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MacNevin W, Chua M, Kraus MS, Keefe DT. Radiation exposure associated with computed tomography for pediatric urolithiasis evaluation: A scoping review of the literature. J Pediatr Urol 2024; 20:386-394. [PMID: 38521719 DOI: 10.1016/j.jpurol.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Computed tomography (CT) imaging is used for assessment of pediatric urolithiasis in cases where ultrasound is inconclusive. The utility of CT imaging must be considered alongside the potential risks of radiation exposure in this patient population due to the increased risk of cancer development. The purpose of this review is to investigate the radiation exposure associated with standard-dose and low-dose computed tomography (CT) imaging for the assessment of pediatric urolithiasis. METHODS A scoping literature review over a 23 year period between 2000 and 2023 was conducted of all English-language studies reporting on the use of non-contrast CT imaging for assessment of pediatric urolithiasis. Patients that were specified as pediatric with age ≤20 years at time of intervention and undergoing standard-dose or low/ultra-low-dose CT were included. Low-dose and ultra-low-dose CT were defined as a radiation dose ≤3.0 mSv and ≤1.9 mSv, respectively. RESULTS A total of 8121 articles were identified and after screening, 6 articles representing 309 patients were included in this scoping review. Of the articles reviewed, standard non-contrast CT radiation doses for pediatric urolithiasis evaluation ranged from 2.9 to 5.5 mSv and low-dose CT radiation dose was reported to be 1.0-2.72 mSv. Only 2 studies directly evaluated low-dose CT imaging compared to standard-dose CT imaging for pediatric urolithiasis assessment. Radiation reduction approaches did not negatively impact urolithiasis detection or characterization in 2 studies reviewed. CONCLUSIONS CT radiation doses for suspected or known pediatric urolithiasis are underreported and vary greatly with underutilization of low-dose/ultra-dose protocols for pediatric urolithiasis especially in comparison to the adult population. Results from this scoping review support that low-dose CTprotocols for pediatric stone disease are feasible to reduce radiation exposure.
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Affiliation(s)
- Wyatt MacNevin
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, M5G 1E8, Canada
| | - Mareen Sarah Kraus
- Department of Diagnostic Radiology, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Daniel T Keefe
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada; Division of Pediatric Urology, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada.
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Breiding PS, Gomollon AMT, Martini K, Nakhostin D, Alkadhi H, Euler A. Photon-Counting Detector CT for Kidney Stone Detection in Excretory Phase CT-Comparison Between Virtual Non-contrast and Virtual Non-iodine Reconstructions in a 3D Printed Kidney Phantom. Acad Radiol 2024:S1076-6332(24)00209-5. [PMID: 38641450 DOI: 10.1016/j.acra.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/24/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
RATIONALE AND OBJECTIVES To evaluate and compare the effectiveness of contrast media subtraction and kidney stone detection between a virtual non-iodine reconstruction algorithm (VNI; PureCalcium) and a virtual non-contrast (VNC) algorithm in excretory phase photon-counting detector computed tomography (PCD-CT), using a 3D printed kidney phantom under various tube voltages and radiation doses. MATERIALS AND METHODS A 3D-printed kidney phantom, holding Calcium Oxalate (CaOx) and uric acid stones within contrast-enhanced calyces, was created. The calyx density mirrored the average density observed in 200 excretory phase patients (916 HU at 110 kV). Imaging was conducted on a clinical dual-source PCD-CT at 120 kV and 140 kV, with radiation doses set at 5, 10, and 15 mGy. VNI and VNC algorithms were applied. Two blinded readers evaluated the image quality, along with the degree of contrast media and kidney stone subtraction, using visual scales. Krippendorff's alpha was calculated to determine inter-reader agreement, and the Chi-squared test was employed for comparing ordinal data. RESULTS Reader 2 rated overall image quality higher for VNI than VNC (4.90 vs. 4.00; P < .05), while Reader 1 found no significant difference (4.96 vs. 5.00; P > .05). Substantial agreement was observed between readers for contrast media subtraction in both VNC and VNI (Krippendorff's alpha range: 0.628-0.748). Incomplete contrast media subtraction occurred more frequently with VNI for both readers (Reader 1: 29% vs. 15%; P < .05; Reader 2: 24% vs. 20%; P > .05). Uric acid and smaller stones (<5 mm) were more likely to be subtracted than CaOx and larger stones in both VNC and VNI. Overall, a higher rate of stone subtraction was noted with VNI compared to VNC (Reader 1: 22% vs. 16%; Reader 2: 25% vs. 10%; P < .05). Neither radiation dose nor tube voltage significantly influenced stone subtraction (P > .05). CONCLUSION VNC demonstrated greater accuracy than VNI for contrast media subtraction and kidney stone visibility. Radiation dose and tube voltage had no significant impact. Nonetheless, both algorithms still exhibited frequent incomplete contrast media subtraction and partial kidney stone subtraction.
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Affiliation(s)
- Philipe S Breiding
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Ana Maria Turrion Gomollon
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Martini
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dominik Nakhostin
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - André Euler
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiology, Kantonsspital Baden, Baden, Switzerland.
