TRAVMATİK OLMAYAN AKUT BATIN VAKALARINDA BİLGİSAYARLI TOMOGRAFİ KULLANIMI: KLİNİK GEREKLİLİK, YAPAY ZEKA VE ETİK SINIRLAR

Yıl 2025, Cilt: 58 Sayı: 2, 85 - 88, 29.08.2025

Yunushan Furkan Aydoğdu , Recep Aydın , Salih Tuncal , Mevlüt Recep Pekcici

https://doi.org/10.20492/aeahtd.1704545

Öz

Amaç: Bu çalışmada, travmatik olmayan akut karın olgularında bilgisayarlı tomografinin (BT) gerekliliği ve sınırlılıkları, klinik endikasyonlar, potansiyel komplikasyonlar ve hassas hasta gruplarında aşırı kullanımın etik sonuçlarına odaklanarak değerlendirilmiştir.
Gereç ve Yöntem: Bu teorik derleme, kontrastlı BT'nin travmatik olmayan akut abdominal durumların tanısındaki rolünü değerlendiren güncel literatüre dayanmaktadır. Hasta risk tabakalandırması, kontrasta bağlı nefropati, radyasyona maruz kalma ve yapay zekanın (YZ) radyolojik değerlendirmeye entegrasyonuna özellikle vurgu yapılmaktadır.
Bulgular: BT, akut apandisit, divertikülit, epiploik apandisit, omental enfarktüs ve mezenterik iskemi gibi durumların teşhisinde bir köşe taşı olmaya devam etmektedir. Bununla birlikte, yaşlı ve komorbid hastalarda uygulanması kontrast kaynaklı nefropati riski taşır. Son çalışmalar, hidrasyon protokollerinin ve riske dayalı seçim kriterlerinin uygulanmasının bu tür komplikasyonları azaltabileceğini göstermektedir. Ayrıca, teknik ve etik sınırlamalar devam etse de, yapay zeka destekli görüntüleme, tanısal doğruluğu artırma ve gereksiz taramaları azaltma konusunda umut vaat etmektedir.
Tartışma: Acil servislerde BT'ye artan güven, görüntülemenin genellikle yeterli klinik gerekçe olmaksızın önleyici olarak istendiği bir “BT refleksine” yol açmıştır. BT, özellikle atipik sunumlarda tanısal güveni artırabilirken, gelişigüzel kullanım etik ilkelerle, özellikle de primum non nocere ilkesiyle çelişmektedir. Gelişmekte olan yapay zeka teknolojileri karar vermeyi destekleyebilir, ancak özellikle karmaşık veya yüksek riskli popülasyonlarda klinik yargının yerini tam olarak alamaz.
Sonuç Travmatik olmayan akut batında BT kullanımı hasta merkezli, klinik olarak gerekçelendirilmiş ve etik olarak sorumlu olmalıdır. Uygun olduğunda ultrasonografi gibi alternatiflere öncelik verilmeli ve yüksek riskli hastalarda komplikasyonları en aza indirmek için önleyici tedbirler alınmalıdır. BT, acil abdominal görüntülemede gerekli ancak otomatik olmayan bir araç olmaya devam etmelidir.

Anahtar Kelimeler

Akut karın , Bilgisayarlı tomografi , Kontrast nefropatisi

THE USE OF COMPUTED TOMOGRAPHY IN NON-TRAUMATIC ACUTE ABDOMEN CASES: CLINICAL NECESSITY, ARTIFICIAL INTELLIGENCE AND ETHICAL LIMITS

Öz

Aim: This study aims to evaluate the necessity and limitations of computed tomography (CT) in non-traumatic acute abdomen cases, focusing on clinical indications, potential complications, and the ethical implications of overuse in vulnerable patient groups.
Material And Method: This theoretical review is based on current literature evaluating the role of contrast-enhanced CT in diagnosing non-traumatic acute abdominal conditions. Particular emphasis is placed on patient risk stratification, contrast-induced nephropathy, radiation exposure, and the integration of artificial intelligence (AI) in radiological assessment.
Results: CT remains a cornerstone in diagnosing conditions such as acute appendicitis, diverticulitis, epiploic appendagitis, omental infarction, and mesenteric ischemia. However, its application in elderly and comorbid patients carries risks of contrast-induced nephropathy. Recent studies show that implementing hydration protocols and risk-based selection criteria can mitigate such complications. Moreover, AI-supported imaging has shown promise in improving diagnostic accuracy and reducing unnecessary scans, although technical and ethical limitations persist.
Discussion: The increasing reliance on CT in emergency departments has led to a “CT reflex,” where imaging is often ordered preemptively without adequate clinical justification. While CT can improve diagnostic confidence, especially in atypical presentations, indiscriminate use contradicts ethical principles, particularly the tenet of primum non nocere. Emerging AI technologies may support decision-making, yet cannot fully replace clinical judgment, especially in complex or high-risk populations.
Conclusion: The use of CT in non-traumatic acute abdomen should be patient-centered, clinically justified, and ethically responsible. Alternatives such as ultrasonography should be prioritized when appropriate, and preventive measures must be taken to minimize complications in high-risk patients. CT should remain an essential, but not automatic, tool in emergency abdominal imaging.

Anahtar Kelimeler

Acute abdomen , Computed tomography , Contrast nephropathy

Etik Beyan

This study is a theoretical review based solely on previously published literature. It does not involve any human participants, animal subjects, or the use of patient data. Therefore, ethical approval from an institutional review board was not required.

Destekleyen Kurum

No funding.

Kaynakça

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