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Leyendecker P, Roustan FR, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Diagnosis. Prog Urol 2023; 33:782-790. [PMID: 37918979 DOI: 10.1016/j.purol.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The choice of imaging modality is guided by the clinical presentation and the context (acute or not). Although ultrasound is safe (no radiation) and easily available, non-contrast-enhanced CT has become the gold standard in the diagnostic strategy for patients with acute flank pain because of its sensitivity (93.1%) and specificity (96.6%). It also allows determining the stone size, volume and density, visualizing their internal structure, and assessing their distance from the skin and the adjacent anatomy. All these parameters can influence the stone management and the choice of intervention modality. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations method (CPR) and the ADAPTE method, depending on whether the issue was considered in the EAU recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Affiliation(s)
- P Leyendecker
- Service de radiologie B, nouvel hôpital Civil, hôpitaux universitaires de Strasbourg, groupe d'imagerie médicale MIM, AFR-SIGU, Strasbourg, France
| | | | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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2
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Schmid FA, Mergen V, Bärlocher T, Kaufmann B, Epprecht L, Soyka MB, Eberli D, Hötker AM. Atherosclerosis of the iliac arteries for the prediction of erectile dysfunction and epistaxis in men undergoing abdominal CT scan. BMC Urol 2023; 23:173. [PMID: 37891557 PMCID: PMC10612309 DOI: 10.1186/s12894-023-01340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND To investigate the association between erectile dysfunction (ED) as well as epistaxis (ES) in relation to the extent of iliac atherosclerosis. METHODS In this retrospective cross-sectional study, all consecutive male patients treated at our institution from 01/2016 to 12/2020 undergoing abdominal CT scan were evaluated. Patients (n = 1272) were invited by mail to participate in the study in returning two questionnaires for the evaluation of ED (IIEF-5) and ES. Patients who returned filled-in questionnaires within a 3-month deadline were included in the study. The extent of atherosclerosis in the common iliac artery (CIA) and the internal iliac artery (IIA) was assessed by calcium scoring on unenhanced CT. Stratification of results was performed according to reported IIEF-5 scores and consequential ED groups. RESULTS In total, 437 patients (34.4% of contacted) met the inclusion criteria. Forty-two patients did not fulfill predefined age requirements (< 75 years) and 120 patients had to be excluded as calcium scoring on nonenhanced CT was not feasible. Finally, 275 patients were included in the analysis and stratified into groups of "no-mild" (n = 146) and "moderate-severe" (n = 129) ED. The calcium score (r=-0.28, p < 0.001) and the number of atherosclerotic lesions (r=-0.32, p < 0.001) in the CIA + IIA showed a significant negative correlation to the IIEF-5 score, respectively. Patients differed significantly in CIA + IIA calcium score (difference: 167.4, p < 0.001) and number of atherosclerotic lesions (difference: 5.00, p < 0.001) when belonging to the "no-mild" vs. "moderate-severe" ED group, respectively. A multivariable regression model, after adjusting for relevant baseline characteristics, showed that the number of atherosclerotic CIA + IIA lesions was an independent predictor of ED (OR = 1.05, p = 0.036), whereas CIA + IIA calcium score was not (OR = 1.00031, p = 0.20). No relevant correlation was found between ES episodes and IIEF-5 scores (r=-0.069, p = 0.25), CIA + IIA calcium score (r=-0.10, p = 0.87) or number of atherosclerotic CIA + IIA lesions (r=-0.032, p = 0.60), respectively. CONCLUSIONS The number of atherosclerotic lesions in the iliac arteries on nonenhanced abdominal CT scans is associated with the severity of ED. This may be used to identify subclinical cardiovascular disease and to quantify the risk for cardiovascular hazards in the future. TRIAL REGISTRATION BASEC-Nr. 2020 - 01637.
