Ultrasound for Suspected Acute Appendicitis in Adult Women Under Age 40: An Evaluation of On-Call Radiology Resident Scanning

Published:August 14, 2020DOI:

      Rationale and Objectives

      At our institution, on-call radiology residents perform emergent ultrasounds (US) outside of departmental working hours. The aim of the study was to evaluate radiology resident-performed US for clinically suspected acute appendicitis in women under the age of 40.

      Materials and Methods

      Retrospective review of 104 consecutive US scans outside of departmental working hours by radiology residents, and 104 consecutive US studies scanned during departmental working hours by sonographers, in women under the age of 40 for clinically suspected appendicitis .


      Appendix visualization rate was 27% for the resident group (sonographer group: 30%, p = 0.759). The sensitivity and specificity of US for appendicitis were 63% (95% confidence interval: 41%–81%) and 98% (95% CI: 91%–100%), respectively for the resident group (sonographer group: 69% [95% CI: 41%–89 %] and 98% [95% CI: 92%–100%], respectively). An alternative cause for right lower quadrant pain was offered in 17% of resident group cases (sonographer group: 21%, p = 0.598). Follow-up CT or MRI was performed in 47% of resident cases (sonographer group: 44%, p = 0.781). Residents performed more focused US (i.e. not imaging the pelvic organs), at 34% (sonographer group: 1%, p < 0.001). When only focused scanning was performed by residents, there was a trend toward increased downstream imaging (CT or MRI), odds ratio = 2.76 (95% CI: 0.99–7.70).


      Out-of-hours US scans performed by radiology residents had similar performance characteristics compared to departmental sonographers. We discovered an increased rate of downstream imaging in cases in which residents performed limited scans and did not document visualization of the pelvic organs.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Körner H.
        • Söndenaa K.
        • Söreide J.A.
        • et al.
        Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis.
        World J Surg. 1997; 21: 313-317
        • Tan V.F.
        • Patlas M.N.
        • Katz D.S.
        Imaging trends in suspected appendicitis-a Canadian perspective.
        Emerg Radiol. 2017; 24: 249-254
        • Garcia E.M.
        • Camacho M.A.
        • Karolyi D.R.
        • et al.
        Expert panel on gastrointestinal imaging. ACR appropriateness Criteria® right lower quadrant pain-suspected appendicitis.
        J Am Coll Radiol. 2018; 15: S373-S387
        • Drake F.T.
        • Florence M.G.
        • Johnson M.G.
        • et al.
        Progress in the diagnosis of appendicitis.
        Ann Surg. 2012; 256: 586-594
        • Kaewlai R.
        • Lertlumsakulsub W.
        • Srichareon P.
        Body mass index, pain score and Alvarado score are useful predictors of appendix visualization at ultrasound in adults.
        Ultrasound Med Biol. 2015; 41: 1605-1611
        • Alvarado A.
        A practical score for the early diagnosis of acute appendicitis.
        Ann Emerg Med. 1986; 15: 557-564
        • Brenner D.
        • Elliston C.
        • Hall E.
        • et al.
        Estimated risks of radiation-induced fatal cancer from pediatric CT.
        AJR Am J Roentgenol. 2001; 176: 289-296
        • Goodman T.R.
        • Amurao M.
        Medical imaging radiation safety for the female patient: rationale and implementation.
        Radiographics. 2012; 32: 1829-1837
        • Mangona K.L.M.
        • Guillerman R.P.
        • Mangona V.S.
        • et al.
        Diagnostic performance of ultrasonography for pediatric appendicitis: a night and day difference?.
        Acad Radiol. 2017; 24: 1616-1620
        • Fedko M.
        • Bellamkonda V.R.
        • Bellolio M.F.
        • et al.
        Ultrasound evaluation of appendicitis: importance of the 3 × 2 table for outcome reporting.
        Am J Emerg Med. 2014; 32: 346-348
        • Blitman N.M.
        • Anwar M.
        • Brady K.B.
        • et al.
        Value of focused appendicitis ultrasound and alvarado score in predicting appendicitis in children: can we reduce the use of CT?.
        Am J Roentgenol. 2015; 204: W707-W712
        • Lourenco P.
        • Brown J.
        • Leipsic J.
        • et al.
        The current utility of ultrasound in the diagnosis of acute appendicitis.
        Clin Imaging. 2016; 40: 944-948
        • Stewart J.K.
        • Olcott E.W.
        • Jeffrey R.B.
        Sonography for appendicitis: nonvisualization of the appendix is an indication for active clinical observation rather than direct referral for computed tomography.
        J Clin Ultrasound. 2012; 40: 455-461
        • Puylaert J.B.
        • Rutgers P.H.
        • Lalisang R.I.
        • et al.
        A prospective study of ultrasonography in the diagnosis of appendicitis.
        N Engl J Med. 1987; 317: 666-669
        • Lee J.H.
        • Jeong Y.K.
        • Park K.B.
        • et al.
        Operator-dependent techniques for graded compression sonography to detect the appendix and diagnose acute appendicitis.
        AJR Am J Roentgenol. 2005; 184: 91-97