography. In: Tack D, Gevenois PA (eds) Medical radiology: diagnostic imaging. Springer, NY, pp 117–128Google Scholar
  16. Kalra MK, Maher MM, D’Souza RV, Rizzo S, Halpern EF, Blake MA, Saini S (2005) Detection of urinary tract stones at low-radiation-dose CT with Z-Axis automatic tube current modulation: phantom and clinical studies. Radiology 235:523–529PubMedCrossRefGoogle Scholar
  17. Kambadakone AR, Prakash P, Hahn PF, Sahani DV (2010) Low-dose CT examinations in Crohn’s disease: impact on image quality, diagnostic performance, and radiation dose. AJR 195:78–88PubMedCrossRefGoogle Scholar
  18. Kamel IR, Goldberg SN, Keogan MT, Rosen MP, Raptopoulos V (2000) Right lower quadrant pain and suspected appendicitis: nonfocused appendiceal CT–review of 100 cases. Radiology 217:159–163PubMedGoogle Scholar
  19. Keyzer C, Tack D, De Maertelaer V, Bohy P, Gevenois PA, Van Gansbeke D (2004) Acute appendicitis: comparison of low-dose and standard-dose unenhanced multi–detector row CT. Radiology 232:164–172PubMedCrossRefGoogle Scholar
  20. Keyzer C, Cullus P, Tack D, De MV, Bohy P, Gevenois PA (2009) MDCT for suspected acute appendicitis in adults: impact of oral and IV contrast media at standard-dose and simulated low-dose techniques. AJR 193:1272–1281PubMedCrossRefGoogle Scholar
  21. Krieg AF, Gambino SR, Galen RS (1975) Why are clinical laboratory tests performed? When are they valid? JAMA 233:76–78PubMedCrossRefGoogle Scholar
  22. Lane MJ, Liu DM, Huynh MD, Jeffrey RB, Mindelzun RE, Katz DS (1999) Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 213:341–346PubMedGoogle Scholar
  23. Leng S, Yu L, McCollough CH (2010) Radiation dose reduction at CT enterography: How low can we go while preserving diagnostic accuracy? AJR 195:76–77PubMedCrossRefGoogle Scholar
  24. Little MP, Wakeford R, Tawn EJ, Bouffler SD, Berrington de Gonzalez A (2009) Risks associated with low doses and low dose rates of ionizing radiation: why linearity may be (almost) the best we can do. Radiology 251:6–12PubMedCrossRefGoogle Scholar
  25. Liu W, Esler JS, Kenny BJ, Goh RH, Rainbow AJ, Stevenson GW (2000) Low-dose nonenhanced helical ct of renal colic: assessment of ureteric stone detection and measurement of effective dose equivalent. Radiology 215:51–54PubMedGoogle Scholar
  26. Mulkens TH, Bellinck P, Baeyaert M, Ghysen D, Van Dijck X, Mussen E, Venstermans C, Termote JL (2005) Use of an automatic exposure control mechanism for dose optimization in multi-detector row CT examinations: clinical evaluation. Radiology 237:213–223PubMedCrossRefGoogle Scholar
  27. Nagel HD (2007) CT parameters that influence radiation dose. In: Tack D, Gevenois PA (eds) Medical radiology: diagnostic imaging. Springer, NY, pp 51–80Google Scholar
  28. Paul JF, Abada HT (2007) Dose in cardiac and vascular MDCT. In: Tack D, Gevenois PA (eds) Medical radiology: diagnostic imaging. Springer, NY, pp 171–184Google Scholar
  29. Platon A, Jlassi H, Rutschmann OT, Becker CD, Verdun FR, Gervaz P, Poletti PA (2009) Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis. Eur Radiol 19:446–454PubMedCrossRefGoogle Scholar
  30. Rogers LF (2001) Radiation exposure in CT: why so high? AJR 177:277PubMedGoogle Scholar
  31. Rusinek H, Naidich DP, McGuinness G, Leitman BS, McCauley DI, Krinsky GA, Clayton K, Cohen H (1998) Pulmonary nodule detection: low-dose versus conventional CT. Radiology 209:243–249PubMedGoogle Scholar
  32. Seo H, Lee KH, Kim HJ, Kim K, Kang SB, Kim SY, Kim YH (2009) Diagnosis of acute appendicitis with sliding slab ray-sum interpretation of low-dose unenhanced CT and standard-dose IV contrast-enhanced CT scans. AJR 193:96–105PubMedCrossRefGoogle Scholar
  33. Shrimpton PC, Hillier MC, Lewis MA, et al (2003). Data from computed tomography (CT) examinations in the UK-2003 review. Chilton: NRPB-67, National Radiological Protection BoardGoogle Scholar
  34. Singh S, Kalra MK, Hsieh J, Licato PE, Do S, Pien HH, Blake MA (2010) Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. Radiology 257:373–383PubMedCrossRefGoogle Scholar
  35. Tack D (2007) Methods and strategies for radiation dose optimization- and reduction-in MDCT with special focus on the image quality. In: Tack D, Gevenois PA (eds) Medical radiology: diagnostic imaging. Springer, NY, pp 99–116Google Scholar
  36. Tack D, Sourtzis S, Delpierre I, De Maertelaer V, Gevenois PA (2003) Low-dose unenhanced multidetector CT of patients with suspected renal colic. AJR 180:305–311PubMedGoogle Scholar
  37. Tack D, Bohy P, Perlot I, De Maertelaer V, Alkeilani O, Sourtzis S, Gevenois PA (2005) Suspected acute colon diverticulitis: imaging with low-dose unenhanced multi–detector row CT. Radiology 237:189–196PubMedCrossRefGoogle Scholar
  38. Tubiana M, Feinendegen LE, Yang C, Kaminski JM (2009) The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology 251:13–22PubMedCrossRefGoogle Scholar
  39. UNSCEAR (2000) Sources and effects of ionizing radiation. NY: United Nations Scientific Committee on the Effects of Atomic Radiation Report to the General Assembly United NationsGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of RadiologyClinique Louis Caty, Hôpital RHMSBaudourBelgium
  2. 2.Department of RadiologyHôpital Erasme, Université libre de BruxellesBrusselsBelgium
  3. 3.Braine-L’AlleudBelgium

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