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Affiliation(s)
- Florian A Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Zurich, 8091, Switzerland.
| | - Victor Mergen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Timo Bärlocher
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Zurich, 8091, Switzerland
| | - Basil Kaufmann
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Zurich, 8091, Switzerland
| | - Lorenz Epprecht
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Zurich, 8091, Switzerland
| | - Andreas M Hötker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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3
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Chai CA, Teoh YC, Tailly T, Emiliani E, Inoue T, Tanidir Y, Gadzhiev N, Bin Hamri S, Ong WL, Shrestha A, Ragoori D, Lakmichi MA, Gorelov D, Soebhali B, Vaddi CM, Bhatia TP, Desai D, Durai P, Heng CT, Chew B, Castellani D, Somani B, Traxer O, Gauhar V. Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR). Minerva Urol Nephrol 2023; 75:493-500. [PMID: 37293816 DOI: 10.23736/s2724-6051.23.05239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Retrograde Intrarenal Surgery (RIRS) is recommended as an alternative to percutaneous nephrolithotomy for stones up to 2 cm. Pre-stenting before RIRS remains controversial with various studies differing in outcomes and recommendations. We aim to understand how pre-stenting influences surgical outcomes. METHODS A number of 6579 patients from the TOWER group registry were divided into pre-stented (group 1) and non-pre-stented groups (group 2). Patients aged ≥18 years old, with normal calyceal anatomy were enrolled. Patients with ureteric stones, anomalous kidneys, bilateral stones, planned for ECIRS were excluded. RESULTS Patients are homogeneously distributed in both groups (3112 vs. 3467). The predominant indication for pre-stenting was symptom relief. Overall stone size was comparable, whilst group 1 had a significantly more multiple (1419 vs. 1283, P<0.001) and lower-pole (LP) stones (1503 vs. 1411, P<0.001). The mean operative time for group 2 was significantly longer (68.17 vs. 58.92, P<0.001). Stone size, LP stones, age, recurrence and multiple stones are contributing factors for residual fragments at the multivariable analysis. The incidence of postoperative day 1 fever and sepsis was significantly higher in group 2, indicating that pre-stenting is associated with a lower risk of post-RIRS infection and a lower overall complications rate (13.62% vs. 15.89%) (P<0.001). CONCLUSIONS RIRS without pre-stenting can be considered safe without significant morbidity. Multiple, lower-pole and large stone is a significant contributor towards residual fragments. Patients who were not pre-stented had significantly higher but low-grade complications, especially for lower pole and large volume stones. While we do not advocate routine pre-stenting, a tailored approach for these patients should include proper counselling regarding pre-stenting.
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Affiliation(s)
- Chu-Ann Chai
- Unit of Urology, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia -
| | - Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Esteban Emiliani
- Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Takaaki Inoue
- Hara Genitourinary Private Hospital, University of Kobe, Kobe, Japan
| | - Yiloren Tanidir
- Department of Urology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - William L Ong
- Department of Urology, Penang General Hospital, Penang, Malaysia
| | - Anil Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Deepak Ragoori
- Asian Institute of Nephrology and Urology, Hyderabad, India
| | - Mohamed A Lakmichi
- Department of Urology, University Hospital Mohammed VI of Marrakesh, Cadi Ayyad University, Marrakesh, Morocco
| | - Dmitry Gorelov
- Department of Endourology, Saint-Petersburg State Medical University, Saint-Petersburg, Russia
| | - Boyke Soebhali
- Faculty of Medicine, Abdul Wahab Sjahranie Hospital, Mulawarman University, Mulawarman, Indonesia
| | - Chandra M Vaddi
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India
| | - Tanuj P Bhatia
- Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India
| | - Devang Desai
- Department of Urology, Toowoomba Base Hospital, Toowoomba, Australia
| | - Pradeep Durai
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Chin-Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Ben Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Daniele Castellani
- AOU Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Olivier Traxer
- Department of Urology, GRC Urolithiasis, Tenon Hospital, Sorbonne University, Paris, France
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Castellani D, Traxer O, Ragoori D, Galosi AB, De Stefano V, Gadzhiev N, Tanidir Y, Inoue T, Emiliani E, Hamri SB, Lakmichi MA, Vaddi CM, Heng CT, Soebhali B, More S, Sridharan V, Gökce MI, Tursunkulov AN, Ganpule A, Pirola GM, Naselli A, Aydin C, Ramón de Fata Chillón F, Mendoza CS, Candela L, Chew BH, Somani BK, Gauhar V. Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice-Lessons Learnt from Global Multicenter Experience of 1250 Patients. EUR UROL SUPPL 2023; 52:51-59. [PMID: 37284041 PMCID: PMC10240508 DOI: 10.1016/j.euros.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 06/08/2023] Open
