Effect of Low Dose Radiation Computerized Tomography Protocols on Distal Ureteral Calculus Detection

Jellison, Forrest; Smith, Jason C.; Heldt, Jonathan P.; Spengler, Nathan M.; Nicolay, Lesli I.; Ruckle, Herbert C.; Koning, Jeffrey L.; Millard, William W.; Jin, Daniel; Baldwin, D. Duane

doi:10.1016/j.juro.2009.08.042

Cited by 72 publications

(34 citation statements)

References 20 publications

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“…There have been studies on reduced-dose CT in cadavers in the United States and in small samples of selected populations outside the country. [12][13][14] These studies have also often excluded or found poor performance of nonsize-adjusted protocols in more obese patients, who are at increased risk for kidney stone and incur a higher radiation dose. 1,[15][16][17][18] Previous studies have also not followed patients receiving reduced-dose CT to determine its ability to predict outcomes and need for intervention.…”

Section: Background and Importancementioning

confidence: 99%

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Moore

Daniels

Ghita

et al. 2015

Annals of Emergency Medicine

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Study objective-Reduced-dose computed tomography (CT) scans have been recommended for diagnosis of kidney stone but are rarely used in the emergency department (ED) setting. Test characteristics are incompletely characterized, particularly in obese patients. Our primary outcome is to determine the sensitivity and specificity of a reduced-dose CT protocol for symptomatic ureteral stones, particularly those large enough to require intervention, using a protocol stratified by patient size.Methods-This was a prospective, blinded observational study of 201 patients at an academic medical center. Consenting subjects underwent both regular-and reduced-dose CT, stratified into a high and low body mass index (BMI) protocol based on effective abdominal diameter. Reduceddose CT scans were interpreted by radiologists blinded to regular-dose interpretations. Follow-up for outcome and intervention was performed at 90 days.Results-CT scans with both regular and reduced doses were conducted for 201 patients, with 63% receiving the high BMI reduced-dose protocol. Ureteral stone was identified in 102 patients (50.7%) of those receiving regular-dose CT, with a ureteral stone greater than 5 mm identified in 26 subjects (12.9%). Sensitivity of the reduced-dose CT for any ureteral stone was 90.2% (95% confidence interval [CI] 82.3% to 95.0%), with a specificity of 99.0% (95% CI 93.7% to 100.0%). For stones greater than 5 mm, sensitivity was 100% (95% CI 85.0% to 100.0%). Reduced-dose CT identified 96% of patients who required intervention for ureteral stone within 90 days. Mean * Corresponding Author. Chris.Moore@yale.edu, Twitter: Chris.Moore@Yale_EUS. Author contributions: CLM, MG, and GPG conceived the study and designed the trial. CLM, DS, and CPG obtained research funding.CLM and SL supervised the conduct of the trial and data collection. SL participated in recruitment of patients. GG performed overreadings of the CT scans in the trial. CLM, SL, and AM managed the data, including quality control. AM and CPG provided statistical advice. BD, GG, AM, DS, and CPG provided advisement on study design and methodology. CLM, SL, AM, and CPG analyzed the data. CLM drafted the article, and all authors contributed substantially to its revision. CLM takes responsibility for the paper as a whole.Presented as an abstract at the Society for Academic Emergency Medicine annual meeting, May 2013, Atlanta, GA.The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript reduction in size-specific dose estimate was 18.6 milligray (mGy), from 21.7 mGy (SD 9.7) to 3.4 mGy (SD 0.9). Conclusion-CT

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Section: Background and Importancementioning

confidence: 99%

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Moore

Daniels

Ghita

et al. 2015

Annals of Emergency Medicine

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“…17 Although treatment modalities are different and include CT scan, they have though minimal, deleterious effects on the patients. 18,19 Most of the patients with UVJ and pre UVJ stones manifest LUTS. Patients manifesting LUTS do not require ureteric orifice dilatation and in them Ureteroscopy is relatively easy and time saving.…”

Section: Discussionmentioning

confidence: 99%

Role of dilatation of intramural ureter in patients with lower urinary tract symptoms (LUTS) in UVJ and pre UVJ calculus: an observational study

2017

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Background: Various literature sources describe three narrowest anatomic spots in the ureter as the most potential points for ureteric calculi to form and these are: the pelvi-ureteric junction (PUJ), the point where the ureters cross over the iliac vessels and the ureterovesical junction (UVJ).Methods: This study included patients who presented with symptomatic obstructing ureteric calculi and who required uretero renoscopic lithotripsy (URSL). The procedure was selected according to stone size, location and degree of impaction.Results: Of the total of 100 patients, 43 were females and 57 were males. 69 patients had Lower Urinary Tract Symptoms and 31 patients had no Lower Urinary Tract Symptoms with the calculi. The age of the patients ranged from 17 years to 65 years and the stone size ranged from 7mm to 15mm. Lower ureteric calculi with LUTS are good indicators.Conclusions: We can approach lower ureteric calculi without use of dilators or 6/7.5ureteroscope in patients with LUTS.

