Implementation of a Program for Appendicitis MRI in a Pediatric Hospital.

MRI is increasingly used as an alternate test to CT for the evaluation of suspected appendicitis in pediatric patients presenting to the emergency department (ED) with abdominal pain, when further imaging is needed after an initial ultrasound. The available literature shows similar diagnostic performance of MRI and CT in this setting. At the authors' institution, MRI to evaluate for appendicitis in children in the ED is performed using a rapid three-sequence free-breathing protocol without IV contrast media. Implementation of a program for appendicitis MRI in children involves multiple steps, including determination of imaging resource availability, collaboration with other services to develop imaging pathways, widespread educational efforts, and regular quality review. Such programs can face numerous practice-specific challenges, for example involving scanner capacity, costs, and buy-in of impacted groups. Nonetheless, through careful consideration of these factors, MRI can be used to positively impact the care of children presenting to the ED with suspected appendicitis. This Clinical Perspective aims to provide guidance on the development of a program for appendicitis MRI in children, drawing on one institution's experience while highlighting advantages of MRI and practical strategies for overcoming potential barriers.