Abstract
Background Bilateral kidney stones are commonly treated in staged procedures. Objective To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones. Design setting and participants Data from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo. Outcome measurements and statistical analysis Continuous variables are presented as medians and 25-75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR. Results and limitations A total of 1250 patients were included. The median age was 48.0 (36-61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The median surgical time was 75.0 (55-90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18-7.49, p = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28-15.73, p < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96-17.94, p < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12-7.31, p = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35-2.62, p < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16-7.66, p = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14-2.34, p < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32-4.74, p < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis. Conclusions SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones. Patient summary In this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Yiloren Tanidir
- Department of Urology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Private Hospital, Kobe University, Kobe, Japan
| | - Esteban Emiliani
- Department of Urology, Fundacion Puigvert, Autónomos University of Barcelona, Barcelona, Spain
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed Amine Lakmichi
- Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
| | | | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Boyke Soebhali
- Department of Urology, Abdul Wahab Sjahranie Hospital, Medical Faculty Mulawarman University, Samarinda, Indonesia
| | - Sumit More
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India
| | - Vikram Sridharan
- Department of Urology, Sree Paduka Speciality Hospital, Thillai Nagar, India
| | - Mehmet Ilker Gökce
- Department of Urology, Ankara University, School of Medicine, Ankara, Turkey
| | | | - Arvind Ganpule
- Department of Urology, Muļjibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Giacomo Maria Pirola
- Urology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Angelo Naselli
- Urology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Cemil Aydin
- Department of Urology, Hitit University, School of Medicine, Çorum, Turkey
| | | | - Catalina Solano Mendoza
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
- Department of Endourology, Uroclin S.A.S, Medellín, Colombia
| | - Luigi Candela
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Harrison JD, Haylock RGE, Jansen JTM, Zhang W, Wakeford R. Effective doses and risks from medical diagnostic x-ray examinations for male and female patients from childhood to old age. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:011518. [PMID: 36808910 DOI: 10.1088/1361-6498/acbda7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
The consideration of risks from medical diagnostic x-ray examinations and their justification commonly relies on estimates of effective dose, although the quantity is actually a health-detriment-weighted summation of organ/tissue-absorbed doses rather than a measure of risk. In its 2007 Recommendations, the International Commission on Radiological Protection (ICRP) defines effective dose in relation to a nominal value of stochastic detriment following low-level exposure of 5.7 × 10-2Sv-1, as an average over both sexes, all ages, and two fixed composite populations (Asian and Euro-American). Effective dose represents the overall (whole-body) dose received by a person from a particular exposure, which can be used for the purposes of radiological protection as set out by ICRP, but it does not provide a measure that is specific to the characteristics of the exposed individual. However, the cancer incidence risk models used by ICRP can be used to provide estimates of risk separately for males and females, as a function of age-at-exposure, and for the two composite populations. Here, these organ/tissue-specific risk models are applied to estimates of organ/tissue-specific absorbed doses from a range of diagnostic procedures to derive lifetime excess cancer incidence risk estimates; the degree of heterogeneity in the distribution of absorbed doses between organs/tissues will depend on the procedure. Depending on the organs/tissues exposed, risks are generally higher in females and notably higher for younger ages-at-exposure. Comparing lifetime cancer incidence risks per Sv effective dose from the different procedures shows that overall risks are higher by about a factor of two to three for the youngest age-at-exposure group, 0-9 yr, than for 30-39 yr adults, and lower by a similar factor for an age-at-exposure of 60-69 yr. Taking into account these differences in risk per Sv, and noting the substantial uncertainties associated with risk estimates, effective dose as currently formulated provides a reasonable basis for assessing the potential risks from medical diagnostic examinations.
