Low-Dose CT With Automatic Tube Current Modulation, Adaptive Statistical Iterative Reconstruction, and Low Tube Voltage for the Diagnosis of Renal Colic: Impact of Body Mass Index

Gervaise, A.; Naulet, P.; Beuret, Florence; Henry, Christelle; Pernin, M.; Portron, Yann; Lapierre-Combes, M.

doi:10.2214/ajr.13.11350

Cited by 50 publications

(42 citation statements)

References 25 publications

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“…It is possible that newer techniques such as adaptive statistical iterative reconstruction allow even better images and should be evaluated, but were not evaluated in this study. 23 Although most important alternative causes of symptoms were detected in this study, further investigation is warranted to determine the overall accuracy of reduced-dose techniques for important alternative findings and to determine the generalizability of these protocols. The number of subjects lost to follow-up (n¼19; 10%) was relatively low but is a limitation of the results.…”

Section: Limitationsmentioning

confidence: 83%

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: Limitationsmentioning

confidence: 83%

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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“…In addition, by optimizing coverage, it is also possible to reduce the exposure of radiosensitive organs, such as the gonads in males and the breasts in females. 26 In practice, like other dose reduction techniques such as iterative reconstruction algorithms, [13][14][15][16][17][18][19]27 optimization of the acquisition coverage could have a significant impact on the dose delivered to patients undergoing a urinary tract CT.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The researchers primarily evaluated the possibility of reducing the dose by increasing the pitch, 8 lowering the tube current, 9-11 using automatic tube current modulation, 12 reducing the tube voltage 13,14 and using iterative reconstruction algorithms. [13][14][15][16][17][18][19] Another simple and effective way to reduce the dose is to limit acquisition coverage from the top of the kidneys to the lower edge of the bladder. For the lower acquisition limit, the lower edge of the symphysis pubis bone is an accurate landmark.…”

Section: Introductionmentioning

confidence: 99%

Optimizing z-axis coverage of abdominal CT scans of the urinary tract: a proposed alternative proximal landmark for acquisition planning

Gervaise¹,

Teixeira²,

Hossu³

et al. 2016

BJR

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Objective: To evaluate an alternative method to reduce the acquisition coverage of urinary tract CT. Methods: This retrospective study included 365 abdominopelvic CT studies. Three radiographers simulated shortened acquisition coverages using three methods to determine the upper limit of the acquisition: Method 1 used the renal contours; Method 2 used the inferior margin of the 10th thoracic vertebra; and Method 3 used the point of intersection of the left diaphragmatic dome and the anterior margin of the vertebral bodies. Reductions in acquisition coverage and number of CT scans with a portion of the kidney excluded from the simulated reduced acquisition were compared between the three methods.Results: The mean 6 standard deviation reduction of acquisition coverage for the three readers with Methods 1, 2 and 3 were 20.5 6 4.8, 15.1 6 6.5 and 18.2 6 5.3%, respectively. Compared with Method 2, Method 3 allowed a mean scan length reduction of 3.6%. The proportions of CT scans with a portion of the kidney excluded from the simulated reduced acquisition with Methods 1, 2 and 3 and averaged over the three readers were 6.7, 0.7 and 1.4%, respectively, with no significant difference between Methods 2 and 3. Interreader and intrareader agreements were excellent with all methods, but interclass correlation coefficients were higher with Method 3. Conclusion: The method using the renal contours should not be used owing to its high proportion of kidneys with a portion excluded from the acquisition. Using the intersection of the left diaphragmatic dome and the anterior margin of the vertebral bodies for proximal landmark for urinary tract CT represents a new alternative method with a better reduction of scan length compared with the method using the inferior margin of T10 and with no significant increase in the number of kidneys with a portion excluded from the reduced acquisition. Advances in knowledge: A new method using the point of intersection of the left diaphragmatic dome and the anterior border of the vertebral bodies on the lateral scout radiograph is introduced to reduce the z-axis coverage of urinary tract CT scans.

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“…The most straightforward solution would therefore be to replace ultrasonographic examinations by other cross sectional imaging techniques, and more particularly CT. With recent improvements in dose reduction, CT scanning can now become the first-line imaging modality for a variety of clinical situations such as suspected renal colic [16][17][18]. We considered that ultrasonography could be replaced by CT for patients with suspected pyelonephritis, cholecystitis, hepatitis, hepatic colic or cholangitis and prostatitis.…”

Section: Discussionmentioning

confidence: 99%

Addressing requests for emergency ultrasonographic examinations when implementing teleradiology services

Junca-Laplace-Valageas

Gervaise

Pernin

et al. 2015

Diagnostic and Interventional Imaging

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Low-Dose CT With Automatic Tube Current Modulation, Adaptive Statistical Iterative Reconstruction, and Low Tube Voltage for the Diagnosis of Renal Colic: Impact of Body Mass Index

Cited by 50 publications

References 25 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

Optimizing z-axis coverage of abdominal CT scans of the urinary tract: a proposed alternative proximal landmark for acquisition planning

Addressing requests for emergency ultrasonographic examinations when implementing teleradiology services

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