Cost analysis of different protocols for imaging a patient with acute flank pain

Abstract

The aim of this study was to analyse the costs of different diagnostic approaches to patients with acute flank pain. Four different diagnostic approaches were considered: (a) spiral CT without contrast medium (CM); (b) plain film, ultrasonography (US) and intravenous urography (IVU)--the latter procedure is used in our department in cases still unsolved following the former investigations (28% in our experience); (c) plain film, US and spiral CT without CM (as an alternative to IVU in 28% of cases); and (d) IVU. The cost of each procedure in a university hospital was calculated, following analysis of the differential costs of each investigation (equipment, depreciation and maintenance costs, related materials and services, radiologists, radiographers, nurses) and their common costs (auxiliary personnel and indirect internal costs). Finally, we calculated the full cost of each procedure and applied it to the different diagnostic approaches. The full cost of each approach was: (a) spiral CT without CM = 74 Euro; (b) plain film, US and IVU (28%) = 66.89 Euro; (c) plain film, US and spiral CT without CM (28%) = 64.93 Euro; (d) IVU = 80.90 Euro. Intravenous urography alone or in unsolved cases is not to be considered because it provides higher costs and worse diagnostic results, whereas X-ray dose to patient is almost equal between IVU and spiral CT. Spiral CT integrated to plain film and US in unsolved cases could be preferred because of lower cost and dose to patient, though reaching a diagnostic conclusion may take longer than an immediate spiral CT.

Value of color doppler ultrasound, kub and urinalysis in diagnosis of renal colic due to ureteral stones

“…Important factors include the local prevalence of stone disease, medical resources available, relative costs in a particular system, and the merits and limitations of each diagnostic modality (6). Although CT is the gold standard for diagnosis of renal colic, it is not available outside hospital facilities and is costly (7). There are recent concerns regarding the radiation exposure during CT examinations and its indiscriminate use.…”

Comparison between ultrasound and noncontrast helical computed tomography for identification of acute ureterolithiasis in a teaching hospital setting

“…20,21 Thus, unenhanced helical CT is currently the imaging test of choice for evaluating patients with acute fl ank pain for whom the clinical diagnosis is uncertain. [22][23][24][25][26][27][28][29] In the CT evaluation of ureteral calculi, the agreement between the group of senior residents and the consensus among the abdominal radiologists were very good, as shown in Table 3. The interobserver agreement for identifying the ureteral stone was almost perfect (k = 0.81).…”

Doppler sonography in the diagnosis of urinary tract obstruction by stone

“…Its use is limited if there is no pyelocaliectasis, and it cannot differentiate between obstructive and nonobstructive dilatation of the renal collecting system. 5,7,[10][11][12][13][14] Studies have shown that 2 hours after onset of a renal obstruction, renal vascular resistance (RVR) increases and renal blood flow (RBF) decreases. [15][16][17][18] Doppler sonography can provide information about these hemodynamic changes.…”

“…1 Sonography is reportedly an accurate (with 90% sensitivity and 65-84% specificity) and noninvasive method for evaluating the renal collecting system and commonly is used as the first-line imaging modality in cases of suspected renal obstruction. [2][3][4][5][6][7][8][9][10] Although gray-scale sonography may provide important anatomic information, it lacks the ability to provide functional data. Its use is limited if there is no pyelocaliectasis, and it cannot differentiate between obstructive and nonobstructive dilatation of the renal collecting system.…”