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Cerrato C, Jahrreiss V, Nedbal C, Ripa F, De Marco V, Monga M, Pietropaolo A, Somani B. Shockwave Lithotripsy for De-Novo Urolithiasis after Kidney Transplantation: A Systematic Review of the Literature. J Clin Med 2023; 12:4389. [PMID: 37445423 DOI: 10.3390/jcm12134389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Allograft urolithiasis is an uncommon, challenging, and potentially dangerous clinical problem. Treatment of allograft stones includes external shockwave lithotripsy (SWL), flexible ureteroscopy and lasertripsy (fURSL), or percutaneous nephrolithotomy (PCNL). A gap in the literature and guidelines exists regarding the treatment of patients in this setting. The aim of this systematic review was to collect preoperative and treatment characteristics and evaluate the outcomes of post-transplant SWL for stone disease. METHODS A systematic search in the literature was performed, including articles up to March 2023. Only original English articles were selected. RESULTS Eight articles (81 patients) were included in the review. Patients were mainly male, with a mean age of 41.9 years (±7.07). The mean stone size was 13.18 mm (±2.28 mm). Stones were predominantly located in the kidney (n = 18, 62%). The overall stone-free rate and complication rates were 81% (range: 50-100%) and 17.2% (14/81), respectively, with only one major complication reported. A pre-operative drainage was placed in eleven (13.5%) patients. Five patients (6.71%) required a second treatment for residual fragments. CONCLUSIONS SWL is a safe and effective option to treat de novo stones after transplantation. Larger studies are needed to better address allograft urolithiasis management.
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Affiliation(s)
- Clara Cerrato
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - Victoria Jahrreiss
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Carlotta Nedbal
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- Urology Unit, School of Urology, Faculty of Medicine, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, 20122 Milan, Italy
| | - Vincenzo De Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy
| | - Manoj Monga
- Department of Urology, University of California San Diego, San Diego, CA 92037, USA
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- European Association of Urology-Young Academic Urologists (EAU-YAU), Urolithiasis and Endourology Working Group, NL-6803 AA Arnhem, The Netherlands
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
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Muacevic A, Adler JR, Aljedani R, Alsaleh MH, Atyia N, Alsedrah A, Albardi M. The Role of Radiological Imaging in the Diagnosis and Treatment of Urolithiasis: A Narrative Review. Cureus 2022; 14:e33041. [PMID: 36589703 PMCID: PMC9795962 DOI: 10.7759/cureus.33041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
The incidence and prevalence of urolithiasis have been increasing worldwide for the last several decades. This increase could be attributed to many factors, including missed cases of small stones, a sedentary lifestyle, a high BMI, a lack of physical activity, and poor dietary intake. In addition, the increased incidence of co-morbidities such as diabetes, dyslipidemia, infections, and multiple urinary tract surgeries could contribute significantly to the formation of urolithiasis. Radiology has a major role in diagnosing a variety of these stone types and can be used in planning management approaches, either as guidance or as a direct therapeutic method for stones. Because of the availability, safety, cost, and effectiveness of radiological imaging nowadays, urolithiasis is rarely missed; furthermore, the availability of radiological treatment options decreases the need for surgical intervention for urolithiasis, which minimizes hospital stay and surgical-related complications. This review aims to scope and analyze the role of radiological imaging modalities in reaching a diagnosis and planning treatment options for urolithiasis in different circumstances. Information was gathered from relevant peer-reviewed publications in PubMed and thereafter refined and summarized to provide a comprehensive review. The selected indexing terms included "radiological imaging modality," "treatment of urolithiasis," and "diagnosis of urolithiasis," among others.
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Juliebø-Jones P, Rooney H, Iacovou J. Beware the ureteric stone hidden in a duplex system. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211022193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Level of evidence: 5
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Affiliation(s)
| | - Helen Rooney
- Department of Urology, Great Western Hospital Swindon, UK
- Department of Urology, University Hospital Monklands, UK
| | - John Iacovou
- Department of Urology, Great Western Hospital Swindon, UK
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Doty E, DiGiacomo S, Gunn B, Westafer L, Schoenfeld E. What are the clinical effects of the different emergency department imaging options for suspected renal colic? A scoping review. J Am Coll Emerg Physicians Open 2021; 2:e12446. [PMID: 34179874 PMCID: PMC8208654 DOI: 10.1002/emp2.12446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Clinicians have minimal guidance regarding the clinical consequences of each radiologic imaging option for suspected renal colic in the emergency department (ED), particularly in relation to patient-centered outcomes. In this scoping review, we sought to identify studies addressing the impact of imaging options on patient-centered aspects of ED renal colic care to help clinicians engage in informed shared decision making. Specifically, we sought to answer questions regarding the effect of obtaining computed tomography (CT; compared with an ultrasound or delayed imaging) on safety outcomes, accuracy, prognosis, and cost (financial and length of stay [LOS]). METHODS We conducted a comprehensive search using Pubmed, EMBASE, Web of Science conference proceedings index, and Google Scholar, identifying studies pertaining to renal colic, urolithiasis, and ureterolithiasis. In a prior qualitative study, stakeholders identified 14 key questions regarding renal colic care in the domains of safety, accuracy, prognosis, and cost. We systematically screened studies and reviewed the full text of articles based on their ability to address the 14 key questions. RESULTS Our search yielded 2570 titles, and 68 met the inclusion criteria. Substantial evidence informed questions regarding test accuracy and radiation exposure, but less evidence was available regarding the effect of imaging modality on patient-oriented outcomes such as cost and prognosis (admissions, ED revisits, and procedures). Reviewed studies demonstrated that both standard renal protocol CT and low-dose CT are highly accurate, with ultrasound having lower accuracy. Several studies found that ureterolithiasis diagnosed by ultrasound was associated with overall reduced radiation exposure. Existing studies did not suggest choice of imaging influences prognosis. Several studies found no substantial differences in monetary cost, but LOS was found to be shorter if a diagnosis was made with point-of-care ultrasound. CONCLUSION There is a plethora of data related to imaging accuracy. However, there is minimal data regarding the effect of CT on many patient-centered outcomes. Further research could improve the patient-centeredness of ED care.