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“…12,19,20 Ultrasonography is rarely used except in pregnancy and for children. 21 This study found that adverse events were rare when participating EPs felt a CT scan was not clinically indicated among adults ages 18 to 50 years with a first episode of suspected renal colic.…”

Section: Discussionmentioning

confidence: 99%

“…9 This is ill-advised as the accuracy of renal colic CT protocols in other diagnostic possibilities is unknown. 19,21,23 We attempted to measure this in our study by asking participating EPs at the start of our study if they were ordering the CT scan for other indications, and none said they did.…”

Section: Discussionmentioning

confidence: 99%

Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician

Epstein

Rosenberg

Samuel

et al. 2013

CJEM

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Objective: Many emergency physicians (EPs) order ''confirmatory'' abdominal computed tomography (CT) in young flank pain patients, despite a high clinical suspicion of renal colic and the risk of radiation exposure. We measured the adverse outcome rate among flank pain patients identified as not requiring abdominal CT by the EP on a data form, regardless of whether CT was eventually ordered. Our secondary objective was to describe diagnoses other than renal colic identified by CT in this population. Methods: We conducted a prospective observational study at two community EDs. We asked staff EPs to complete a data sheet on patients ages 18 to 50 years with a first episode of flank pain, recording 1) if the flank pain was consistent with renal colic and 2) if the EP felt abdominal CT was indicated. Adverse outcomes (defined a priori as urgent surgical procedures, disability, or death) were assessed by research assistants at 4 weeks using telephone follow-up and a hospital records search. Results: We enrolled 389 patients; 353 completed follow-up (91%). The average age was 38.8 years, and 72.0% were male. Of 212 patients identified in the ''CT not indicated'' group, 2 had another diagnosis identified (unruptured diverticulitis and a ruptured ovarian cyst), but none had adverse outcomes (95% CI 0-1.4). Conclusions: Adverse events were rare (, 1.5%) among patients , 50 years old with flank pain when CT was not required according to the clinical assessment of the EP. Future research should assess the adverse outcomes of withholding CT in low-risk patients using a larger patient sample. RÉ SUMÉObjectifs: De nombreux mé decins d'urgence (MU) demandent une tomodensitomé trie (TDM) abdominale de « confirmation » chez les jeunes patients qui ressentent une douleur du flanc, malgré une forte pré somption de colique né phré tique et le risque d'exposition au rayonnement. Nous avons mesuré le taux de ré sultats dé favorables parmi les patients qui ressentaient une douleur du flanc et chez qui une TDM abdominale n'é tait pas né cessaire selon le MU sur le formulaire de donné es, peu importe qu'une TDM ait é té demandé e plus tard ou non. L'objectif secondaire é tait de dé crire les autres diagnostics que celui de la colique né phré tique, ré vé lé s par la TDM chez les patients concerné s. Mé thode: Nous avons mené une é tude d'observation prospective, dans deux services d'urgence (SU) communautaires. Nous avons demandé aux MU de remplir une fiche de donné es sur les patients â gé s de 18 à 50 ans, chez qui il s'agissait de la premiè re crise de douleur du flanc, en notant 1) si la douleur du flanc é tait compatible avec la colique né phré tique et 2) si, à leur avis, la TDM abdominale é tait indiqué e. Les é vé nements indé sirables (dé finis a priori comme une intervention chirurgicale d'urgence, l'incapacité ou la mort) ont é té é valué s, au bout de 4 semaines, par des adjoints à la recherche, au moyen d'un entretien té lé phonique de suivi et d'un examen des dossiers mé dicaux hospitaliers. Ré sultats: Au total, 3...

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Effect of Low Dose Radiation Computerized Tomography Protocols on Distal Ureteral Calculus Detection

Abstract: Ultra low dose computerized tomography protocols detected distal ureteral calculi in a fashion similar to that of conventional computerized tomography protocols in a cadaveric model. These protocols may decrease the radiation dose up to 95%, reducing the risk of secondary malignancies.

Cited by 72 publications

References 20 publications

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Role of dilatation of intramural ureter in patients with lower urinary tract symptoms (LUTS) in UVJ and pre UVJ calculus: an observational study

Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician

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