The use of more ultrasound translates to less CT use for diagnosing appendicitis in children, according to research published August 4 in the Journal of Surgical Research.
A team led by Jack Scaife from the University of Utah in Salt Lake City found a negative correlation between increasing ultrasound use and concurrent CT use for these indications. It also found that white children and children living in lower socioeconomic neighborhoods are more likely to visit hospitals with high concurrent imaging use.
“These findings indicate that hospital experience in ultrasound and patient socioeconomic factors are correlated to overimaging,” Scaife and colleagues wrote.
Imaging guidelines recommend using ultrasound first to evaluate possible appendicitis to minimize radiation exposure. However, the researchers noted that it’s not clear how ultrasound and CT use for diagnosing appendicitis in children are associated. They added that “very little” is known about whether overimaging practices disproportionately impact various patient demographic groups.
Previous research suggests that over the past 15 years, widespread CT use in assessing possible pediatric appendicitis has been decreasing while ultrasound has increased.
Scaife et al studied how increased ultrasound use correlated with CT use in evaluating and diagnosing pediatric acute appendicitis. Using the 2019 Nationwide Emergency Department Sample, the researchers included 485 hospitals and 23,976 pediatric patients (under 18 years old) in their retrospective analysis.
Of the total patients, 34% were treated at hospitals in the lowest tertile hospital. Another 35% were at the middle tertile hospitals and 31% were treated at the highest tertile hospitals.
The team observed a negative correlation between increased ultrasound use and concurrent imaging use. This included a correlation of -0.27 (p < 0.001).
Also, compared to white patients, Black and Hispanic patients had lower odds of presenting to a hospital with a higher concurrent imaging rate. This included adjusted odds ratios (aOR) of 0.6 and 0.7, respectively.
Finally, compared with the highest income quartile, patients in the second and lowest income quartiles had higher odds of presenting to a hospital with a higher concurrent imaging rate. His included aORs of 1.9 and 3.7, respectively.
The study authors suggested that universal adoption of ultrasound use in diagnosing appendicitis may help minimize disproportionate radiation exposure. They also highlighted that increased ultrasound use can decrease emergency department visit costs and length of stay.
“This study’s findings agree with the previous research and suggest that lower socioeconomic pediatric patients are over-imaged compared to their peers in a higher socioeconomic stratification,” they concluded.
The full study can be found here.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
