Validity of SECTRA table guided virtual CT scan with contrast for the diagnosis of query Acute surgical abdominal pain

Acute3 abdomen is a clinical syndrome characterized by sudden onset of abdominal pain, which can be due to a variety of underlying conditions such as appendicitis, cholecystitis, diverticulitis, and perforated ulcers. Prompt and accurate diagnosis is crucial, as timely intervention can significantly reduce morbidity and mortality rates associated with these conditions (Tiwari and Haribhakti, 2022).

Abdominal pain is among the most frequent causes of emergency department (ED) visits, comprising approximately 10 to 20% of all cases. Of the patients presenting with abdominal pain, a considerable proportion will necessitate surgical intervention. Estimates for acute surgical abdomen in emergency settings vary, but it is generally believed that 20 - 30% of patients with acute abdominal pain will eventually require surgery (Kapral et al., 2020).

A descriptive retrospective study analyzed the medical records of 299 patients diagnosed with acute abdomen who were admitted between March 21, 2018, and March 21, 2019, to the general surgery ward at Aliabad Teaching Hospital. The findings indicated a higher prevalence in males, with a male-to-female ratio of 1.14:1. The largest cohort of patients was within the age range of 15 to 24 years (n = 122), constituting 40.8% (Danish, 2022).

The predominant etiology identified for acute abdomen was acute appendicitis, comprising 57.5% of all admissions. Subsequently, there was an incidence of acute intestinal obstruction (20.7%) and acute cholecystitis (10.4%). The predominant complaint was abdominal discomfort, and the most often performed surgical procedures were open appendectomy for acute appendicitis, followed by exploratory laparotomy. The research reported a complication incidence of 17% and a death rate of 3.6% (Danish, 2022).

Radiological investigation has also become a cornerstone in the diagnostic evaluation of acute abdomen, providing high-resolution images that can help identify the cause of pain. Non-invasive CT is particularly beneficial in ambiguous cases where the diagnosis is not immediately precise, guiding clinicians in decision-making (Xu, 2023).

The SECTRA table is a sophisticated medical imaging system designed to support a range of imaging procedures, primarily in radiology departments, hospitals, and diagnostic centers. Manufactured by SECTRA, a global leader in medical imaging technology, the SECTRA table is engineered to enhance the efficiency, precision, and comfort of diagnostic imaging workflows (Horn and Benninger, 2025).

SECTRA imaging systems, including the tables, are known for their integration with advanced imaging modalities such as X-ray, CT (Computed Tomography), MRI (Magnetic Resonance Imaging), fluoroscopy, and more (Horn and Benninger, 2025).

The SECTRA table serves as the foundation for high-quality diagnostic imaging, offering features that enhance both the patient and clinician experience. Whether it's ensuring optimal positioning of patients for more explicit images, providing ergonomic design to reduce healthcare worker strain, or integrating seamlessly with imaging systems for improved workflow efficiency, the SECTRA table is an essential component of modern diagnostic practices (Horn and Benninger, 2025).

AIM OF THE WORK

Evaluate Diagnostic Validity: Assess the sensitivity and specificity of SECTRA in diagnosing acute surgical abdominal pain compared to traditional diagnostic methods. Identify common pathologies associated with acute surgical abdominal pain. To study the incidence of acute abdominal emergencies. To analyse the nature, presentation, and causes of acute abdominal emergencies treated in surgical units.

PATIENTS AND METHODS

Type of study: Diagnostic Prospective Cross-sectional study

Study setting: Emergency Department at 6th October University Hospital.

Target population: patients older than 18^th come to the Emergency Room presenting with acute abdominal pain, undergo CT imaging with oral and IV contrast as part of their diagnostic evaluation before any surgical intervention.

Inclusion Criteria

Age: Adults aged 18 years and older.

Clinical Presentation: Patients presenting with acute abdominal pain.

Exclusion Criteria

Trauma: Acute abdominal pain secondary to blunt or penetrating trauma (unstable patient).

Contraindication to contrast CT: A contraindication that prevented the patient from receiving the standard contrast CT due to severe renal impairment.

Physiological instability: Patient presenting in haemorrhagic shock or too unstable to complete a standard CT scan.

