Low-Dose Computed Tomography in the Evaluation of Urolithiasis

BhattKavita,; MongaManoj,; Remer, Erick M.

doi:10.1089/end.2014.0711

Cited by 12 publications

(8 citation statements)

References 65 publications

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“…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).…”

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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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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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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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“…We used low-dose NCCT with 60mAs in non-obese patients (BMI <30kg/m 2 ) and NCCT with 160mAs in obese patients for this study to minimize the radiation exposure without compromising image quality (22, 23). NCCT image noise varies proportional to the value of the square root of the miliampere product.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography window affects kidney stones measurements

et al. 2019

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Objectives: Measurements of stone features may vary according to the non-contrast computed tomography (NCCT) technique. Using magnifi ed bone window is the most accurate method to measure urinary stones. Possible differences between stone measurements in different NCCT windows have not been evaluated in stones located in the kidney. The aim of this study is to compare measurements of kidney stone features between NCCT bone and soft tissue windows in patients submitted to retrograde intrarenal surgery (RIRS). Materials and Methods: Preoperative and 90th postoperative day NCCT were performed in 92 consecutive symptomatic adult patients (115 renal units) with kidney stones between 5 mm to 20 mm (< 15 mm in the lower calyx) treated by RIRS. NCCT were evaluated in the magnifi ed bone window and soft tissue window in three axes in a different time by a single radiologist blinded for the measurements of the NCCT other method. Results: Stone largest size (7.92±3.81 vs. 9.13±4.08; mm), volume (435.5±472.7 vs. 683.1±665.0; mm3) and density (989.4±330.2 vs. 893.0±324.6; HU) differed between bone and soft-tissue windows, respectively (p<0.0001) 5.2% of the renal units (6/115) were reclassifi ed from residual fragments > 2 mm on soft tissue window to 0-2 mm on bone window. Conclusion: Kidney stone measurements vary according to NCCT window. Measurements in soft tissue window NCCT of stone diameter and volume are larger and stone density is lesser than in bone window. These differences may have impact on clinical decisions.

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“…3 A low dose non-contrast CT scan of the kidneys is an especially attractive option combining the superior imaging capability of a CT scan combined for stone and hydronephrosis detection with low radiation dose comparable to a KUB (1-2mSV). 5,14,15 For example, the mean standard protocol CT radiation dose in one study of 4,562 patients ranged from 6.5-8.5 mSV. Dose-reduced CT in a meta-analysis reported much lower radiation exposure with maximum effective doses of 0.7-2.8 mSV while maintaining pooled sensitivity and specificity of 0.97 and 0.95, respectively, compared with conventional CT. 16 Despite superior imaging offered by a CT scan, in a recent review by Hyams et al, over 75% of urological studies assessing stone outcomes used KUB as the primary post-operative evaluation.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Stone-free Outcomes of Flexible Ureteroscopy for Renal Calculi Utilizing Computed Tomography Imaging

York

Zheng

Elmansy

et al. 2019

Urology

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Objectives: To assess stone free rates following URS for renal calculi at our institution using low dose renal only CT (LDCT). Methods: A retrospective review of patients undergoing flexible URS for renal stones only with subsequent CT scan within 3 months. Meticulous basketing of all stone fragments was performed whenever possible. A "true" zero fragment SFR was determined by reviewing the CT scan and radiologist's report. Patients with nephrocalcinosis (as determined by visual inspection of papilla at the time of URS) were assigned the "stone free" category. Results: Flexible URS was performed in 288 renal units of 214 patients with renal calculi from 2013 to 2016. Median pre-operative stone size was 6.2mm with the average kidney containing 6.4 stones. An access sheath was used in 92% of cases. A total of 73% (209/288) renal units were completely stone free by CT assessment. Patients with residual fragments were as follows: 1mm in 2% (7/288), 2-4 mm in 16% (46/288), and >4 mm in 9% of kidneys (26/288). Conclusions: The true stone free rate in patients undergoing flexible URS for renal calculi utilizing active basketing of fragments as determined by strict CT assessment was 73%. In patients with residual fragments, the majority are 2-4 mm in size making URS a treatment option for renal calculi with excellent stone free results.

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Low-Dose Computed Tomography in the Evaluation of Urolithiasis

Cited by 12 publications

References 65 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

Computed tomography window affects kidney stones measurements

Stone-free Outcomes of Flexible Ureteroscopy for Renal Calculi Utilizing Computed Tomography Imaging

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