Very low-dose computerized tomography for confirmation of urinary stone presence

Raskin, Daniel; Winkler, Harry; Kleinmann, Nir; Schor-Bardach, Rachel; Guranda, Larisa; Muzikansky, Gregory; Portnoy, Orith

doi:10.1007/s00345-020-03142-x

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…While the ACR and AUA use cut-points of 3 and 4 mSv, respectively, to designate LD CT KUB, some authors have independently created new categories such as ''ultra-low dose'' (£1.9 mSv) 18,19 and ''very low-dose'' (<1.5 mSv). 20 Such terms may further confuse urologists in the absence of broad consensus on their definitions. This consensus is likely a prerequisite before urologists can effectively advocate for appropriate imaging with primary care and emergency medicine colleagues, who are the actual source of care for most patients with nephrolithiasis.…”

Section: Discussionmentioning

confidence: 99%

Multi-Institutional Variation in Performance of Low-Dose Computed Tomography for the Evaluation of Suspected Nephrolithiasis

Raskolnikov

Tzou

Ahn

et al. 2022

Journal of Endourology

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Introduction and Objective: Guidelines from the American Urological Association (AUA) and American College of Radiology (ACR) recommend that patients with suspected nephrolithiasis undergo low-dose CT of the kidney, ureter, and bladder (LD CT KUB) as opposed to higher dose conventional imaging. We hypothesized that even at institutions with established LD protocols, higher dose imaging is common. Materials and Methods: We identified four academic medical centers where LD CT KUB protocols were implemented to yield an effective dose (EDose) consistent with national guidelines. Fifty consecutive adult patients who underwent CT KUB specifically for the evaluation of nephrolithiasis were retrospectively reviewed at each site. Patient age, sex, body mass index (BMI), imaging location, and EDose (millisieverts [mSv]) were recorded. Results: Two hundred patients with a mean age of 54 years were identified. Forty-six patients (23%) underwent CT KUB with an EDose £4 mSv, accounting for 10% to 48% of each institution's cohort. One hundred sixteen patients had a BMI <30, and would have been expected to receive LD CTs by the AUA criteria for LD CT KUB. Within this subset, only 37 patients (32%) actually underwent LD CT KUB. The highest dose CT KUB at each institution resulted in an EDose of 33.8 to 44.6 mSv, exceeding the recommended exposure of LD CT KUB by 10-fold. Conclusions: At academic institutions where LD CT KUB was implemented for the evaluation of nephrolithiasis, a minority of patients with BMI <30 received guideline-concordant imaging. Differences in patient BMI did not account for the variation in radiation exposure. Further research is necessary to elucidate barriers to LD CT implementation.

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Section: Discussionmentioning

confidence: 99%

Multi-Institutional Variation in Performance of Low-Dose Computed Tomography for the Evaluation of Suspected Nephrolithiasis

Raskolnikov

Tzou

Ahn

et al. 2022

Journal of Endourology

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“…A meta-analysis of 12 studies with a pooled 1529 patients compared standard dose CT as a reference and reported the following: low-dose CT (<3.5 mSV) sensitivity 90- 98% and specificity 88–100%; ultra-low-dose CT (<1.9 mSV) sensitivity 72–99% and specificity of 86–100%; similar diagnostic accuracy between low dose (94.3%) and ultra-low-dose (95.5%) CT [14]. Compared to standard CT, low dose and ultra-low-dose CT are associated with a reduction in the dose of radiation up to 78–89% [15–17].…”

Section: Reducing Radiation Exposure: ’As Low As Reasonably Achievable’mentioning

confidence: 99%

Imaging in stone diagnosis and surgical planning

Serrell

Best

2022

Current Opinion in Urology

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Purpose of reviewRadiological imaging techniques and applications are constantly advancing. This review will examine modern imaging techniques in the diagnosis of urolithiasis and applications for surgical planning. Recent findingsThe diagnosis of urolithiasis may be done via plain film X-ray, ultrasound (US), or contrast tomography (CT) scan. US should be applied in the workup of flank pain in emergency rooms and may reduce unnecessary radiation exposure. Low dose and ultra-low-dose CT remain the diagnostic standard for most populations but remain underutilized. Single and dual-energy CT provide three-dimensional imaging that can predict stone-specific parameters that help clinicians predict stone passage likelihood, identify ideal management techniques, and possibly reduce complications. Machine learning has been increasingly applied to 3-D imaging to support clinicians in these prognostications and treatment selection.

