Ureteral colic: US versus CT

Ripollés, Tomás; Errando, J Palao; Agramunt, Marcos; Martínez, María Jesús

doi:10.1007/s00261-003-0098-7

Cited by 34 publications

(25 citation statements)

References 12 publications

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“…Imaging in suspected renal colic is an area in which there is wide practice variability; given a similar patient with a high likelihood of kidney stone and low likelihood of alternative diagnosis, a clinician may opt for a regular-dose CT, reduced-dose CT, radiograph, ultrasonography, or no imaging at all. [29][30][31][32] Some have advocated that the radiograph be abandoned entirely, given the possibility of conducting a reduced-dose CT. 33 CT (regular or reduced dose) is less likely to be performed for kidney stone outside of the United States. 30,[34][35][36] It is also arguable that many of these patients could be appropriately managed without imaging in the acute setting if the clinician is confident in the diagnosis.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…CT is more effective than excretory urography for the detection of ureteral calculi (18), with sensitivity and specificity ranging between 92% and 99% (19). CT also is better than urography for diagnosing the complications of stone disease.…”

Section: Developing Practice Policies and Guidelinesmentioning

confidence: 99%

Radiation Exposure and Pregnancy: When Should We Be Concerned?

McCollough¹,

Schueler²,

et al. 2007

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The potential biological effects of in utero radiation exposure of a developing fetus include prenatal death, intrauterine growth restriction, small head size, mental retardation, organ malformation, and childhood cancer. The risk of each effect depends on the gestational age at the time of exposure, fetal cellular repair mechanisms, and the absorbed radiation dose level. A comparison between the dose levels associated with each of these risks and the estimated fetal doses from typical radiologic examinations lends support to the conclusion that fetal risks are minimal and, therefore, that radiologic and nuclear medicine examinations that may provide significant diagnostic information should not be withheld from pregnant women. The latter position is advocated by the International Commission on Radiological Protection, National Council on Radiation Protection, American College of Radiology, and American College of Obstetrics and Gynecology. However, although the risks are small, it is important to ensure that radiation doses are kept as low as reasonably achievable.

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“…US of the urinary tract is highly operator-dependent, with sensitivity of US for acute flank pain reported at 61% to 93% and largely limited by poor visualization of the ureters. 57–59 While plain radiography with US would greatly decrease radiation dose by an order of magnitude, sensitivity is lower than for CT. 60–62 This is why US leads to many equivocal studies for which CT may ultimately be necessary. 63 Finally, although MRI can identify ureteral obstruction, its limited availability and suboptimal power to identify the cause and exact location limits its use.…”

Section: Resultsmentioning

confidence: 99%

Radiation Dose From Medical Imaging: A Primer for Emergency Physicians

Jones¹,

Mills²,

Mogensen³

et al. 2012

WestJEM

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IntroductionMedical imaging now accounts for most of the US population's exposure to ionizing radiation. A substantial proportion of this medical imaging is ordered in the emergency setting. We aim to provide a general overview of radiation dose from medical imaging with a focus on computed tomography, as well as a literature review of recent efforts to decrease unnecessary radiation exposure to patients in the emergency department setting.MethodsWe conducted a literature review through calendar year 2010 for all published articles pertaining to the emergency department and radiation exposure.ResultsThe benefits of imaging usually outweigh the risks of eventual radiation-induced cancer in most clinical scenarios encountered by emergency physicians. However, our literature review identified 3 specific clinical situations in the general adult population in which the lifetime risks of cancer may outweigh the benefits to the patient: rule out pulmonary embolism, flank pain, and recurrent abdominal pain in inflammatory bowel disease. For these specific clinical scenarios, a physician-patient discussion about such risks and benefits may be warranted.ConclusionEmergency physicians, now at the front line of patients' exposure to ionizing radiation, should have a general understanding of the magnitude of radiation dose from advanced medical imaging procedures and their associated risks. Future areas of research should include the development of protocols and guidelines that limit unnecessary patient radiation exposure.

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Ureteral colic: US versus CT

Cited by 34 publications

References 12 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

Radiation Exposure and Pregnancy: When Should We Be Concerned?

Radiation Dose From Medical Imaging: A Primer for Emergency Physicians

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