Evaluation and Follow-Up of Patients with Urinary Lithiasis: Minimizing Radiation Exposure

Hyams, Elias S.; Shah, Ojas

doi:10.1007/s11934-010-0092-x

Cited by 37 publications

(22 citation statements)

References 48 publications

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“…Some have focused on diagnostic procedures such as voiding cystourethrography 10, 11 for congenital abnormalities or CT scanning for identification of urolithiasis. 12, 13 Others have looked at ways to reduce radiation exposure during endourological procedures with specific protocols and technical modifications. 14 An example of such a protocol was designed to standardize how many images and which types were to be typically performed during urodynamic studies, yielding 71% reduction in fluoroscopy times (40.9 to 11.7 seconds per procedure), 73% reductions in mean air kerma (15.48 to 4.25 mGy), and 71% reduction in mean dose area product (518.90 to 150.28 mGym 2 ).…”

Section: Discussionmentioning

confidence: 99%

Prospective Systematic Intervention to Reduce Patient Exposure to Radiation During Pediatric Ureteroscopy

et al. 2013

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Purpose After prospective measurement of radiation exposure during pediatric ureteroscopy (URS) for urolithiasis, we identified targets for intervention. Our objective was to systematically reduce radiation exposure during pediatric URS. Materials and Methods We designed and implemented a pre-fluoroscopy quality checklist for patients undergoing URS at our institution as part of a quality improvement initiative. Pre-operative patient characteristics, operative factors, fluoroscopy settings and radiation exposure were recorded. Primary outcomes were entrance skin dose (ESD, in mGy) and midline dose (MLD, in mGy) before and after implementation of the checklist. Results Direct observation was performed on 32 consecutive URS procedures using the safety checklist, 27 of whom were pediatric patients meeting inclusion criterion. Outcomes were compared to 37 patients from the pre-checklist phase. Pre- and post-checklist groups were similar with regard to patient age, total surgical time, or patient thickness. Mean ESD was reduced by 88% (p<0.01) and mean MLD by 87% (p<0.01). Significant improvements were noted among the major determinants of radiation dose including the total fluoroscopy time (reduced by 67%, p<0.01), dose rate setting (appropriate reduced dose setting in 93% vs 51%, p<0.01), and excess skin to intensifier distance (reduced by 78%, p<0.01). Conclusions After systematic evaluation of our practices and implementation of a fluoroscopy quality checklist, there were dramatic reductions in the radiation doses to children during URS procedures.

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Section: Discussionmentioning

confidence: 99%

Prospective Systematic Intervention to Reduce Patient Exposure to Radiation During Pediatric Ureteroscopy

et al. 2013

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“…Low dose and ultra-low dose CT of the urinary tract have high diagnostic accuracy and less radiation dose [15], but they have not been used popularly. The overuse of CT has become a public health concern [12,16]. Sternberg and Littenberg [17] retrospectively analyzed imaging examinations in 7,659 patients with calculi within 90 days of their first visit.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography Can Replace CT Scans as the Initial Imaging Examination of Ureteral Calculi

Liu

Chen

et al. 2019

Urol Int

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Objective: To study the feasibility of ultrasonography (US) as a replacement for CT during the diagnosis of ureteral calculi (UC). Materials and Methods: Clinical and imaging data of patients with UC between January 2013 and December 2017 were retrospectively analyzed. According to the imaging method, patients were divided into 3 groups: Group A, CT alone; Group B, CT and US, Group C, US alone. Age, location, and the size of stones were compared among the groups. According to the maximum diameter (MD) measured by using CT in Group B, patients were subdivided into 3 groups (subgroup 1–3): MD <0.5 cm, 0.5 cm ≤ MD ≤1.0 cm, and MD >1.0 cm. The MD measured by US and CT were compared in the subgroups. Results: A total of 1,289 patients with UC were admitted. The use of CT correlated with age (p = 0.000) and stone location (p = 0.004). The sensitivity and specificity of US were 71.3 and 100%. Positive US results correlated with stone size (p = 0.008), but not location (p = 0.861). The mean MDs of the calculi measured by US and CT: in subgroup 1: 0.80 ± 0.31 and 0.35 ± 0.05 cm (p = 0.000); in subgroup 2: 0.94 ± 0.32 and 0.72 ± 0.16 cm (p = 0.000); in subgroup 3: 1.75 ± 0.68 and 1.59 ± 0.52 cm (p = 0.094). Conclusions: US confirmed that UC do not require confirmatory CT. US can replace CT as the initial imaging examination of UC.

