Case based simulation in MRI for suspected appendicitis in children

Published:September 21, 2017DOI:


      • We found a significant increase in self-reported diagnostic competence to levels above the threshold from advanced beginner to competent
      • By creating a simulation setting from readily available cases and software, radiologists were able to increase exposure and practice their interpretative skills on a realistic environment
      • Reinterpreting cases might facilitate adoption of new technologies and allow departments with lower volumes to disseminate knowledge faster and improve training
      • This study opens the possibility of developing a full curriculum of pediatric MRI applications that improve diagnostic confidence



      To establish the effect on diagnostic confidence of a simulation setting, in which radiologists re-interpret anonymized pediatric MRI cases.


      In this IRB-approved study, participants completed surveys rating confidence before and after interpreting 10 MRI cases for suspected appendicitis in children.


      18 radiologists (4 faculty, 5 fellows, and 9 residents) correctly identified an average of 7.44 cases (range 5–9). Self-described confidence regarding technique and interpretation increased from 2.0 (SD 0.77) and 2.33 (SD 0.69) to 2.83 (SD 0.71) and 2.94 (SD 0.73), respectively.


      Simulated interpretation of pediatric MRI in suspected appendicitis results in increased self-describe confidence without requiring additional capital/equipment expenses.


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        • Scheinfeld M.H.
        • Moon J.-Y.
        • Fagan M.J.
        • Davoudzadeh R.
        • Wang D.
        • Taragin B.H.
        MRI usage in a pediatric emergency department: an analysis of usage and usage trends over 5 years.
        Pediatr Radiol. 2017; 47: 327-332
        • O'Connor M.
        • Ryan J.
        • Foley S.
        A review of cross-sectional imaging, ultrasound and nuclear medicine utilization patterns in paediatric patients in Ireland, 2003-12.
        Br J Radiol. 2015; 88: 20140767
        • Smith M.P.
        • Katz D.S.
        • Lalani T.
        • Carucci L.R.
        • Cash B.D.
        • Kim D.H.
        • et al.
        ACR Appropriateness Criteria® Right lower quadrant pain—suspected appendicitis.
        Ultrasound Q. 2015; 31: 85-91
        • Aspelund G.
        • Fingeret A.
        • Gross E.
        • et al.
        Ultrasonography/MRI versus CT for diagnosing appendicitis.
        Pediatrics. 2014; 133: 586-593
        • Moore M.M.
        • Kulaylat A.N.
        • Hollenbeak C.S.
        • Engbrecht B.W.
        • Dillman J.R.
        • Methratta S.T.
        Magnetic resonance imaging in pediatric appendicitis: a systematic review.
        Pediatr Radiol. 2016; 46: 928-939
        • Epifanio M.
        • Antonio de Medeiros Lima M.
        • Corrêa P.
        • Baldisserotto M.
        An imaging diagnostic protocol in children with clinically suspected acute appendicitis.
        Am Surg. 2016; 82: 390-396
        • Koning J.L.
        • Naheedy J.H.
        • Kruk P.G.
        Does abdominal pain duration affect the accuracy of first-line MRI for pediatric appendicitis?.
        Abdom Imaging. 2015; 40: 352-359
        • Orth R.C.
        • Guillerman R.P.
        • Zhang W.
        • Masand P.
        • Bisset G.S.
        Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis.
        Radiology. 2014 Jul; 272: 233-240
        • Thieme M.E.
        • Leeuwenburgh M.M.N.
        • Valdehueza Z.D.
        • Bouman D.E.
        • de Bruin I.G.J.M.
        • Schreurs W.H.
        • et al.
        Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis.
        Eur Radiol. 2014; 24: 630-637
        • Gardner L.
        From novice to expert: Benner's legacy for nurse education.
        Nurse Educ Today. 2012; 32: 339-340
        • Leeuwenburgh M.M.N.
        • Wiarda B.M.
        • Bipat S.
        • Nio C.Y.
        • Bollen T.L.
        • Kardux J.J.
        • et al.
        Acute appendicitis on abdominal MR images: training readers to improve diagnostic accuracy.
        Radiology. 2012; 264: 455-463
        • Poot J.D.
        • Chetlen A.L.
        A simulation screening mammography module created for instruction and assessment: radiology residents vs national benchmarks.
        Acad Radiol. 2016; 23: 1454-1462
        • Wood B.P.
        Visual expertise.
        Radiology. 1999; 211: 1-3
        • Nodine C.F.
        • Kundel H.L.
        • Mello-Thoms C.
        • Weinstein S.P.
        • Orel S.G.
        • Sullivan D.C.
        • et al.
        How experience and training influence mammography expertise.
        Acad Radiol. 1999; 6: 575-585