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“…As it has already been mentioned, the total entrance dose was 8.38 mGy, resulting in 0.22 mSv and 3.84 mSv effective equivalent doses for urolithiasis/nephrolithiasis and atherosclerotic plaques, respectively. Previous studies for discrimination between different mineral crystal types found in kidney/uteric stones using CT resulted in an entrance dose of 10 mGy and an effective dose of 8 up to 10 mSv [105][106][107][108][109]. When DECT was used in phantom studies, the entrance dose ranged from 6 to 26.2 mGy and 8.2 to 14.6 mGy when patients were involved [10,[110][111][112][113].…”

Section: Experimental Verificationmentioning

confidence: 99%

“…When DECT was used in phantom studies, the entrance dose ranged from 6 to 26.2 mGy and 8.2 to 14.6 mGy when patients were involved [10,[110][111][112][113]. Low dose (LDCT) and ultra-low dose CT (ULDCT) were also used, resulting in an absorbed dose of 3 mSv or less [105,[107][108][109]114]. In all cases, there were difficulties in discrimination between mineral crystals when the stones were 3.00 mm or smaller, and especially when LDCT and ULDCT were used [105,[107][108][109]114].…”

Section: Experimental Verificationmentioning

confidence: 99%

“…Low dose (LDCT) and ultra-low dose CT (ULDCT) were also used, resulting in an absorbed dose of 3 mSv or less [105,[107][108][109]114]. In all cases, there were difficulties in discrimination between mineral crystals when the stones were 3.00 mm or smaller, and especially when LDCT and ULDCT were used [105,[107][108][109]114]. As for atherosclerotic plaques, the effective dose of CT ranges from 5.4 to 8 mSv, while the typical entrance dose for DECT is 19 mGy and 23 mGy for the low-and high-energy, respectively [71,[115][116][117][118].…”

Section: Experimental Verificationmentioning

confidence: 99%

See 1 more Smart Citation

Mineral Characterization in Human Body: A Dual Energy Approach

et al. 2021

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Kidney and uteric stones are a common cause of pain and disturbance in numerous people worldwide, as they tend to reappear. There are several studies investigating the association of urolithiasis and nephrolithiasis with atherosclerosis, as patients suffering from the former diseases were found to have been diagnosed with atherosclerotic plaques. Hydroxyapatite and calcium oxalate are the most common mineral crystals found in both kidney/uteric stones and atherosclerotic plaques’ calcifications. Even though for stones smaller than 5 mm surgery is not recommended, the knowledge of the stone composition is an important tool for the physician in order to provide better treatment for the patient. The mineral crystal characterization of atherosclerotic plaques’ calcifications smaller than 3 mm (spotty calcifications) will assist the physician to limit the possibility of myocardial infraction and stroke, as the presence of hydroxyapatite indicates possible plaque rapture. To this aim, a dual energy (DE) X-ray method was developed in this work. The calcium/phosphorus mass ratio (mCamP) was determined through analytical simulations and the results were verified experimentally. Both monoenergetic and polyenergetic simulation studies were implemented for hydroxyapatite, calcium carbonate and calcium oxalate with thicknesses ranging from 0.50 to 3.00 mm, at 100 μm increments, to obtain the optimized irradiation conditions. The experimental verification of the proposed method was performed using an X-ray tube combined with a high resolution complementary metal-oxide-semiconductor (CMOS) active pixel sensor (APS) detector. The Mann–Whitney U test indicated that statistically significant differences were found between the different types of minerals examined for thicknesses of 0.70 mm or higher.

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Very low-dose computerized tomography for confirmation of urinary stone presence

Cited by 6 publications

References 24 publications

Multi-Institutional Variation in Performance of Low-Dose Computed Tomography for the Evaluation of Suspected Nephrolithiasis

Multi-Institutional Variation in Performance of Low-Dose Computed Tomography for the Evaluation of Suspected Nephrolithiasis

Imaging in stone diagnosis and surgical planning

Mineral Characterization in Human Body: A Dual Energy Approach

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