Effect of Reduced Radiation CT Protocols on the Detection of Renal Calculi

Jin, Daniel; Lamberton, Gregory R.; Broome, Dale R.; Saaty, Hans P; Bhattacharya, Shravani; Lindler, Tekisha U.; Baldwin, D. Duane

doi:10.1148/radiol.09090583

Cited by 50 publications

(21 citation statements)

References 24 publications

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“…There have been studies on reduced-dose CT in cadavers in the United States and in small samples of selected populations outside the country. [12][13][14] These studies have also often excluded or found poor performance of nonsize-adjusted protocols in more obese patients, who are at increased risk for kidney stone and incur a higher radiation dose. 1,[15][16][17][18] Previous studies have also not followed patients receiving reduced-dose CT to determine its ability to predict outcomes and need for intervention.…”

Section: Background and Importancementioning

confidence: 99%

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Moore

Daniels

Ghita

et al. 2015

Annals of Emergency Medicine

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Study objective-Reduced-dose computed tomography (CT) scans have been recommended for diagnosis of kidney stone but are rarely used in the emergency department (ED) setting. Test characteristics are incompletely characterized, particularly in obese patients. Our primary outcome is to determine the sensitivity and specificity of a reduced-dose CT protocol for symptomatic ureteral stones, particularly those large enough to require intervention, using a protocol stratified by patient size.Methods-This was a prospective, blinded observational study of 201 patients at an academic medical center. Consenting subjects underwent both regular-and reduced-dose CT, stratified into a high and low body mass index (BMI) protocol based on effective abdominal diameter. Reduceddose CT scans were interpreted by radiologists blinded to regular-dose interpretations. Follow-up for outcome and intervention was performed at 90 days.Results-CT scans with both regular and reduced doses were conducted for 201 patients, with 63% receiving the high BMI reduced-dose protocol. Ureteral stone was identified in 102 patients (50.7%) of those receiving regular-dose CT, with a ureteral stone greater than 5 mm identified in 26 subjects (12.9%). Sensitivity of the reduced-dose CT for any ureteral stone was 90.2% (95% confidence interval [CI] 82.3% to 95.0%), with a specificity of 99.0% (95% CI 93.7% to 100.0%). For stones greater than 5 mm, sensitivity was 100% (95% CI 85.0% to 100.0%). Reduced-dose CT identified 96% of patients who required intervention for ureteral stone within 90 days. Mean * Corresponding Author. Chris.Moore@yale.edu, Twitter: Chris.Moore@Yale_EUS. Author contributions: CLM, MG, and GPG conceived the study and designed the trial. CLM, DS, and CPG obtained research funding.CLM and SL supervised the conduct of the trial and data collection. SL participated in recruitment of patients. GG performed overreadings of the CT scans in the trial. CLM, SL, and AM managed the data, including quality control. AM and CPG provided statistical advice. BD, GG, AM, DS, and CPG provided advisement on study design and methodology. CLM, SL, AM, and CPG analyzed the data. CLM drafted the article, and all authors contributed substantially to its revision. CLM takes responsibility for the paper as a whole.Presented as an abstract at the Society for Academic Emergency Medicine annual meeting, May 2013, Atlanta, GA.The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript reduction in size-specific dose estimate was 18.6 milligray (mGy), from 21.7 mGy (SD 9.7) to 3.4 mGy (SD 0.9). Conclusion-CT

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Section: Background and Importancementioning

confidence: 99%

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Moore

Daniels

Ghita

et al. 2015

Annals of Emergency Medicine

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“…There are well-established practices of using low-dose CT in the detection of renal stone disease resulting in inherently ‘noiser’ images than in conventional CT examinations but without compromising diagnostic confidence for this clinical entity [3, 4]. In this article, we focus on the emergence of new iterative reconstruction techniques that have developed over the past few years.…”

Section: Introductionmentioning

confidence: 99%

Comparison of image quality between filtered back-projection and the adaptive statistical and novel model-based iterative reconstruction techniques in abdominal CT for renal calculi

et al. 2013

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ObjectivesTo compare image quality on computed tomographic (CT) images acquired with filtered back-projection (FBP), adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR) techniques in CT kidney/ureter/bladder (KUB) examination.MethodsEighteen patients underwent standard protocol CT KUB at our institution. The same raw data were reconstructed using FBP, ASIR and MBIR. Objective [mean image noise, contrast-to-noise ratio (CNR) for kidney and mean attenuation values of subcutaneous fat] and subjective image parameters (image noise, image contrast, overall visibility of kidneys/ureters/bladder, visibility of small structures, and overall diagnostic confidence) were assessed using a scoring system from 1 (best) to 5 (worst).ResultsObjective image measurements revealed significantly less image noise and higher CNR and the same fat attenuation values for the MBIR technique (P < 0.05). MBIR scored best in all the subjective image parameters (P < 0.001) with averages ranging between 2.05–2.73 for MBIR, 2.95–3.10 for ASIR and 3.08–3.31 for FBP. No significant difference was observed between FBP and ASIR (P > 0.05), while there was a significant difference between ASIR vs. MBIR (P < 0.05). The mean effective dose was 3 mSv.ConclusionMBIR shows superior reduction in noise and improved image quality (both objective and subjective analysis) compared with ASIR and FBP CT KUB examinations.Main Messages• There are many reconstruction options in CT.• Novel model-based iterative reconstruction (MBIR) showed the least noise and optimal image quality.• For CT of the kidneys/ureters/bladder, MBIR should be utilised, if available.• Further studies to reduce the dose while maintaining image quality should be pursued.

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“…These studies have consistently shown that low-dose CT provides a sensitivity and specificity >95 % and is similar to conventional CT for the detection of both renal and ureteral calculi [31,36,37]. Low-dose CT has also shown efficacy in detecting stone composition by measured Hounsfield units [38][39][40][41] and may assist in selecting the correct treatment regimen [42].…”

Section: Reducing Radiation During Work-up For Urolithiasismentioning

confidence: 84%

Techniques for Minimizing Radiation Exposure During Evaluation, Surgical Treatment, and Follow-up of Urinary Lithiasis

Arenas

Baldwin

2015

Curr Urol Rep

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Patients receive significant radiation exposure during the diagnosis, treatment, and follow-up of urinary stone disease. This radiation exposure may result in patient harm and is believed to contribute to the risk for malignancy. This review will present current information to allow surgeons to optimize their diagnostic, treatment, and follow-up regimens to allow optimal care of stone disease patients at the lowest radiation dose possible.

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Effect of Reduced Radiation CT Protocols on the Detection of Renal Calculi

Cited by 50 publications

References 24 publications

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Comparison of image quality between filtered back-projection and the adaptive statistical and novel model-based iterative reconstruction techniques in abdominal CT for renal calculi

Techniques for Minimizing Radiation Exposure During Evaluation, Surgical Treatment, and Follow-up of Urinary Lithiasis

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