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Affiliation(s)
- John D Harrison
- Oxford Brookes University, Faculty of Health and Life Sciences, Oxford OX3 0BP, United Kingdom
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards, Didcot, Oxon, OX11 0RQ, United Kingdom
| | - Richard G E Haylock
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards, Didcot, Oxon, OX11 0RQ, United Kingdom
| | - Jan T M Jansen
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards, Didcot, Oxon, OX11 0RQ, United Kingdom
| | - Wei Zhang
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards, Didcot, Oxon, OX11 0RQ, United Kingdom
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
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Niehoff JH, Carmichael AF, Woeltjen MM, Boriesosdick J, Michael AE, Schmidt B, Panknin C, Flohr TG, Shahzadi I, Piechota H, Borggrefe J, Kroeger JR. Clinical Low-Dose Photon-Counting CT for the Detection of Urolithiasis: Radiation Dose Reduction Is Possible without Compromising Image Quality. Diagnostics (Basel) 2023; 13:diagnostics13030458. [PMID: 36766563 PMCID: PMC9914353 DOI: 10.3390/diagnostics13030458] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Background: This study evaluated the feasibility of reducing the radiation dose in abdominal imaging of urolithiasis with a clinical photon-counting CT (PCCT) by gradually lowering the image quality level (IQL) without compromising the image quality and diagnostic value. Methods: Ninety-eight PCCT examinations using either IQL70 (n = 31), IQL60 (n = 31) or IQL50 (n = 36) were retrospectively included. Parameters for the radiation dose and the quantitative image quality were analyzed. Qualitative image quality, presence of urolithiasis and diagnostic confidence were rated. Results: Lowering the IQL from 70 to 50 led to a significant decrease (22.8%) in the size-specific dose estimate (SSDE, IQL70 4.57 ± 0.84 mGy, IQL50 3.53 ± 0.70 mGy, p < 0.001). Simultaneously, lowering the IQL led to a minimal deterioration of the quantitative quality, e.g., image noise increased from 9.13 ± 1.99 (IQL70) to 9.91 ± 1.77 (IQL50, p = 0.248). Radiologists did not notice major changes in the image quality throughout the IQLs. Detection rates of urolithiasis (91.3-100%) did not differ markedly. Diagnostic confidence was high and not influenced by the IQL. Conclusions: Adjusting the PCCT scan protocol by lowering the IQL can significantly reduce the radiation dose without significant impairment of the image quality. The detection rate and diagnostic confidence are not impaired by using an ultra-low-dose PCCT scan protocol.
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Affiliation(s)
- Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany
- Correspondence: ; Tel.: +49-571-790-4601; Fax: +49-571-790-294601
| | - Alexandra Fiona Carmichael
- Department of Urology, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany
| | - Matthias Michael Woeltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany
| | - Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany
| | | | | | | | | | - Hansjuergen Piechota
- Department of Urology, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany
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Zhang L, Li J, Pan C, Zhan Y, Li Z, Bai S. Development and validation of a predictive model for treatment outcome after emergency extracorporeal shockwave lithotripsy in patients with symptomatic ureteral stones during the COVID-19 pandemic: in a large prospective cohort. Urolithiasis 2022; 51:26. [PMID: 36585472 PMCID: PMC9803595 DOI: 10.1007/s00240-022-01401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023]
Abstract
The predictors of treatment outcome after emergency extracorporeal shockwave lithotripsy (SWL) are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting treatment outcome after emergency SWL in patients with symptomatic ureteral stones. The development cohort included 358 patients with symptomatic ureteral stones who underwent emergency SWL between June 2020 and August 2021 in our hospital. One hundred and twenty-nine patients with symptomatic ureteral stones participated in the validation cohort from September 2021 to April 2022. The data were prospectively recorded. The backward stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 15.6% (56/358) of patients in the development cohort and 14.0% (18/129) of those in the validation cohort suffered from stone-free failure after emergency SWL. We identified four predictors for stone-free failure: stone size, stone density, skin to stone distance (SSD), and degree of hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic (AUROC) curves of 0.935 (0.899-0.971) and good calibration (P = 0.059). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that stone size, stone density, SSD, and degree of hydronephrosis were predictors of treatment outcome after emergency SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of patients may increase the success rate of emergency SWL during the COVID-19 pandemic.
