Cumulative CT Exposures in Emergency Department Patients Evaluated for Suspected Renal Colic

Broder, Joshua; Bowen, Josie; Lohr, Jeffrey M.; Babcock, Andrew; Yoon, Jungyeon

doi:10.1016/j.jemermed.2006.12.035

Cited by 90 publications

(70 citation statements)

References 19 publications

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“…3 Its main limitation is related to radiation, especially as urinary stone disease mainly affects patients who are young, with a tendency to relapse. 4,5 In accordance with the cautionary principle of as low as reasonably achievable and given the potential risk of radiation-induced cancers associated with low X-ray doses, 6,7 reducing the dose in urinary tract CT is paramount.…”

Section: Introductionmentioning

confidence: 99%

Optimizing z-axis coverage of abdominal CT scans of the urinary tract: a proposed alternative proximal landmark for acquisition planning

Gervaise¹,

Teixeira²,

Hossu³

et al. 2016

BJR

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Objective: To evaluate an alternative method to reduce the acquisition coverage of urinary tract CT. Methods: This retrospective study included 365 abdominopelvic CT studies. Three radiographers simulated shortened acquisition coverages using three methods to determine the upper limit of the acquisition: Method 1 used the renal contours; Method 2 used the inferior margin of the 10th thoracic vertebra; and Method 3 used the point of intersection of the left diaphragmatic dome and the anterior margin of the vertebral bodies. Reductions in acquisition coverage and number of CT scans with a portion of the kidney excluded from the simulated reduced acquisition were compared between the three methods.Results: The mean 6 standard deviation reduction of acquisition coverage for the three readers with Methods 1, 2 and 3 were 20.5 6 4.8, 15.1 6 6.5 and 18.2 6 5.3%, respectively. Compared with Method 2, Method 3 allowed a mean scan length reduction of 3.6%. The proportions of CT scans with a portion of the kidney excluded from the simulated reduced acquisition with Methods 1, 2 and 3 and averaged over the three readers were 6.7, 0.7 and 1.4%, respectively, with no significant difference between Methods 2 and 3. Interreader and intrareader agreements were excellent with all methods, but interclass correlation coefficients were higher with Method 3. Conclusion: The method using the renal contours should not be used owing to its high proportion of kidneys with a portion excluded from the acquisition. Using the intersection of the left diaphragmatic dome and the anterior margin of the vertebral bodies for proximal landmark for urinary tract CT represents a new alternative method with a better reduction of scan length compared with the method using the inferior margin of T10 and with no significant increase in the number of kidneys with a portion excluded from the reduced acquisition. Advances in knowledge: A new method using the point of intersection of the left diaphragmatic dome and the anterior border of the vertebral bodies on the lateral scout radiograph is introduced to reduce the z-axis coverage of urinary tract CT scans.

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Section: Introductionmentioning

confidence: 99%

Optimizing z-axis coverage of abdominal CT scans of the urinary tract: a proposed alternative proximal landmark for acquisition planning

Gervaise¹,

Teixeira²,

Hossu³

et al. 2016

BJR

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“…16,17 Lee and colleagues 18 demonstrated that ED physicians significantly underestimated the radiation dose from a single CT procedure. Most of these physicians did not believe that CT increased the lifetime risk of cancer.…”

Section: Introductionmentioning

confidence: 99%

The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients

Edmonds

Yan

Sedran

et al. 2010

CJEM

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Objective: Computed tomography (CT) is an imaging modality used to detect renal stones. However, there is concern about the lifetime cumulative radiation exposure attributed to CT. Ultrasonography (US) has been used to diagnose urolithiasis, thereby avoiding radiation exposure. The objective of this study was to determine the ability of US to identify renal colic patients with a low risk of requiring urologic intervention within 90 days of their initial emergency department (ED) visit. Methods: We completed a retrospective medical record review for all adult patients who underwent ED-ordered renal US for suspected urolithiasis over a 1-year period. Independent, double data extraction was performed for all imaging reports and US results were categorized as "normal," "suggestive of ureterolithiasis," "ureteric stone seen" or "disease unrelated to urolithiasis." Charts were reviewed to determine how many patients underwent subsequent CT and urologic intervention. Results: Of the 817 renal US procedures ordered for suspected urolithiasis during the study period, the results of 352 (43.2%) were classified as normal, and only 2 (0.6%) of these patients required urologic intervention. The results of 177 (21.7%) renal US procedures were suggestive of ureterolithiasis. Of these, 12 (6.8%) patients required urologic intervention. Of the 241 (29.5%) patients who had a ureteric stone seen on US, 15 (6.2%) required urologic intervention. The rate of urologic intervention was significantly lower in those with normal results on US (p < 0.001) than in those with abnormal results on US. Conclusion: A normal result on renal US predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected urolithiasis.Keywords: renal colic, urolithiasis, urologic intervention, ultrasonography, emergency department RÉSUMÉObjectif : Le tomodensitogramme est une technique d'imagerie utilisée pour détecter les calculs rénaux. Cependant, on se préoccupe de l'exposition cumulative aux rayonnements associés aux appareils de tomodensitométrie. On utilise les échographies pour diagnostiquer l'urolithiase, évi-tant ainsi l'exposition aux rayonnements. L'objectif de cette étude était de déterminer la capacité des échographies à repérer les patients atteints de colique néphrétique et pré -sentant un faible risque de devoir subir une intervention urologique dans les 90 jours suivant leur visite à l'urgence. Méthodes : Nous avons réalisé une étude rétrospective des dossiers médicaux pour tous les patients adultes qui avaient subi, sur une période d'un an, une échographie rénale prescrite à l'urgence pour suspicion d'urolithiase. Nous avons procédé à l'extraction de données en double pour tous les rapports d'imagerie, et les résultats des échographies ont été classés ainsi : normaux, évocateurs d'une urolithiase, calcul rénal détecté, ou maladie non associée à une l'urolithiase. Nous avons examiné les dossiers médicaux pour déterminer combien de patients avaient subi ultérieurement une tomodensitométrie et une interventi...

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“…An ongoing clinical trial will shed more light on this very important topic. 9,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] Ultrasound First (And Always? ): Central Venous Access…”

Section: Lynn a Fordham MDmentioning

confidence: 99%

2012 Ultrasound First Forum Proceedings

Minton

Abuhamad

2013

Journal of Ultrasound in Medicine

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Cumulative CT Exposures in Emergency Department Patients Evaluated for Suspected Renal Colic

Cited by 90 publications

References 19 publications

Optimizing z-axis coverage of abdominal CT scans of the urinary tract: a proposed alternative proximal landmark for acquisition planning

Optimizing z-axis coverage of abdominal CT scans of the urinary tract: a proposed alternative proximal landmark for acquisition planning

The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients

2012 Ultrasound First Forum Proceedings

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