Pregnancy

Due to radiation exposure. In our study, we evaluated all adult patients (≥ 18 years old) who were admitted to the ED of our 120-bed community hospital between December 2024 and December 2025 with acute abdominal pain. The surgeons routinely ordered CT examinations to confirm diagnoses in cases requiring surgical intervention or to exclude conditions that would necessitate surgical intervention. The radiology department offered 24-hour imaging services for the ED, with a radiologist available at all times. A total of 60 patients (36 men and 24 women; 33.2±13.8 years; range, 18–75) were included in this study.

Imaging Protocol

All CT examinations were carried out on a helical CT system (High Speed Advantage Philips multi-slice 16 MX-16 SLICE 150/300). The scanning protocol consisted of contiguous 1.5-mm axial sections from the diaphragm to the pubic symphysis, performed before and after IV and oral contrast administration for contrast-enhanced CTs. 350 mL of Omnipaque was administered intravenously at a rate of 2-3 ml/s with a power injector, and image acquisition was started 70 s after initiation of the contrast material injection.

Data Collection

We asked the ED physicians who requested abdominal CT examinations to complete a questionnaire before CT information was available for each patient. These questionnaires included the following information: (1) demographic data; (2) brief complaint and short current history; (3) results of physical examinations; (4) results of abnormal laboratory examinations;(5) results of abdominal and pelvis ultrasonography findings; and (6) results of plain radiographs.

The physicians were asked to estimate the most likely diagnosis (pre-CT diagnosis) and to state the certainty (0–100%) that the initial diagnosis was correct. They were also asked to select their treatment plans if no CT information was available, from the following options: (1) no treatment required, or discharge home with or without medication; (2) admission as an in-patient for conservative (non-surgical) treatment; (3) admission as an in-patient for surgical treatment; and (4) direct admission for emergency surgery. Immediately after CT was performed and the images were interpreted by a radiologist, the same physician was asked to provide a revised leading diagnosis (post-CT diagnosis), the certainty of this diagnosis, and the proposed treatment plan for the patient.

To evaluate the usefulness of IV and oral contrast material administration, a radiologist who interpreted the CT images selected from the following list: IV and oral contrast material administration: (1) was essential for establishing the diagnosis of the cause of acute abdominal pain; (2) made the diagnosis more readily apparent, or helped evaluate the severity or characteristics of the diseases; (3) was not necessary.

A radiologist always selected option (3) when CT images were interpreted as usual, although the use of IV contrast material might have helped exclude lesions.

Figure (1): Colo-colic intussusception noted a large lipoma arising from the right colon.

Final Diagnoses

The definitive diagnoses were established through surgical and pathological evaluations in patients who underwent laparotomy (n = 35). If patients were admitted to an inpatient ward but did not undergo surgical procedures, the most probable discharge diagnoses were used as the final diagnoses (n = 14). If required, clinical follow-up was performed at the outpatient clinic; however, no alterations to the final diagnosis were observed in any instance. All patients discharged home, regardless of medication status, were monitored through outpatient follow-up, and their definitive clinical diagnoses were established (n = 11).

Figure (2): Smudged fat planes, surrounding minimal collection, prominent mesenteric lymph nodes, and a thickening wall of the appendix, picture of appendicitis.

Figure (3): Richter hernia.

Figure (4): Picture of gastric perforation noted escape of dye from the site of perforation.

Study design:

Sampling

An exploratory study with all eligible patients for 12 months at the 6th October University Hospital.

Statistical Design

Data processing and statistical analysis were performed using IBM SPSS Statistics version 23.0 (IBM Corp., Armonk, NY, USA), a software platform for data management, coding, and executing statistical procedures.

Ethical issues:

This is a prospective Cohort Feasibility study. All data will be anonymized to protect the privacy and confidentiality of patients' information, and all patients will provide consent for the procedures.

Publication policy:

Any publication resulting from this research will include the names of all contributors, with the order of authorship reflecting the extent of individual contributions to data interpretation and manuscript preparation. Additional external authors may be incorporated if their input substantively enhances the content and they meet internationally recognized authorship criteria.

The collected data were processed and entered using IBM SPSS Statistics, version 28 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to characterize the dataset. Continuous variables were summarized by calculating the mean, standard deviation (SD), median, and minimum and maximum values to reflect both central tendency and variability. Categorical variables were reported as absolute counts (n) and corresponding percentages to illustrate the distribution across categories.