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Affiliation(s)
- Lvwen Zhang
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004 People’s Republic of China
- Department of Urology, Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui China
| | - Jia Li
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004 People’s Republic of China
| | - Chunyu Pan
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004 People’s Republic of China
| | - Yunhong Zhan
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004 People’s Republic of China
| | - Zhenhua Li
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004 People’s Republic of China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004 People’s Republic of China
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8
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Smith-Bindman R, Nielsen ME, Wang RC. Unchanged Diagnostic Imaging for Urinary Stone Disease-Where Do We Go From Here? JAMA Intern Med 2022; 182:1246-1247. [PMID: 36315160 DOI: 10.1001/jamainternmed.2022.4917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.,Departments of Urology, Epidemiology, and Health Policy & Management, University of North Carolina, Chapel Hill
| | - Matthew E Nielsen
- Department of Emergency Medicine, University of California, San Francisco
| | - Ralph C Wang
- Department of Emergency Medicine, University of California, San Francisco
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Higgins AM, Ganesan V, Ghani KR, Agarwal DK, Borofsky MS, Dauw CA. The 2023 Stone-Free CT Mandate: Addressing the Two Sides of the Debate. J Endourol 2022; 36:1522-1525. [PMID: 36150029 DOI: 10.1089/end.2022.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To the editors of the Journal of Endourology, we write to express our reservations in the recent announcement that starting in 2023 all reporting of stone-free rates be based on CT.
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Affiliation(s)
- Andrew M Higgins
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Deepak K Agarwal
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael S Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Casey A Dauw
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
PURPOSE OF REVIEW Radiological imaging techniques and applications are constantly advancing. This review will examine modern imaging techniques in the diagnosis of urolithiasis and applications for surgical planning. RECENT FINDINGS The diagnosis of urolithiasis may be done via plain film X-ray, ultrasound (US), or contrast tomography (CT) scan. US should be applied in the workup of flank pain in emergency rooms and may reduce unnecessary radiation exposure. Low dose and ultra-low-dose CT remain the diagnostic standard for most populations but remain underutilized. Single and dual-energy CT provide three-dimensional imaging that can predict stone-specific parameters that help clinicians predict stone passage likelihood, identify ideal management techniques, and possibly reduce complications. Machine learning has been increasingly applied to 3-D imaging to support clinicians in these prognostications and treatment selection. SUMMARY The diagnosis and management of urolithiasis are increasingly personalized. Patient and stone characteristics will support clinicians in treatment decision, surgical planning, and counseling.
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Smith-Bindman R, Yu S, Wang Y, Kohli MD, Chu P, Chung R, Luong J, Bos D, Stewart C, Bista B, Alejandrez Cisneros A, Delman B, Einstein AJ, Flynn M, Romano P, Seibert JA, Westphalen AC, Bindman A. An Image Quality-informed Framework for CT Characterization. Radiology 2022; 302:380-389. [PMID: 34751618 PMCID: PMC8805663 DOI: 10.1148/radiol.2021210591] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 02/03/2023]
Abstract
Background Lack of standardization in CT protocol choice contributes to radiation dose variation. Purpose To create a framework to assess radiation doses within broad CT categories defined according to body region and clinical imaging indication and to cluster indications according to the dose required for sufficient image quality. Materials and Methods This was a retrospective study using Digital Imaging and Communications in Medicine metadata. CT examinations in adults from January 1, 2016 to December 31, 2019 from the University of California San Francisco International CT Dose Registry were grouped into 19 categories according to body region and required radiation dose levels. Five body regions had a single dose range (ie, extremities, neck, thoracolumbar spine, combined chest and abdomen, and combined thoracolumbar spine). Five additional regions were subdivided according to dose. Head, chest, cardiac, and abdomen each had low, routine, and high dose categories; combined head and neck had routine and high dose categories. For each category, the median and 75th percentile (ie, diagnostic reference level [DRL]) were determined for dose-length product, and the variation in dose within categories versus across categories was calculated and compared using an analysis of variance. Relative median and DRL (95% CI) doses comparing high dose versus low dose categories were calculated. Results Among 4.5 million examinations, the median and DRL doses varied approximately 10 times between categories compared with between indications within categories. For head, chest, abdomen, and cardiac (3 266 546 examinations [72%]), the relative median doses were higher in examinations assigned to the high dose categories than in examinations assigned to the low dose categories, suggesting the assignment of indications to the broad categories is valid (head, 3.4-fold higher [95% CI: 3.4, 3.5]; chest, 9.6 [95% CI: 9.3, 10.0]; abdomen, 2.4 [95% CI: 2.4, 2.5]; and cardiac, 18.1 [95% CI: 17.7, 18.6]). Results were similar for DRL doses (all P < .001). Conclusion Broad categories based on image quality requirements are a suitable framework for simplifying radiation dose assessment, according to expected variation between and within categories. © RSNA, 2021 See also the editorial by Mahesh in this issue.
