Surgical Appropriateness of Imaging in Acute Cholecystitis: A Danish Audit

ABSTRACT Background Acute cholecystitis is a common surgical condition, most frequently caused by gallstones. Ultrasound is recommended as the first‐line imaging modality, while CT and MRCP are reserved for inconclusive cases or suspected complications. Increasing use of CT in Denmark raises concerns regarding unnecessary radiation exposure. This study evaluated the use of radiological imaging modalities in patients with acute cholecystitis at a Danish regional hospital, including an audit of CT scan justification. Materials and Methods The study population consisted of patients admitted with acute cholecystitis at a Danish regional hospital between March 2019 and February 2023. This retrospective quality assurance study assessed annual incidence, and a random sample of 200 patients was analysed for clinical characteristics and use of imaging modalities. Two independent surgeons evaluated whether CT as the initial imaging modality was justified; disagreements were resolved by consensus. Results Ultrasound was used as the first imaging modality in 54% of patients and as the sole modality in 37%. Overall, 69% of patients underwent only one imaging modality. MRCP was most frequently used as the final modality (40.3%). Murphy's sign was undocumented in 49.2% of cases. Ultrasound was more frequently selected as the initial modality when Murphy's sign was positive (74%) compared with negative (48%) or undocumented (42%). In the CT audit, 16.1% of CT scans were deemed unjustified. Conclusion Ultrasound remains the primary first‐line imaging modality in acute cholecystitis, and documentation of Murphy's sign significantly influences imaging selection. Systematic assessment and documentation of Murphy's sign may improve imaging appropriateness and reduce unnecessary CT use. Notably, approximately one‐sixth of CT scans were unjustified.