How to perform low-dose computed tomography for renal colic in clinical practice

Gervaise, A.; Gervaise-Henry, C; Pernin, M.; Naulet, P.; Junca-Laplace, C; Lapierre-Combes, M.

doi:10.1016/j.diii.2015.05.013

Cited by 28 publications

(11 citation statements)

References 62 publications

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“…However, even among CT examinations labeled as low dose, the radiation dose did not appear to be reduced. For example, the most commonly used study descriptors for reduced-dose CT (CT abdomen pelvis low-dose kidney calculi without intravenous contrast material, or "CT Abd Pelvis Lo Dose Kidney Calc wo IVCon") represented more than 80% of the labeled reduced-dose CT examinations and had a median DLP of 646 mGy • cm (IQR, 400-1027 mGy • cm) for an effective dose of approximately 10 mSv, which is three times the level of radiation that has been shown to be sufficient to identify kidney stones at CT. ACR, and literature (11,18,(23)(24)(25) that supports use of reduced-dose CT, particularly for kidney stone evaluation.…”

Section: Rpid861mentioning

confidence: 97%

“…Since 2012, national awareness about CT-associated radiation has continued to increase and literature (14)(15)(16) validating the use of reduced-dose CT for kidney stone evaluation has been published. CT technology that reduces radiation dose while maintaining image quality is used more widely (17)(18)(19). Therefore, it is reasonable to expect a downward trend in radiation dose for this indication, as well as subsequent More than 70% of kidney stones in the United States are diagnosed by means of CT, and many of these patients are relatively young, averaging 45 years old at first diagnosis (4)(5)(6)(7).…”

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confidence: 99%

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Evaluation of Kidney Stones with Reduced–Radiation Dose CT: Progress from 2011−2012 to 2015−2016—Not There Yet

et al. 2018

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Purpose To determine if the use of reduced-dose computed tomography (CT) for evaluation of kidney stones increased in 2015-2016 compared with that in 2011-2012, to determine variability in radiation exposure according to facility for this indication, and to establish a current average radiation dose for CT evaluation for kidney stones by querying a national dose registry. Materials and Methods This cross-sectional study was exempt from institutional review board approval. Data were obtained from the American College of Radiology dose registry for CT examinations submitted from July 2015 to June 2016. Study descriptors consistent with single-phase unenhanced CT for evaluation of kidney stones and associated RadLex® Playbook identifiers (RPIDs) were retrospectively identified. Facilities actively submitting data on kidney stone-specific CT examinations were included. Dose metrics including volumetric CT dose index, dose-length product, and size-specific dose estimate, when available, were reported, and a random effects model was run to account for clustering of CT examinations at facilities. A z-ratio was calculated to test for a significant difference between the proportion of reduced-radiation dose CT examinations (defined as those with a dose-length product of 200 mGy · cm or less) performed in 2015-2016 and the proportion performed in 2011-2012. Results Three hundred four study descriptors for kidney stone CT corresponding to data from 328 facilities that submitted 105 334 kidney stone CT examinations were identified. Reduced-dose CT examinations accounted for 8040 of 105 334 (7.6%) CT examinations, a 5.6% increase from the 1010 of 49 903 (2%) examinations in 2011-2012 (P < .001). Mean overall dose-length product was 689 mGy · cm (95% confidence interval: 667, 712), decreased from the mean of 746 mGy · cm observed in 2011-2012. Median facility dose-length product varied up to sevenfold, from less than 200 mGy · cm to greater than 1600 mGy · cm. Conclusion Use of reduced-radiation dose CT for evaluation of kidney stones has increased since 2011-2012, but remains low; variability of radiation dose according to facility continues to be wide. National mean CT radiation exposure for evaluation of renal colic during 2015-2016 decreased relative to 2011-2012 values, but remained well above what is reasonably achievable. RSNA, 2017.

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Section: Rpid861mentioning

confidence: 97%

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confidence: 99%

Evaluation of Kidney Stones with Reduced–Radiation Dose CT: Progress from 2011−2012 to 2015−2016—Not There Yet

et al. 2018

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“…Reducing slice thickness has been shown to improve the ability to pick up small urinary calculi; however, this too is hampered by an associated increase in image noise [10]. This is particularly apparent in LD scans where mA and kVp have been significantly reduced [11]. The step change to allow ULD scanning has largely been engendered by the move to the use of various iterative reconstruction (IR) methods which are much more computationally intensive and have only more recently become available clinically.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review