Data summarization:

Qualitative Data:

Categorical variables were presented using absolute frequencies (n), representing the number of observations within each category, and relative frequencies (%), indicating the proportion of observations in each category relative to the total sample.

Quantitative Data:

·        Continuous variables were summarized using the following statistical measures:

·        Mean: The arithmetic average, calculated by dividing the total sum of observed values by the number of observations.

·        Median: The central value in an ordered dataset, used particularly for skewed distributions due to its resistance to the influence of outliers.

·        Standard Deviation (SD): A measure of dispersion that quantifies the amount of variation or spread in a set of values; calculated as the square root of the variance.

·        Interquartile Range (IQR): The range between the 25th and 75th percentiles, capturing the middle 50% of the data and indicating variability within this central segment.

·        Range: The difference between the maximum and minimum observed values, representing the total spread of the data.

Statistical Analysis:

All statistical analyses were conducted at a significance level of p ≤ 0.05. Results were interpreted as follows:

p > 0.05: Not statistically significant

p ≤ 0.05: Statistically significant

Tests for categorical variables:

Chi-Square Test (χ²): A non-parametric test used to examine associations between two or more categorical variables.

Fisher’s Exact Test: Applied in situations where expected cell counts in contingency tables are low (i.e., more than 20% of cells have expected counts less than 5), providing a more accurate assessment of association in small sample sizes.

Tests for continuous variables:

Independent Samples t-Test: A parametric test used to compare the means of two independent groups, assuming normally distributed data and random sampling.

Paired Samples t-Test: A parametric test used to compare the means of two related groups (paired observations), under the assumption of normal distribution and random sampling.

RESULTS

Table (1): Demographic Characteristics of Study Population

Table (2): Operative Findings in 35 Patients with Acute Abdominal Pain

Table (3): X-ray findings of the patient studied

Table (4): USG findings of the patient studied

Table (5): CT findings of patients studied

Table (6): SECTRA findings of patients studied

Table (7): Intraoperative Findings in correlation with USG, CT, and SECTRA

Table (8): Cause

Table (9): Hospital stay of the patient studied

Table (10): Management Outcomes and Clinical Decisions

Table (11): Diagnostic Performance Metrics Comparison

Figure (5): ROC Curve Analysis for Diagnostic Performance

Table (12Ultrasound Performance:

Table (13SECTRA CT Performance:

DISCUSSION

The ability of CT not only to obtain a correct diagnosis but also to enhance diagnostic certainty and exclude alternative diagnoses is essential for emergency physicians in selecting an appropriate treatment plan. Even if the diagnosis is unchanged on CT, it is necessary to enhance the surgeon's confidence in the diagnosis so that proper discussions can take place with patients and relatives and valid informed consent can be obtained.

The current work assessed the sensitivity and specificity of this advanced imaging technique compared with traditional diagnostic methods used in emergency settings.

Additionally, this research seeks to identify and characterize the most common pathological conditions associated with acute surgical abdominal pain.

The study successfully enrolled 60 patients with acute abdominal pain, demonstrating a demographic profile typical of emergency presentations, with a mean age of 33.2 years and a male predominance (60.0%). A majority of patients (66.7%) had no significant comorbidities, with diabetes mellitus being the most prevalent comorbidity (26.7%).

The most common surgical pathology was appendicular pathology (acute appendicitis and complications), totaling 26.7% (n=16) of cases, followed by gallbladder disease and visceral perforation, each at 8% (n=5).

CT information appeared to help diagnose or exclude acute appendicitis and led to more appropriate treatment, as previously reported. Rao and colleagues reported that the results of CT led to a change in the treatment of 59 of 100 patients with clinically suspected appendicitis (Rao et al., 1998).e

Management outcomes indicated that the majority of patients (58.33%) required immediate surgical intervention, underscoring the acute, often surgical nature of the presentations. Only 5.0% of surgical explorations were negative. The age-stratified analysis indicates that older patients (mean age 39.2 years) were more often managed with observation/admission, whereas younger patients (mean age 28.1 years) were more likely to be discharged.