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Affiliation(s)
- Erik Doty
- Department of Emergency MedicineUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
| | - Stephen DiGiacomo
- Department of Emergency MedicineUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
| | - Bridget Gunn
- Information and Knowledge Services, Health Sciences Library, Baystate Medical CenterSpringfieldMAUSA
| | - Lauren Westafer
- Department of Emergency MedicineUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
- Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
| | - Elizabeth Schoenfeld
- Department of Emergency MedicineUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
- Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
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Mussmann B, Hardy M, Jung H, Ding M, Osther PJ, Graumann O. Can Dual Energy CT with Fast kV-Switching Determine Renal Stone Composition Accurately? Acad Radiol 2021; 28:333-338. [PMID: 32217056 DOI: 10.1016/j.acra.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES To determine whether a single source computed tomography (CT) system utilizing fast kV switching and low dose settings can characterize (diameter and chemical composition) renal stones accurately when compared infrared spectroscopy. MATERIALS AND METHODS The chemical composition of 15 renal stones was determined using Fourier transform infrared spectroscopy. The stones were inserted into a porcine kidney and placed within a water tank for CT scanning using both fast kV switching dual energy and standard protocols. Effective atomic number of each stone was measured using scanner software. Stone diameter measurements were repeated twice to determine intra-rater variation and compared to actual stone diameter as measured by micro CT. RESULTS The chemical composition of three stones (one calcium phosphate and two carbonite apatite) could not be determined using the scanner software. The composition of 10/12 remaining stones was correctly identified using dual energy computed tomography (83% absolute agreement; k = 0.69). No statistical difference (p = 0.051) was noted in the mean stone diameter as measured by clinical CT and micro CT. CONCLUSION Dual energy computed tomography using fast kV switching may potentially be developed as a low dose clinical tool for identifying and classifying renal stones in vivo supporting clinical decision-making.
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Affiliation(s)
- Bo Mussmann
- Department of Radiology, Odense University Hospital, Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Maryann Hardy
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Helene Jung
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
| | - Ming Ding
- Department of Orthopaedic surgery and traumatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Palle J Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
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Kasi A, Steffens T, Starkey D, Braithwaite V. The proportion of computed tomography kidneys, ureters and bladder (CTKUB) scans that comply with scan extent protocol in an emergency department: a clinical audit and dose ramification study. J Med Radiat Sci 2021; 68:13-20. [PMID: 33350603 PMCID: PMC7890918 DOI: 10.1002/jmrs.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION To assess computed tomography kidneys, ureters and bladder (CTKUB) scan extent protocol compliance and associated doses in the Emergency Department (ED) of an Australian tertiary hospital. METHODS A retrospective clinical audit of 150 consecutive ED CTKUB cases was completed. For each patient, scan extent compliance at the superior (kidneys) and inferior (pubic symphysis) borders, in reference to the protocol was recorded. Compliance and non-compliance (over-/under-scanning) was identified, described (superior/inferior), quantified (via IMPAX measurements) and recorded via a purpose-built audit tool. In addition, a PBU40 phantom was scanned to assess the percentage of dose (DLP) increase per centimetre of over-scanning to contextualise results. RESULTS A notable non-compliance with department protocol was noted. Eight cases (5.3%) demonstrated overall CT scan extent compliance. The remaining 142 cases (94.7%) demonstrated some form of non-compliance; superiorly, inferiorly or both. Analysing the 150 superior and 150 inferior data points independently, the most common non-compliance was over-scanning at the kidneys by 4 cm to5 cm (19 cases, ~10% extra DLP) beyond tolerance and over-scanning inferiorly at the pubic symphysis by 1 cm to 2 cm (29 cases, ~6.4% extra DLP). Estimated dose increases of up to 35% to 45% were found when clinical audit results were simulated using a PBU40. CONCLUSIONS Over-scanning is a predominant occurrence in CTKUB scans in this department. Reasons for over-scanning weren't investigated. It's anticipated this audit will lead to greater awareness of scan extent compliance and dose ramifications of non-compliance. The usage of more easily identified anatomical landmarks and a follow-up audit is suggested.