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“…[20] Although rare, the contrast medium itself may cause serious acute (anaphylactic reaction) or late-onset (nephropathy) side effects. [21,22] Conspicuous uncomplicated or asymptomatic urinary pathologies, such as mild dilation or mild stasis due to conditions such as a peripelvic cyst, persistent caliectasis, or prominent extrarenal pelvis, should be able to be evaluated using methods other than those involving contrast enhancement or radiation exposure, especially in young patients who are the most sensitive to the hazards of radiation or anaphylaxis. In addition, cross-sectional, contrast-enhanced procedures can be time-consuming and more expensive.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, US is a non-invasive, real-time, inexpensive method that does not require iodinated contrast administration or radiation exposure. [21,22] Moreover, for defining obstructive pathologies, gray-scale US can also be a guide for localizing the lower ureteral orifices and examining the ureteric jet flows into the bladder.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of ureteric jet flow with Doppler ultrasonography during manual compression

Yıldırım¹,

Bozkurt²,

Çırakoğlu³

2011

Turkish Journal of Urology

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Objective: This study aimed to distinguish between obstructive and non-obstructive dilation of the upper urinary tract using ureterovesical jet flow analysis with Doppler ultrasonography (US) and manual flank compression. Materials and methods:The study enrolled 54 patients (11 women, 43 men; mean age 27.5 years) with unilateral hydronephrosis. All but 2 pregnant patients underwent the Doppler US and the reference standard test [intravenous pyelogram (IVP)] after standardized hydration. The distended urinary bladder was visualized in the transverse plane to evaluate both ureteral orifices simultaneously. During and after compression of each flank, the jet flows were recorded in Doppler mode. The jet flows were quantified by calculating the longitudinal extent of the color spread into the bladder on both sides. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the test for determining the degree of obstruction were evaluated statistically. Results:Ureterovesical jet flow could not be visualized with flank compression in 4 cases. Three of these cases had complete obstruction on IVP. In the 22 cases that had markedly reduced flow compared to the contralateral side on Doppler US, the IVP showed similar stasis. In the 19 cases that had mildly diminished flow compared to the contralateral side on Doppler US, no significant difference was detected in the pyelogram and nephrogram phases on IVP.Conclusion: Doppler examination of the ureterovesical jet flows during flank compression may be a good diagnostic method for evaluating the degree of obstruction, especially in patients in whom magnetic resonance imaging or computerized tomography is contraindicated. Gereç ve yöntem:Çalışmaya tek taraflı hidronefroz tespit edilmiş 54 olgu (11 kadın, 43 erkek; ortalama yaş 27.5 yıl) dahil edildi. Hidrasyon düzeyi standardize edilerek, tüm hastalara Doppler US inceleme ve 2 gebe olgu dışındaki diğer tüm hastalara referans standart test olarak intravenöz piyelografi (İVP) yapıldı. Her iki üreter orifisi görülecek şekilde distandü mesane yatay pozisyonda görüntülendi. Renal lojun kompresyonu sırasında ve sonrasında oluşan jet akımlar Doppler mod ile kaydedildi. Mesane içerisine doğru gelişen renk saçılımının uzunluğu dikkate alınarak jet akımlar kantifiye edildi. Obstrüksiyon derecesinin ayırımında sensisitivite, spesifite, pozitif ve negatif prediktif değerler istatistiksel olarak hesaplandı. Bulgular: Üreterovezikal bileşke akımı toplam 4 olguda hiç gözlenemedi. Bunlardan biri hariç diğer üçün-de İVP ile de tam obstrüksiyon rapor edilmişti. Kalan olguların 22'sinde, Doppler US'de karşı tarafa göre kısalmış jetler sözkonusu iken, İVP'de de bununla uyumlu nonprogresif staz görüldü. Diğer 19 olguda, Doppler US'de karşı tarafa göre hafif azalmış jetler sözkonusu iken İVP incelemelerinde piyelogram ve nefrogram fazlarında anlamlı fark tespit edilmemişti. Sonuç:Özellikle manyetik rezonans görüntüleme veya bilgisayarlı tomografinin kontrendike olduğu olgularda, renal lojların manu...

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Evaluation and Follow-Up of Patients with Urinary Lithiasis: Minimizing Radiation Exposure

Cited by 37 publications

References 48 publications

Prospective Systematic Intervention to Reduce Patient Exposure to Radiation During Pediatric Ureteroscopy

Prospective Systematic Intervention to Reduce Patient Exposure to Radiation During Pediatric Ureteroscopy

Ultrasonography Can Replace CT Scans as the Initial Imaging Examination of Ureteral Calculi

Evaluation of ureteric jet flow with Doppler ultrasonography during manual compression

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