The central finding of this study is the marked difference in diagnostic performance between SECTRA CT and conventional ultrasound. The overall diagnostic accuracy for SECTRA CT was 67%, a clinically transformative improvement compared to ultrasound's accuracy of only 52%.

Analysis of data concordance revealed a striking disparity. In 48.3% (n=29) of cases, SECTRA CT was positive, but ultrasound was negative. This substantial discordance highlights the superior sensitivity of SECTRA technology. Crucially, there were four cases (7%) where ultrasound provided a positive diagnosis that SECTRA CT missed. Complete agreement between both modalities was observed in only 31.6% (n=19) of cases.

SECTRA CT achieved excellent sensitivity at 65%, representing a 16% improvement over ultrasound's poor sensitivity of 49.1%. This indicates that SECTRA CT has a substantially greater ability to identify patients with pathology correctly.

SECTRA CT achieved 100% diagnostic accuracy in three pathological categories, including:

Appendicular Mass/Complications, Intestinal obstruction, perforation.

In contrast, ultrasound showed significant limitations, demonstrating complete diagnostic failure (0% accuracy) in colitis (0/6), acute pancreatitis (0/4), and perforation (0/5). Ultrasound also performed poorly in acute appendicitis (40.0% accuracy) and gall bladder pathology (55.5% accuracy).

CT may also enable pre-operative planning of the surgical approach. Taourel and co-authors  noticed that CT modified the primary therapeutic strategy in 30% of 40 cases with acute abdominal pain and avoided seven laparotomies (Taourel et al., 1992).

Siewert and co-authors reported that management was changed after CT in 27.5% of 91 patients who did not undergo surgery. These results suggest that CT is a valuable tool for selecting an appropriate treatment strategy, in particular for separating patients who require surgery from those who may be treated more conservatively (Siewert et al., 1997).

This study concludes that SECTRA offers essential diagnostic and clinical benefits in assessing acute abdominal pain, despite its high cost and radiation risk; its superior accuracy makes it a tool worth integrating into the emergency protocol for selected cases. It is also recommended that artificial intelligence techniques be incorporated to validate these results and strengthen diagnostic strategies in the care of patients with acute abdominal pain.

1.      Danish, A. 2022. A retrospective case series study for acute abdomen in general surgery ward of Aliabad Teaching Hospital. Annals of Medicine and Surgery, 73, 103199.

2.      Gans, S. L., Pols, M. A., Stoker, J., Boermeester, M. A. & Group, E. S. 2015. Guideline for the diagnostic pathway in patients with acute abdominal pain. Digestive surgery, 32, 23-31.

3.      Horn, D. & Benninger, B. 2025. A novel Visualization Table by Sectra was used to render cadaver CT/MRI scans into 3‐D images which were manipulated to enhance functional healthcare anatomy. The FASEB Journal, 29, LB17.

4.      JG, M., SA, K., LJ, A. & EA, A. 2017. Intestinal obstruction caused by appendicitis: a systematic review. Journal of the West African College of Surgeons, 7, 94.

5.      Kapral, N. M., Pesch, A. J. & Khot, R. 2020. Abdominal Emergencies. Seminars in Roentgenology, 55, 336-63.

6.      Lakhoo, K., Almario, C. V., Khalil, C. & Spiegel, B. M. 2021. Prevalence and characteristics of abdominal pain in the United States. Clinical Gastroenterology and Hepatology, 19, 1864-72. e5.

7.      Rao, P. M., Rhea, J. T., Novelline, R. A., Mostafavi, A. A. & McCabe, C. J. 1998. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. New England Journal of Medicine, 338, 141-6.

8.      Siewert, B., Raptopoulos, V., Mueller, M., Rosen, M. & Steer, M. 1997. Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. AJR. American journal of roentgenology, 168, 173-8.

9.      Taourel, P. a., Baron, M., Pradel, J., Fabre, J., Seneterre, E. & Bruel, J. 1992. Acute abdomen of unknown origin: impact of CT on diagnosis and management. Gastrointestinal radiology, 17, 287-91.

10.   Thomas, W. E., Reed, M. W. & Wyatt, M. G. 2016. Oxford textbook of fundamentals of surgery, Oxford University Press.

11.   Xu, J. J. 2023. Quantitative Methods in Abdominal Dual-Energy CT.