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Affiliation(s)
- Arianne Kasi
- Department of Medical ImagingPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
- School of Clinical Sciences, Faculty of HealthQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
| | - Tom Steffens
- Department of Medical ImagingPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - Deborah Starkey
- School of Clinical Sciences, Faculty of HealthQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
| | - Vicki Braithwaite
- School of Clinical Sciences, Faculty of HealthQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
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Anderson S, McNicholas D, Murphy C, Cheema I, McLornan L, Davis N, Quinlan M. The impact of COVID-19 on acute urinary stone presentations: a single-centre experience. Ir J Med Sci 2021; 191:45-49. [PMID: 33629270 PMCID: PMC7904391 DOI: 10.1007/s11845-021-02562-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/17/2021] [Indexed: 01/19/2023]
Abstract
Background The COVID-19 pandemic has seen a change in the numbers of patients presenting to the emergency department (ED) with non-COVID symptoms, resulting in delayed presentations of many medical and surgical conditions. Aims To examine the impact of COVID-19 on acute urolithiasis presentations to the ED. Methods In this retrospective, single-centre, observational study, we reviewed all CT KUBs (and their corresponding cases) ordered in ED for possible acute urolithiasis in a 100-day period immediately prior to COVID-19 and in a 100-day period immediately afterwards. We sought to establish the number of CT KUBs performed and the number confirming urolithiasis. We recorded patients’ age, gender, stone size and location. We also analysed CRP, WCC and creatinine as well as the duration of patients’ pain and the management strategy adopted for each case. Results One hundred ninety-eight CT KUBs were performed, 94 pre-COVID and 104 intra-COVID. A total of 70.2% (n = 66) and 66.3% (n = 69) were positive for urolithiasis pre-COVID and intra-COVID respectively (p = 0.56). There was a significantly higher percentage of females pre-COVID compared with intra-COVID (54% vs 36%, p = 0.012). There was no difference in median ureteric stone size seen between the groups (4.7 mm pre-COVID vs 4.0 mm intra-COVID, p = 0.179). There were no significant differences in WCC, CRP or creatinine levels. One patient in the pre-COVID group and two in the intra-COVID groups required percutaneous nephrostomies. Conclusion The COVID-19 pandemic did not result in fewer or sicker patients presenting with acute ureteric colic cases to the ED.
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Affiliation(s)
- Steven Anderson
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Daniel McNicholas
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Claudine Murphy
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Ijaz Cheema
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Liza McLornan
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Niall Davis
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.,Dept of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Quinlan
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland. .,Dept of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.
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Uldin H, McGlynn E, Cleasby M. Using the T11 vertebra to minimise the CT-KUB scan field. Br J Radiol 2020; 93:20190771. [PMID: 32208971 PMCID: PMC10993226 DOI: 10.1259/bjr.20190771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Computed tomography scans of the kidney, ureters, and bladder (CT-KUB) are crucial in investigating urinary calculi but impart a substantial radiation doses. Radiation can be limited by minimising the scanning field to the necessary area (i.e. from the kidneys to urethra). Before auditing, the superior limit of CT-KUB scans had not been formally clarified at our trust. Consistently ensuring the upper limit of scans is at or below T10 has been shown to be a viable method of performing CT-KUB scans. This study aimed to assess the overscan length of CT-KUB investigations and modify practice accordingly to minimise it. There were two standards that were set for CT-KUB scanning. First, the mean percentage overscan length (i.e. percentage of the scan above the kidneys) should be <15%. Second, all scans should include the superior borders of both kidneys. METHODS 90 consecutive CT-KUB scans for ureteric calculus were retrospectively investigated using IMPAX software in the first phase of data collection. After these data were analysed, a newly devised protocol using T11 as the superior scan limit was delivered to radiographers in the department. and 105 in the second phase (re-audit). The analysis parameters were: percentage overscan length, distance between diaphragm and upper border of kidneys, vertebral level at which the scan commenced, and whether both kidneys were fully included. RESULTS In the first phase, overscan of >15% was present in 94.4% of scans. The mean percentage overscan length was 28.2%. The superior vertebral limit of 59% of scans was at T10 or below and a lower superior vertebral limit correlated with decreasing overscan. 99% of scans fully included both kidneys. In the second phase (3 months later), the mean overscan percentage reduced to 10.6% (standard deviation = 4.4%). Excessive overscan affected 35.2% of scans. The superior vertebral limit of 8% of scans was at T10 or below. 100% of scans fully included both kidneys. CONCLUSION Excessive overscanning was due to inconsistent technique in capturing CT-KUB scans. Before this audit, the superior limit of CT-KUB scans had not been formally clarified at our trust. By successfully standardising the process with a reproducible method, the overscan target was comfortably met. Therefore, patient dose was minimised without compromising scan quality. ADVANCES IN KNOWLEDGE This audit has successfully shown a feasible standardised protocol for CT-KUB investigations which can be used to minimise overscanning of patients.
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Affiliation(s)
- Hasaam Uldin
- Heartlands, Good Hope, and Solihull Hospitals, University
Hospitals Birmingham NHS Foundation Trust,
Birmingham, United Kingdom
| | - Eunan McGlynn
- Heartlands, Good Hope, and Solihull Hospitals, University
Hospitals Birmingham NHS Foundation Trust,
Birmingham, United Kingdom
| | - Morgan Cleasby
- Heartlands, Good Hope, and Solihull Hospitals, University
Hospitals Birmingham NHS Foundation Trust,
Birmingham, United Kingdom
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11
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Walter SS, Maurer M, Storz C, Weiss J, Archid R, Bamberg F, Kim JH, Nikolaou K, Othman AE. Effects of Radiation Dose Reduction on Diagnostic Accuracy of Abdominal CT in Young Adults with Suspected Acute Diverticulitis: A Retrospective Intraindividual Analysis. Acad Radiol 2019; 26:782-790. [PMID: 30268717 DOI: 10.1016/j.acra.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the effects of radiation dose reduction on image quality and diagnostic accuracy of abdominal computed tomography (CT) in young adults with suspected acute diverticulitis. MATERIALS AND METHODS Fifty-four patients ≤40 years who received contrast-enhanced abdominal CT for suspected acute diverticulitis were included. Low-dose CT (LDCT) datasets (25%, 50%, and 75% of the original dose) were generated using sinogram synthesis and quantum noise modeling. A five-point scale was used to assess images qualitatively (overall image quality, noise, artefacts, and sharpness) and for diagnostic confidence (5 being the best possible outcome). Furthermore, the diagnostic accuracy was determined for the presence of acute diverticulitis. RESULTS Among 54 patients (mean age: 35.2 ± 5.3 years, 77.8% male), the prevalence of acute diverticulitis was high (57.4%). Subjective image quality was highest for original datasets and lowest for LDCT datasets with 25% of the original dose (median [interquartile range]: 5 [5] vs. 3 [2-3], p < 0.001). Diagnostic confidence was high for all datasets down to 50% of the original dose, while 25% LDCT datasets were associated with a significantly decreased diagnostic confidence (p < 0.001). Diagnostic accuracy was high for all LDCT and original datasets (sensitivity: 100%, negative predictive value [NPV]: 100% for 75% and 100% dose levels; sensitivity: 96.8%, NPV: 95.8% for 50% dose level; sensitivity: 93.6%, NPV: 91.7% for 25% dose level, respectively). Inter-rater agreement regarding the detection of diverticulitis was almost perfect at doses ≥50% (kappa: >0.81), while lower for datasets of 25% of the original radiation dose agreement (kappa: 0.67-0.78). CONCLUSION Radiation dose reduction down to 50% of the original radiation exposure permits high image quality, diagnostic confidence, and accuracy for the assessment of acute diverticulitis in abdominal CT in young adults without the use of iterative reconstruction algorithms.
