Low Dose Unenhanced Helical Computerized Tomography For The Evaluation Of Acute Flank Pain

Hamm, Michael W.; Knöpfle, E.; Wartenberg, Susanne; Wawroschek, Friedhelm; Weckermann, Dorothea; Harzmann, R.

doi:10.1016/s0022-5347(05)65178-6

Cited by 146 publications

(43 citation statements)

References 17 publications

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“…Previous studies have shown that reduced-dose CT studies are accurate for the detection of renal stones (13)(14)(15)(16)(17)(18)(19). A meta-analysis (20) of reduced-dose CT for renal colic (with effective dose less than 3 mSv) yielded a pooled sensitivity and specificity of 0.97 and 0.95, respectively, compared with conventional CT.…”

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confidence: 98%

Radiation Dose Index of Renal Colic Protocol CT Studies in the United States: A Report from the American College of Radiology National Radiology Data Registry

Lukasiewicz¹,

Bhargavan-Chatfield²,

Coombs³

et al. 2014

Radiology

103

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Purpose-To determine radiation dose indexes for computed tomography (CT) performed with renal colic protocols in the United States, including frequency of reduced-dose technique usage and any institutional-level factors associated with high or low dose indexes.Materials and Methods-The Dose Imaging Registry (DIR) collects deidentified CT data, including examination type and dose indexes, for CT performed at participating institutions; thus, the DIR portion of the study was exempt from institutional review board approval and was HIPAA compliant. CT dose indexes were examined at the institutional level for CT performed with a renal colic protocol at institutions that contributed at least 10 studies to the registry as of January 2013. Additionally, patients undergoing CT for renal colic at a single institution (with institutional review board approval and informed consent from prospective subjects and waiver of consent from retrospective subjects) were studied to examine individual renal colic CT dose index patterns and explore relationships between patient habitus, demographics, and dose indexes. Descriptive statistics were used to analyze dose indexes, and linear regression and Spearman correlations were used to examine relationships between dose indexes and institutional factors.Results-There were 49 903 renal colic protocol CT examinations conducted at 93 institutions between May 2011 and January 2013. Mean age ± standard deviation was 49 years ± 18, and Address correspondence to C.L.M. (chris.moore@yale.edu). Online supplemental material is available for this article. Author contributions:Guarantor of integrity of entire study, C.L.M.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; literature research, A.L., J.W., G.G., C.L.M.; clinical studies, M.G., J.W.; experimental studies, J.W.; statistical analysis, A.L., M.B., L.C., C.L.M.; and manuscript editing, A.L., M.B., L.C., J.W., G.G., C.L.M. The purpose of this study was to determine the radiation dose indexes for CT examinations performed with renal colic protocols in the United States, including how frequently reduceddose techniques are used and any institutional-level factors that are associated with high or low dose indexes. Disclosures of Conflicts of Materials and Methods Study SampleThe Dose Index Registry (DIR), part of the American College of Radiology-sponsored National Radiology Data Registry (www.nrdr.acr.org), receives deidentified data from individual CT examinations performed at participating institutions (21). Participating institutions send anonymized data to the DIR for all CT studies of all types that are performed, barring technical issues or scanner incompatibility. For each submitted study, the DIR includes the type of CT study, the technique factors for each acquisition, estimated CT dose index, and total dose-length product (DLP,...

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confidence: 98%

Radiation Dose Index of Renal Colic Protocol CT Studies in the United States: A Report from the American College of Radiology National Radiology Data Registry

Lukasiewicz¹,

Bhargavan-Chatfield²,

Coombs³

et al. 2014

Radiology

103

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“…Implementation of radiation dose reduction strategies may be a more attainable goal that can be more consistently applied. Data from both the adult 19-23 and pediatric 24 literature demonstrate that CT dose reductions of >50% are attainable without sacrificing diagnostic quality for the vast majority of patients with SU. Ultimately, the decision regarding whether to apply a staged ultrasound +/- CT, a CT dose-reduction protocol, or both lies with the individual hospital.…”

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confidence: 99%

Nationwide Emergency Department Imaging Practices for Pediatric Urolithiasis: Room for Improvement

2014

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Purpose Children are particularly vulnerable to the harmful effects of medical radiation, and children with urolithiasis are one group who may receive repeated radiation-intensive imaging tests. Our study aimed to characterize imaging practices for children presenting to the emergency department (ED) with suspected urolithiasis (SU) and determine factors associated with the choice of imaging study. Methods Using the 2006-10 Nationwide Emergency Department Sample (NEDS), we conducted a retrospective cohort study of patients <18 years old presenting with SU. We determined imaging practices for visits in EDs where billing codes for computed tomography (CT) and ultrasound were reliably reported. Logistic regression was used to delineate patient- and hospital-level factors associated with the use of CT vs. ultrasound. Results There were 18096 pediatric SU visits in the 1191 NEDS EDs with reliable imaging codes. Of the 11215 patients receiving a CT alone, an ultrasound alone, or both, 9773 (87%) were imaged with CT alone. CT use peaked in 2007, and declined thereafter. On multivariate analysis, the following factors were associated with the use of CT alone: lower proportion of pediatric patients treated in the ED, older age, location in the Midwest or South, evaluation at a non-teaching hospital, and visit on a weekend. Conclusions CT use is highly prevalent for children presenting with SU. The lowest CT use is in EDs that care for more children. Ultrasound is used very infrequently regardless of site. Awareness regarding risks of CT and consideration of alternatives including ultrasound are warranted in caring for these patients.

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“…Other authors 5,8,16,17 used NCHCT scanning with a collimation of 5 mm to evaluate acute flank pain. The use of 1 mm collimation is clinically impractical in the routine evaluation of acute flank pain.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Non-Contrast Helical Computed Tomography in the Prediction of Urinary Stone Composition In Vivo

Demirel

Suma

2003

J Int Med Res

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The composition of urinary stones was predicted on the basis of the differences in their Hounsfield unit (HU) densities as detected by in vivo non-contrast helical computed tomography (NCHCT). A total of 87 stones, which had been obtained from patients admitted to the emergency department with acute flank pain, were analysed biochemically. These stones had been visualized by NCHCT before spontaneous passage, ureteroscopic extraction or surgical removal, and their HU densities had been recorded. The HU densities of the stones were compared with the results of biochemical analysis. The mean HU densities of the stones composed of calcium oxalate (n = 54), struvite (n = 19) and uric acid (n = 14) were 812 ± 135, 614 ± 121 and 413 ± 143, respectively. The differences between the mean HU densities of these three stone types were statistically significant. This initial clinical study demonstrated that in vivo NCHCT analysis may be used to predict the composition of urinary stones.

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Low Dose Unenhanced Helical Computerized Tomography For The Evaluation Of Acute Flank Pain

Cited by 146 publications

References 17 publications

Radiation Dose Index of Renal Colic Protocol CT Studies in the United States: A Report from the American College of Radiology National Radiology Data Registry

Radiation Dose Index of Renal Colic Protocol CT Studies in the United States: A Report from the American College of Radiology National Radiology Data Registry

Nationwide Emergency Department Imaging Practices for Pediatric Urolithiasis: Room for Improvement

The Efficacy of Non-Contrast Helical Computed Tomography in the Prediction of Urinary Stone Composition In Vivo

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