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OBJECTIVE The purpose of this study was to ascertain if standardized radiologic reporting for appendicitis imaging increases diagnostic accuracy. MATERIALS AND METHODS We developed a standardized appendicitis reporting system that includes objective imaging findings common in appendicitis and a certainty score ranging from 1 (definitely not appendicitis) through 5 (definitely appendicitis). Four radiologists retrospectively reviewed the preoperative CT scans of 96 appendectomy patients using our reporting system. The presence of appendicitis-specific imaging findings and certainty scores were compared with final pathology. These comparisons were summarized using odds ratios (ORs) and the AUC. RESULTS The appendix was visualized on CT in 89 patients, of whom 71 (80%) had pathologically proven appendicitis. Imaging findings associated with appendicitis included appendiceal diameter (odds ratio [OR] = 14 [> 10 vs < 6 mm]; p = 0.002), periappendiceal fat stranding (OR = 8.9; p < 0.001), and appendiceal mucosal hyperenhancement (OR = 8.7; p < 0.001). Of 35 patients whose initial clinical findings were reported as indeterminate, 28 (80%) had appendicitis. In this initially indeterminate group, using the standardized reporting system, radiologists assigned higher certainty scores (4 or 5) in 21 of the 28 patients with appendicitis (75%) and lower scores (1 or 2) in five of the seven patients without appendicitis (71%) (AUC = 0.90; p = 0.001). CONCLUSION Standardized reporting and grading of objective imaging findings correlated well with postoperative pathology and may decrease the number of CT findings reported as indeterminate for appendicitis. Prospective evaluation of this reporting system on a cohort of patients with clinically suspected appendicitis is currently under way.

Purpose Computed tomography (CT) is a fast and ubiquitous tool to evaluate intra-abdominal organs and diagnose appendicitis. However, traditional CT reporting does not necessarily capture the degree of uncertainty and indeterminate findings are still common. The purpose of this study was to evaluate the reproducibility of a standardized CT reporting system for appendicitis across a large population and the system’s impact on radiologists’ certainty in diagnosing appendicitis. Methods Using a previously described standardized reporting system, eight radiologists retrospectively evaluated CT scans in a cohort of 561 patients imaged for possible appendicitis (2010–2014). Based on the original reports, 159 of these scans were selected to be over-read by a second reviewer. Reproducibility of reporting and certainty in the diagnosis of appendicitis was compared between the radiologists, and correlation made with clinical diagnoses. Results Appendicitis occurred in 20% of patients (mean age 38, 67% male) in the overall cohort (n=113 of 561). Using the standardized report, radiologists were highly accurate at identifying appendicitis (AUC=0.968, 95%CI: 0.95, 0.99), which occurred in 48% of selected exams (113 of 237). Inter-reader agreement was >80% for most objective findings, and certainty in diagnosing appendicitis was high and reproducible (AUC=0.955 and AUC=0.936 for primary readers and over-readers, respectively). In the subgroup of patients with previously “indeterminate” reports, 57% (24 of 42) were assigned the correct diagnosis using the standardized report. Conclusions Using a standardized reporting system resulted in high reproducibility of objective CT findings for appendicitis and achieved high diagnostic accuracy in an at-risk population. Predictive tools based on this reporting system may further improve communication about certainty in diagnosis and guide patient management, especially when CT findings are indeterminate.

While computed tomography (CT) remains the most accurate and widely used modality for appendicitis imaging, ultrasound has developed its own niche role, especially in the pediatric population and in premenopausal women. Ultrasound is commonly used as the initial imaging test when available, with indeterminate or clinically equivocal cases proceeding to CT. To avoid the radiation and time and cost of CT, ultrasound needs to be improved. While previous studies have focused on improving the diagnostic accuracy of ultrasound through better patient selection and technique, relatively little attention has been brought to the ultrasound report, which often serves as the sole mode of communication between the radiologist and the clinician. Standardization of reporting and terminology has been found to improve patient outcomes and management in breast imaging. A standardized report for appendicitis has the potential to decrease confusion and increase accuracy. A potential format could include a standardized list of the presence or absence of imaging findings associated with appendicitis, with a final summary or score indicating the likelihood of appendicitis being present. Aggregation of data over time through use of a common format could help guide radiologist recommendations based on which imaging findings are present. Overall, a standardized report could help increase the value of ultrasound, leading to improved radiologist-clinician communication, better patient outcomes, and decreased costs.

Covalently crosslinked polymeric materials, known as thermosets, possess enhanced mechanical strength and thermal stability relative to the corresponding uncrosslinked thermoplastics. However, the presence of covalent inter‐chain crosslinks that makes thermosets so attractive is precisely what makes them so difficult to reprocess and recycle. Here, we demonstrate the introduction of chemically cleavable groups into a bis‐diazirine crosslinker. Application of this cleavable crosslinker reagent to commercial low‐functionality polyolefins (or to a small‐molecule model) results in the rapid, efficient introduction of molecular crosslinks that can be uncoupled by specific chemical inputs. These proof‐of‐concept findings provide one potential strategy for circularization of the thermoplastic/thermoset plastics economy, and may allow crosslinked polyolefins to be manufactured, used, reprocessed, and re‐used without losing value. As an added benefit, the method allows the ready introduction of functionality into non‐functionalized commodity polymers.