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Image Quality and Patient-Specific Organ Doses in Stone Protocol CT: A Comparison of Traditional CT to Low Dose CT with Iterative Reconstruction. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5120974. [PMID: 30363655 PMCID: PMC6181004 DOI: 10.1155/2018/5120974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/16/2018] [Indexed: 02/03/2023]
Abstract
Objective To compare organ specific radiation dose and image quality in kidney stone patients scanned with standard CT reconstructed with filtered back projection (FBP-CT) to those scanned with low dose CT reconstructed with iterative techniques (IR-CT). Materials and Methods Over a one-year study period, adult kidney stone patients were retrospectively netted to capture the use of noncontrasted, stone protocol CT in one of six institutional scanners (four FBP and two IR). To limit potential CT-unit use bias, scans were included only from days when all six scanners were functioning. Organ dose was calculated using volumetric CT dose index and patient effective body diameter through validated conversion equations derived from previous cadaveric, dosimetry studies. Board-certified radiologists, blinded to CT algorithm type, assessed stone characteristics, study noise, and image quality of both techniques. Results FBP-CT (n=250) and IR-CT (n=90) groups were similar in regard to gender, race, body mass index (mean BMI = 30.3), and stone burden detected (mean size 5.4 ± 1.2 mm). Mean organ-specific dose (OSD) was 54-62% lower across all organs for IR-CT compared to FBP-CT with particularly reduced doses (up to 4.6-fold) noted in patients with normal BMI range. No differences were noted in radiological assessment of image quality or noise between the cohorts, and intrarater agreement was highly correlated for noise (AC2=0.873) and quality (AC2=0.874) between blinded radiologists. Conclusions Image quality and stone burden assessment were maintained between standard FBP and low dose IR groups, but IR-CT decreased mean OSD by 50%. Both urologists and radiologists should advocate for low dose CT, utilizing reconstructive protocols like IR, to reduce radiation exposure in their stone formers who undergo multiple CTs.
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13
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Evaluation of optimal parameters for using low-dose computed tomography to diagnose urolithiasis. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Fallahzadeh MA, Hassanzadeh J, Fallahzadeh MH. What do we know about pediatric renal microlithiasis? J Renal Inj Prev 2017; 6:70-75. [PMID: 28497077 PMCID: PMC5423286 DOI: 10.15171/jrip.2017.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/25/2016] [Indexed: 11/09/2022] Open
Abstract
Renal or calyceal microlithiasis is a common disorder with increasing prevalence especially in infants and younger children. The main presenting symptoms and the underlying metabolic abnormalities of renal microlithiasis are similar to renal stone. Although renal microlithiasis is considered as a main problem of the health system with diverse etiologies, our information about its natural course is very limited. Hence, further investigations to make an appropriate clinical approach to this entity is mandatory. Also, general practitioners, pediatricians, nephrologists and urologists have to be well educated regarding renal microlithiasis for early diagnosis, appropriate evaluation and proper management of this entity. In this review study, we focused on collection of the present information about different aspects of renal microlithiasis in children.
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Affiliation(s)
| | - Jafar Hassanzadeh
- Department of Biostatistics and Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Abstract
INTRODUCTION With the broadening indications of ureteroscopy (URS) for complex stones and high-risk patients, more URS is being performed and hence there is an increasing risk of major potentially life-threatening complications. We wanted to define the incidence, predisposing factors, management, and long-term sequelae for post-URS perirenal hematoma (PRH). MATERIAL AND METHODS We conducted a systematic review of literature according to Cochrane and preferred reporting items for systematic reviews and meta-analysis guidelines for all studies reporting on post-URS PRH from 1980 to September 2016. A literature search was conducted through PubMed, EMBASE, CINAHL, and Cochrane Library for all English language articles. RESULTS Based on a literature search of 210 articles, seven studies (8929 patients) met the inclusion criteria with an incidence of post-URS PRH reported as 0.45% (40 patients, range: 0.15%-8.9% per study) with a mean age of 53 years and a mean stone size of 1.7 cm. The predisposing factors were moderate-severe hydronephrosis, thin renal cortex, prolonged operative duration, hypertension, and preoperative urinary tract infection (UTI). The management strategy varied from conservative management with blood transfusion and antibiotics (n = 22, 55%) to percutaneous drainage (n = 11, 27.5%). Surgical intervention was needed in seven (17.5%) patients. Two of these were emergency angiography of which one proceeded to open nephrectomy. Open surgery with clot removal was done in three patients, nephrostomy for severe hydronephrosis in one patient, and surgery to correct malpositioned stent in one patient. There was one mortality reported, wherein a patient who had postangiography nephrectomy died of multiple organ failure after the intervention. CONCLUSION URS related PRH is a rare, but potentially life threatening complication with a small risk of renal loss. Although most cases may be managed conservatively, incidence of PRH can be minimized by control of blood pressure, treatment of preoperative UTI, and reduction in intrarenal pressures and operative time duration.