Rodger¹,

Roditi²,

Aboumarzouk³

2018

Urol Int

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Background: Non-contrast computed tomography of the kidneys, ureters, and bladder (CT KUB) is the investigation of choice for renal colic; however, radiation exposure can be a concern. Aims: The study aimed to investigate the diagnostic accuracy of low dose (LD) and ultra-low dose (ULD) CT of the urinary tract for detection of urinary tract stones in patients with renal colic. Methods: A Cochrane style systematic review of the literature from 1995 to 2017 was carried out. Literature search and data extraction were conducted by 2 reviewers. Specificity and sensitivity values were calculated for LD (<3.5 mean radiation dose [mSv]) and ULD (<1.9 mSv) CT separately. Results: A total of 12 studies were included following screening. A total of 1,529 patients were included in the review (475 in the LD group and 1,054 in the ULD group). Using standard dose CT KUB as the reference standard, the sensitivity of LD CT KUB ranged from 90 to 98% and specificity from 88 to 100%. The sensitivity of ULD CT KUB ranged from 72 to 99% and the specificity ranged from 86 to 100%. The diagnostic accuracy for LD CT was 94.3% and for ULD CT was 95.5%. Conclusions: LD and ULD CT KUB provide effective methods of identifying urinary tract stones. High diagnostic accuracy, sensitivity, and specificity are maintained despite significant radiation dose reduction in comparison to standard dose CT.

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“…Detection of secondary features was similar between modalities and highly accurate overall, while SDCT detected more parenchymal lesions due to improved detection of lesions of <2 cm. It is relatively straightforward for most CT scanners to be used for ULDCT [7] and, based on the present and other studies, ULDCT should therefore be considered as the first-line modality for evaluation of renal colic in routine practice.…”

Section: Resultsmentioning

confidence: 78%

“…Much effort has been expended to reduce radiation exposure, including use of ultrasound in randomised trials [1]. Another approach is use of low-dose CT (<3-3.5 mSv) or ultra-low-dose CT (ULDCT, <1-1.9 mSv), which affords lower dose radiation equivalent to plain film (0.5-1 mSv) with the accuracy and localisation of cross-sectional imaging [6][7][8]. While the European Association of Urology (EAU) guidelines stipulate low-dose CT to be the first choice for detection of ureteric calculi [2], the performance and benefit from routine adoption in clinical practice are unclear.…”

Section: Introductionmentioning

confidence: 99%

A prospective, matched comparison of ultra‐low and standard‐dose computed tomography for assessment of renal colic

et al. 2020

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Objective To determine the diagnostic accuracy of ultra‐low‐dose computed tomography (ULDCT) compared with standard‐dose CT (SDCT) in the evaluation of patients with clinically suspected renal colic, in addition to secondary features (hydroureteronephrosis, perinephric stranding) and additional pathological entities (renal masses). Patients and methods A prospective, comparative cohort study was conducted amongst patients presenting to the emergency department with signs and symptoms suggestive of renal or ureteric colic. Patients underwent both SDCT and ULDCT. Single‐blinded review of the image sets was performed independently by three board‐certified radiologists. Results Among 21 patients, the effective radiation dose was lower for ULDCT [mean (SD) 1.02 (0.16) mSv] than SDCT [mean (SD) 4.97 (2.02) mSv]. Renal and/or ureteric calculi were detected in 57.1% (12/21) of patients. There were no significant differences in calculus detection and size estimation between ULDCT and SDCT. A higher concordance was observed for ureteric calculi (75%) than renal calculi (38%), mostly due to greater detection of calculi of <3 mm by SDCT. Clinically significant calculi (≥3 mm) were detected by ULDCT with high specificity (97.6%) and sensitivity (100%) compared to overall detection (specificity 91.2%, sensitivity 58.8%). ULDCT and SDCT were highly concordant for detection of secondary features, while ULDCT detected less renal cysts of <2 cm. Inter‐observer agreement for the ureteric calculi detection was 93.9% for SDCT and 87.8% for ULDCT. Conclusion ULDCT performed similarly to SDCT for calculus detection and size estimation with reduced radiation exposure. Based on this and other studies, ULDCT should be considered as the first‐line modality for evaluation of renal colic in routine practice.

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How to perform low-dose computed tomography for renal colic in clinical practice

Cited by 28 publications

References 62 publications

Evaluation of Kidney Stones with Reduced–Radiation Dose CT: Progress from 2011−2012 to 2015−2016—Not There Yet

Evaluation of Kidney Stones with Reduced–Radiation Dose CT: Progress from 2011−2012 to 2015−2016—Not There Yet

Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review

A prospective, matched comparison of ultra‐low and standard‐dose computed tomography for assessment of renal colic

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