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Affiliation(s)
- Rebecca Smith-Bindman
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Sophronia Yu
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Yifei Wang
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Marc D. Kohli
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Philip Chu
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Robert Chung
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Jason Luong
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Denise Bos
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Carly Stewart
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Biraj Bista
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Alejandro Alejandrez Cisneros
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Bradley Delman
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Andrew J. Einstein
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Michael Flynn
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Patrick Romano
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - J. Anthony Seibert
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Antonio C. Westphalen
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Andrew Bindman
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
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12
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The reasons of unsatisfactory results of extracorporeal shock wave lithotripsy in patients with ureterolithiasis. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone.The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy.
Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed.
Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don’t cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long–term (more than two months) ureteric stone persistence increase the risk of intramucosal “ingrowth” of the calculi greatly.
Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock–wave lithotripsy) and reduce its efficacy.
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13
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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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14
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Harrison JD, Balonov M, Bochud F, Martin C, Menzel HG, Ortiz-Lopez P, Smith-Bindman R, Simmonds JR, Wakeford R. ICRP Publication 147: Use of Dose Quantities in Radiological Protection. Ann ICRP 2021; 50:9-82. [PMID: 33653178 DOI: 10.1177/0146645320911864] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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15
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Zeng G, Cai C, Duan X, Xu X, Mao H, Li X, Nie Y, Xie J, Li J, Lu J, Zou X, Mo J, Li C, Li J, Wang W, Yu Y, Fei X, Gu X, Chen J, Kong X, Pang J, Zhu W, Zhao Z, Wu W, Sun H, Liu Y, la Rosette JD. Mini Percutaneous Nephrolithotomy Is a Noninferior Modality to Standard Percutaneous Nephrolithotomy for the Management of 20-40mm Renal Calculi: A Multicenter Randomized Controlled Trial. Eur Urol 2020; 79:114-121. [PMID: 32994063 DOI: 10.1016/j.eururo.2020.09.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND High quality of evidence comparing mini percutaneous nephrolithotomy (mPNL) with standard percutaneous nephrolithotomy (sPNL) for the treatment of larger-sized renal stones is lacking. OBJECTIVE To compare the efficacy and safety of mPNL and sPNL for the treatment of 20-40mm renal stones. DESIGN, SETTING, AND PARTICIPANTS A parallel, open-label, and noninferior randomized controlled trial was performed at 20 Chinese centers (2016-2019). The inclusion criteria were patients 18-70 yr old, with normal renal function, and 20-40mm renal stones. INTERVENTION Percutaneous nephrolithotomy PNL was performed using either 18 F or 24 F percutaneous nephrostomy tracts. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the one-session stone-free rate (SFR). The secondary outcomes included operating time, visual analog pain scale (VAS) score, blood loss, complications as per the Clavien-Dindo grading system, and length of hospitalization. RESULTS AND LIMITATIONS The 1980 intention-to-treat patients were randomized. The mPNL group achieved a noninferior one-session SFR to the sPNL group by the one-side noninferiority test (0.5% [difference], p < 0.001). The transfusion and embolization rates were comparable; however, the sPNL group had a higher hemoglobin drop (5.2 g/l, p < 0.001). The sPNL yielded shorter operating time (-2.2 min, p = 0.008) but a higher VAS score (0.8, p < 0.001). Patients in the sPNL group also had longer hospitalization (0.6 d, p < 0.001). There was no statistically significant difference in fever or urosepsis occurrences. The study's main limitation was that only 18F or 24F tract sizes were used. CONCLUSIONS Mini mPNL achieves noninferior SFR outcomes to sPNL, but with reduced bleeding, less postoperative pain, and shorter hospitalization. PATIENT SUMMARY We evaluated the surgical outcomes of percutaneous nephrolithotomy using two different sizes of nephrostomy tracts in a large population. We found that the smaller tract might be a sensible alternative for patients with 20-40mm renal stones.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China.