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Affiliation(s)
- Lily A Whitehurst
- 1 Department of Urology, Royal Hampshire County Hospital , Winchester, United Kingdom
| | - Bhaskar K Somani
- 2 Department of Urology, University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
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16
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Rob S, Bryant T, Wilson I, Somani BK. Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature. Clin Radiol 2016; 72:11-15. [PMID: 27810168 DOI: 10.1016/j.crad.2016.10.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/25/2016] [Accepted: 10/06/2016] [Indexed: 01/26/2023]
Abstract
AIM To investigate whether reducing the radiation dose of computed tomography (CT) of the kidney, ureters, and bladder (KUB) for acute renal colic impacts upon the specificity, sensitivity, and detection of urolithiasis. MATERIALS AND METHODS A systematic review of the literature over a 20-year period between 1995 and 2015 was conducted of all prospective studies in the English language reporting on adult patients who underwent CT KUB or non-contrast CT for renal colic or urolithiasis. Retrospective studies and those that included pregnant females, children, non-human test subjects, cadaveric use, and simulations were excluded. Data were collected using an Excel spreadsheet and ultra-low-dose (ULD CT) and low-dose CT KUB (LD CT) was defined as a radiation dose ≤1.9 and <3.5 mSv, respectively. RESULTS A total of 417 articles were identified, and after screening, seven articles (1,104 patients) were included in the present study with a male:female ratio of 3:2. Of the four studies with ULD CT for both males and females, the prevalence of urolithiasis ranged from 36% and 73%, with additional pathologies found in 12-15%. The effective radiation dose of ULD CT ranged from 0.5-1.9 mSv. Overall, ULD CT and LD CT had a sensitivity of 90-100% and a specificity of 86-100% across all studies. CONCLUSIONS ULD CT and LD CT are effective techniques and yield high sensitivity and specificity. Although they yield comparable results against standard-dose CT KUB in detecting alternative diagnoses, they may not be as effective in detecting stones <3 mm in size or in patients with a body mass index of >30 kg/m2; however, this should be the first-line investigation for the majority of renal colic patients in the modern era.
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Affiliation(s)
- S Rob
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - T Bryant
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - I Wilson
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
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Koteshwar P, Kakkar C, Sripathi S, Parakh A, Shrivastav R. Low Dose MDCT with Tube Current Modulation: Role in Detection of Urolithiasis and Patient Effective Dose Reduction. J Clin Diagn Res 2016; 10:TC01-5. [PMID: 27437322 DOI: 10.7860/jcdr/2016/16765.7735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/31/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Urolithiasis is one of the major, recurring problem in young individuals and CT being the commonest diagnostic modality used. In order to reduce the radiation dose to the patient who are young and as stone formation is a recurring process; one of the simplest way would be, low dose CT along with tube current modulation. AIM Aim of this study was to compare the sensitivity and specificity of low dose (70mAs) with standard dose (250mAs) protocol in detecting urolithiasis and to define the tube current and mean effective patient dose by these protocols. MATERIALS AND METHODS A prospective study was conducted in 200 patients over a period of 2 years with acute flank pain presentation. CT was performed in 100 cases with standard dose and another 100 with low dose protocol using tube current modulation. Sensitivity and specificity for calculus detection, percentage reduction of dose and tube current with low dose protocol was calculated. RESULTS Urolithiasis was detected in 138 patients, 67 were examined by high dose and 71 were by low dose protocol. Sensitivity and Specificity of low dose protocol was 97.1% and 96.4% with similar results found in high BMI patients. Tube current modulation resulted in reduction of effective tube current by 12.17%. The mean effective patient dose for standard dose was 10.33 mSv whereas 2.92 mSv for low dose with 51.13-53.8% reduction in low dose protocol. CONCLUSION The study has reinforced that low-dose CT with tube current modulation is appropriate for diagnosis of urolithiasis with significant reduction in tube current and patient effective dose.
