When should a computed tomography (CT) program be considered?

From the Guidelines

A computed tomography (CT) program should be considered when there is diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis. This is based on the most recent and highest quality study available, which suggests that CT imaging can be used to complement the history, examination, and laboratory findings to establish the diagnosis of diverticulitis 1.

The decision to implement a CT program should take into account several factors, including:

• The presence of diagnostic uncertainty in patients with suspected acute left-sided colonic diverticulitis
• The availability of adequate physical space and power requirements to accommodate the CT scanner
• The presence of qualified staff, including radiologists and CT technologists
• Financial considerations, including equipment costs and service contracts

Some key points to consider when deciding whether to implement a CT program include:

• CT imaging has high sensitivity and specificity for diagnosing diverticulitis, with moderate-certainty evidence showing that it is associated with very high sensitivity and specificity 1
• The use of CT imaging should be judicious, taking into account the potential harms of radiation exposure and the cost of the procedure
• Alternative imaging modalities, such as abdominal ultrasonography or magnetic resonance imaging, may be considered in certain situations, such as when CT cannot be obtained or when ultrasonography provides inconclusive results 1

Overall, the decision to implement a CT program should be based on a comprehensive needs assessment and financial analysis, taking into account the potential benefits and harms of the program, as well as the availability of alternative imaging modalities. The most recent and highest quality study available suggests that CT imaging is a valuable tool in the diagnosis of acute left-sided colonic diverticulitis, and should be considered when there is diagnostic uncertainty 1.

From the Research

Considerations for CT Program

• The decision to use a computed tomography (CT) program should be based on the specific needs of the patient and the potential benefits of the scan 2, 3, 4.
• CT scans can be useful in diagnosing injuries to various regions, such as the abdomen, liver, spleen, pancreas, kidney, and chest 4.
• In cases of head trauma, CT scanning is the current first imaging technique to be used, and it is particularly useful for demonstrating scalp, bone, extra-axial hematomas, and parenchymal injury 3.
• CT scans can also be useful in evaluating acute abdominal pain in patients who do not undergo surgery, and can help to define the cause and therapeutic strategy in these patients 5.

Timing of CT Program

• The timing of a CT program depends on the specific clinical scenario and the needs of the patient 2, 3, 4.
• In general, CT scans can be performed early in the management of trauma patients, and can help to guide therapy and improve patient outcomes 2.
• However, the use of CT scans should be carefully considered, as they can be associated with morbidity and cost, and strict oversight by surgeons and radiologists is essential 2.

Specific Clinical Scenarios

• In cases of blunt abdominal trauma, CT scans can be useful in evaluating the extent of injury and guiding therapy 6.
• In patients with acute abdomen, CT scans can help to define the cause and therapeutic strategy, and can be particularly useful in patients with no history of abdominal disease 5.
• In cases of head trauma, CT scans can be used to demonstrate the extent of injury and guide therapy, and MRI can be used to study early head injury and measure cerebral blood flow, cerebral blood volume, and the location and extent of cerebral edema 3.