Assistant Professor of Radiology and Biomedical Imaging Yale New Haven Hospital, United States
Purpose: CT-AP is frequently ordered for nonspecific abdominal pain in reproductive-age females, despite the predominance of benign or gynecologic etiologies that are more accurately and safely assessed with ultrasound or, in select cases, MRI. This practice results in unnecessary exposure to ionizing radiation, increased healthcare costs, and a higher rate of incidental findings that rarely alter management.
Methods/Materials: This exhibit will emphasize imaging algorithms based on ACR Appropriateness Criteria, illustrate cases where CT added limited value, and outline strategies for radiologists to support evidence-based imaging selection.
Results: Data show a steady rise in CT-AP utilization in reproductive-age women, even when guidelines recommend ultrasound as the initial test. Drivers include practice variation, time pressure in emergency settings, and the perceived comprehensiveness of CT.
Comparative evidence underscores that ultrasound accurately detects common gynecologic causes such as ovarian torsion, hemorrhagic cysts, and ectopic pregnancy, while avoiding ionizing radiation. MRI provides an additional radiation-free option in equivocal cases.
Conclusions: Overutilization of CT-AP in young females leads to avoidable radiation exposure, increased costs, and frequent incidental findings. Radiologists can mitigate this trend by promoting guideline-driven pathways, educating referring clinicians, and advocating for ultrasound and MRI as first-line modalities. Improved imaging stewardship enhances patient safety and optimizes resource use.