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Affiliation(s)
- Prakashini Koteshwar
- Professor, Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal University , Manipal, Udupi District, Karnataka, India
| | - Chandan Kakkar
- Assistant Professor, Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Smiti Sripathi
- Professor, Department of Radiology, Kasturba Medical College, Manipal University , Manipal, Udupi District, Karnataka, India
| | - Anushri Parakh
- Resident, Department of Radiology, Kasturba Medical College , Manipal, Udupi, India
| | - Rajendra Shrivastav
- Associate Professor, Department of Radiology, Kasturba Medical College , Manipal, Udupi, India
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Hamimi A, El Azab M. MSCT renal stone protocol; dose penalty and influence on management decision of patients: Is it really worth the radiation dose? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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O'Kane D, D'Arcy FT, Papa N, Smith N, McClintock S, Lawrentschuk N, Bolton DM. Radiation dosing in the investigation and follow-up of urolithiasis: Comparison between historical and contemporary practices. Investig Clin Urol 2016; 57:113-7; discussion 118. [PMID: 26981593 PMCID: PMC4791672 DOI: 10.4111/icu.2016.57.2.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/20/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose Computed tomography (CT) is the gold standard imaging modality for the diagnosis and follow-up of urolithiasis. Before the use of CT, intravenous urography (IVU) was the imaging modality of choice. CT remains contentious because of the cancer risk related to radiation exposure above a threshold level. We aimed to compare the radiation exposure dose to the average patient with urolithiasis in the era of CT with that of IVU. Materials and Methods Our hospital medical records database was searched for patients who presented to the Emergency Department over a 1-month period in 1990 with a diagnosis of renal colic. Patients with the same presentation, from the same month, in 2013 were also identified. A total of 14 patients from each year fulfilled the inclusion criteria. The estimated effective radiation exposure dose for each patient was calculated by using data from population-based studies. Results The median effective radiation dose per patient in the 1990 group, for initial diagnosis and subsequent follow-up, was 4.05 mSv (interquartile range [IQR], 3.7–4.4 mSv). The corresponding median dose in the 2013 group was 4.2 mSv (IQR, 4.2–4.9 mSv), and there was no evidence of a statistical difference between the groups (p=0.8). Conclusions Despite the contentiousness related to the use of serial CT scanning, our study demonstrated that for radiological investigation and follow-up of urolithiasis, the estimated effective radiation exposure dose to each patient is only marginally higher than in the era of IVU, with improvements in length of hospital stay and time to definitive diagnosis.
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Affiliation(s)
- Dermot O'Kane
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia.; Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Frank T D'Arcy
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Nathan Papa
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Neil Smith
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Scott McClintock
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | | | - Damien M Bolton
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
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Malkawi IM, Han E, Atalla CS, Santucci RA, O'Neil B, Wynberg JB. Low-Dose (10%) Computed Tomography May Be Inferior to Standard-Dose CT in the Evaluation of Acute Renal Colic in the Emergency Room Setting. J Endourol 2016; 30:493-6. [PMID: 26728321 PMCID: PMC4876551 DOI: 10.1089/end.2015.0760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Noncontrast CT is the standard of care to evaluate nephrolithiasis. We evaluated the performance of low-dose CT (LDCT) scan for evaluation of renal colic in the emergency room (ER). Materials and Methods: Patients visiting the ER with suspected nephrolithiasis received a standard-dose CT (SDCT) and an LDCT. Two urologists read the LDCTs and later they read SDCTs. Stone information was recorded on a diagram of the renal system. Findings on SDCTs and LDCTs were correlated through side-by-side comparison of the diagrams. Later, the two urologists adjudicated all nonconcordance between SDCTs and LDCTs in an unblinded manner. Results: Twenty-seven patients were included. SDCTs revealed 27 stones in 18 patients. Mean stone size was 3.81 mm. LDCTs revealed 27 stones in 18 patients with a mean stone size of 4.7 mm (p = 0.23). Overall sensitivity and specificity of LDCTs were 70% and 39%, respectively. There were eight false-positive and eight false-negative stones. All the false-positive stones on LDCTs were placed in the ureter, in which all of the corresponding SDCTs were visible calcifications outside the ureter. Of the eight false-negative stones on LDCTs, seven were visible calcifications on the SDCTs and the eighth stone was 1 mm and was not visible. Conclusion: LDCT may not perform well in the evaluation of suspected nephrolithiasis in the acute setting. LDCT scan accurately demonstrates calcifications; however, accurate placement of calcifications in or out of the urinary tract may be diminished due to impaired resolution of soft tissue structures.
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Affiliation(s)
- Ibraheem M Malkawi
- 1 Department of Urology, Detroit Medical Center, College of Osteopathic Medicine, Michigan State University, Detroit, Michigan
| | - Esther Han
- 1 Department of Urology, Detroit Medical Center, College of Osteopathic Medicine, Michigan State University, Detroit, Michigan
| | - Christopher S Atalla
- 1 Department of Urology, Detroit Medical Center, College of Osteopathic Medicine, Michigan State University, Detroit, Michigan
| | - Richard A Santucci
- 1 Department of Urology, Detroit Medical Center, College of Osteopathic Medicine, Michigan State University, Detroit, Michigan
| | - Brian O'Neil
- 2 Department of Emergency Medicine, Wayne-State University , Detroit, Michigan
| | - Jason B Wynberg
- 1 Department of Urology, Detroit Medical Center, College of Osteopathic Medicine, Michigan State University, Detroit, Michigan
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Tailly T, Larish Y, Nadeau B, Violette P, Glickman L, Olvera-Posada D, Alenezi H, Amann J, Denstedt J, Razvi H. Combining Mean and Standard Deviation of Hounsfield Unit Measurements from Preoperative CT Allows More Accurate Prediction of Urinary Stone Composition Than Mean Hounsfield Units Alone. J Endourol 2016; 30:453-9. [PMID: 26597058 DOI: 10.1089/end.2015.0209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The mineral composition of a urinary stone may influence its surgical and medical treatment. Previous attempts at identifying stone composition based on mean Hounsfield Units (HUm) have had varied success. We aimed to evaluate the additional use of standard deviation of HU (HUsd) to more accurately predict stone composition. METHODS We identified patients from two centers who had undergone urinary stone treatment between 2006 and 2013 and had mineral stone analysis and a computed tomography (CT) available. HUm and HUsd of the stones were compared with ANOVA. Receiver operative characteristic analysis with area under the curve (AUC), Youden index, and likelihood ratio calculations were performed. RESULTS Data were available for 466 patients. The major components were calcium oxalate monohydrate (COM), uric acid, hydroxyapatite, struvite, brushite, cystine, and CO dihydrate (COD) in 41.4%, 19.3%, 12.4%, 7.5%, 5.8%, 5.4%, and 4.7% of patients, respectively. The HUm of UA and Br was significantly lower and higher than the HUm of any other stone type, respectively. HUm and HUsd were most accurate in predicting uric acid with an AUC of 0.969 and 0.851, respectively. The combined use of HUm and HUsd resulted in increased positive predictive value and higher likelihood ratios for identifying a stone's mineral composition for all stone types but COM. CONCLUSIONS To the best of our knowledge, this is the first report of CT data aiding in the prediction of brushite stone composition. Both HUm and HUsd can help predict stone composition and their combined use results in higher likelihood ratios influencing probability.
