Improving the accuracy of abdominal sonography for the diagnosis or exclusion of acute appendicitis in order to reduce the need for subsequent computed tomography (CT) due to a non-diagnostic ultrasound, thereby reducing radiation exposure. Focused abdominal sonograms of the appendix performed at a tertiary care community hospital, including patients of all age groups, between 2008 and 2013 were retrospectively analyzed. Percentage visualization of the appendix was determined. To improve visualization rates, certain methods were implemented across all of the in-patient and out-patient locations. These included, supplemental training of ultrasound technicians by a specialized pediatric sonographer that comprised of a 30 minute didactic on the study technique, methods of identifying the appendix, problem solving techniques and recognition of positive and negative examinations; a 90 minute hands on demonstration and practice utilizing volunteers from the group; standardization of the exam mandating a minimum length of time spent searching for the appendix and obtaining standardized views to facilitate finding the appendix; and utilizing problem solving techniques. Furthermore, a worksheet was designed to be completed along with every exam to help prompt adherence to the standardized protocol. Following implementation of the new methods, an increase in the visualization of the appendix from 10.2% (29 out of 285 patients) to 21% (23 out of 106 patients) was observed (p <0.05). Acute appendicitis remains an important diagnosis in the emergency setting in patients presenting with abdominal pain. Increasing the rate of success of focused abdominal ultrasound of the appendix to diagnose or exclude acute appendicitis can result in significant reduction of exposure to ionizing radiation from CT and improve patient safety.