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Affiliation(s)
- Thomas Tailly
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Yaniv Larish
- 2 Division of Urology, Lenox Hill Hospital , New York, New York
| | - Brandon Nadeau
- 3 Department of Radiology, The University of Western Ontario , London, Ontario, Canada
| | - Philippe Violette
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Leonard Glickman
- 4 Division of Urology, Hackensack University Medical Center , Hackensack, New Jersey
| | - Daniel Olvera-Posada
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Husain Alenezi
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Justin Amann
- 3 Department of Radiology, The University of Western Ontario , London, Ontario, Canada
| | - John Denstedt
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Hassan Razvi
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
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23
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Choi SY, Ahn SH, Choi JD, Kim JH, Lee BI, Kim JI, Park SB. Determination of optimal imaging settings for urolithiasis CT using filtered back projection (FBP), statistical iterative reconstruction (IR) and knowledge-based iterative model reconstruction (IMR): a physical human phantom study. Br J Radiol 2015; 89:20150527. [PMID: 26577542 DOI: 10.1259/bjr.20150527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare CT image quality for evaluating urolithiasis using filtered back projection (FBP), statistical iterative reconstruction (IR) and knowledge-based iterative model reconstruction (IMR) according to various scan parameters and radiation doses. METHODS A 5 × 5 × 5 mm(3) uric acid stone was placed in a physical human phantom at the level of the pelvis. 3 tube voltages (120, 100 and 80 kV) and 4 current-time products (100, 70, 30 and 15 mAs) were implemented in 12 scans. Each scan was reconstructed with FBP, statistical IR (Levels 5-7) and knowledge-based IMR (soft-tissue Levels 1-3). The radiation dose, objective image quality and signal-to-noise ratio (SNR) were evaluated, and subjective assessments were performed. RESULTS The effective doses ranged from 0.095 to 2.621 mSv. Knowledge-based IMR showed better objective image noise and SNR than did FBP and statistical IR. The subjective image noise of FBP was worse than that of statistical IR and knowledge-based IMR. The subjective assessment scores deteriorated after a break point of 100 kV and 30 mAs. CONCLUSION At the setting of 100 kV and 30 mAs, the radiation dose can be decreased by approximately 84% while keeping the subjective image assessment. ADVANCES IN KNOWLEDGE Patients with urolithiasis can be evaluated with ultralow-dose non-enhanced CT using a knowledge-based IMR algorithm at a substantially reduced radiation dose with the imaging quality preserved, thereby minimizing the risks of radiation exposure while providing clinically relevant diagnostic benefits for patients.
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Affiliation(s)
- Se Y Choi
- 1 Department of Urology, The Armed Forces Il-Dong Hospital, Pocheon, Republic of Korea.,2 Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Seung H Ahn
- 3 Department of Urology, KEPCO Medical Center, Seoul, Republic of Korea
| | - Jae D Choi
- 3 Department of Urology, KEPCO Medical Center, Seoul, Republic of Korea
| | - Jung H Kim
- 3 Department of Urology, KEPCO Medical Center, Seoul, Republic of Korea
| | - Byoung-Il Lee
- 4 Radiation Health Research Institute, Korea Hydro and Nuclear Power, Seoul, Republic of Korea
| | - Jeong-In Kim
- 4 Radiation Health Research Institute, Korea Hydro and Nuclear Power, Seoul, Republic of Korea
| | - Sung B Park
- 5 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Luyckx F. Who wants to go further has to know the past: A comment upon: Ultrasonography versus computed tomography for suspected nephrolithiasis-R. Smith-Bindman et al. N Engl J Med. 2014 Sep 18;371(12):1100-1110. World J Urol 2014; 33:1371-2. [PMID: 25544375 DOI: 10.1007/s00345-014-1468-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- François Luyckx
- Service d'Urologie, CHD Vendée, 85000, La Roche sur Yon, France.
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Bechis SK, Eisner BH. The STONE score can help diagnose urolithiasis and decrease the use of CT scans. EVIDENCE-BASED MEDICINE 2014; 19:234. [PMID: 25053641 DOI: 10.1136/ebmed-2014-110017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Seth K Bechis
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian H Eisner
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Sfoungaristos S, Gofrit ON, Katz R, Yutkin V, Landau EH, Pode D, Duvdevani M. A Predictive Model for Stone Radiopacity in Kidney-ureter-bladder Film Based on Computed Tomography Parameters. Urology 2014; 84:1021-5. [DOI: 10.1016/j.urology.2014.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/02/2014] [Accepted: 06/24/2014] [Indexed: 10/24/2022]
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