| | - Chao Cai
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Xianzhong Duan
- Department of Urology, Baoshan No.2 People's Hospital, Baoshan, China
| | - Xun Xu
- Department of urology, Affiliated Nanhai Hospital, Southern Medical University (People's Hospital of Nanhai District), Foshan, China
| | - Houping Mao
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xuedong Li
- Department of Urology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yong Nie
- Department of Urology, Yiling Hospital,Yichang, China
| | - Jianjun Xie
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University
| | - Jiongming Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jun Lu
- Department of Urology, Shanghai General Hospital, Shanghai, China
| | - Xiaofeng Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Jianfeng Mo
- Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China
| | - Chengyang Li
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianzhong Li
- Department of Urology, General Hospital of Northern Theater Command
| | - Weiguo Wang
- Department of Urology, Jining No.1 People's Hospital, Jining, China
| | - Yonggang Yu
- Department of Urology, 181st Hospital of Chinese People's Liberation Army, Guilin, China
| | - Xiang Fei
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Xianen Gu
- Department of Urology, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Jianhui Chen
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiangbo Kong
- Department of Urology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Jian Pang
- Department of Urology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yet-sen University, Jiangmen, China
| | - Wei Zhu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Zhijian Zhao
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Wenqi Wu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Hongling Sun
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Yongda Liu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Jean de la Rosette
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China; Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Urology, Istanbul Medipol University, Istanbul, Turkey
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16
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Xie Y, Tao J, Liu H, Zang X, Zhang Z, Guo G, Liu B. THE USE OF LOW-DOSE CT WITH ADAPTIVE STATISTICAL ITERATIVE RECONSTRUCTION FOR THE DIAGNOSIS OF URINARY CALCULI. RADIATION PROTECTION DOSIMETRY 2020; 190:200-207. [PMID: 32685973 DOI: 10.1093/rpd/ncaa094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to explore the diagnosis of urinary calculi through utilisation of low-dose computed tomography (LDCT) with adaptive statistical iterative reconstruction (ASIR). Data from 140 patients that had undergone pathological or operative diagnosis with urinary calculi were analysed. Patients were divided into two groups based on whether they received conventional-dose computed tomography (CDCT) or LDCT, respectively, followed by filtered back projection or ASIR. Average CDCT radiation doses were roughly 4-fold higher than LDCT doses. Despite this difference, there were no significant differences between groups with respect to stone size or location, image quality (P = 0.261), image noise (P = 0.153) and diagnostic efficacy (P = 0.371). LDCT is an effective approach to urinary calculi diagnosis, performing to ASIR while decreasing the effective radiation dose, improving the safety of this procedure.
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Affiliation(s)
- Yingdi Xie
- Department of Radiology, Binhai County People's Hospital, YanCheng 224500, China
| | - Jingshan Tao
- Department of Radiology, Binhai County People's Hospital, YanCheng 224500, China
| | - Hailing Liu
- Department of Radiology, Binhai County People's Hospital, YanCheng 224500, China
| | - Xiaojin Zang
- Department of Radiology, Binhai County People's Hospital, YanCheng 224500, China
| | - Zhengming Zhang
- Department of Radiology, Binhai County People's Hospital, YanCheng 224500, China
| | - Guangjie Guo
- Department of Radiology, Binhai County People's Hospital, YanCheng 224500, China
| | - Bin Liu
- Department of Radiology, Binhai County People's Hospital, YanCheng 224500, China
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
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17
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Georgieva MV, Wheeler SB, Erim D, Smith-Bindman R, Loo R, Ng C, Garg T, Raynor M, Nielsen ME. Comparison of the Harms, Advantages, and Costs Associated With Alternative Guidelines for the Evaluation of Hematuria. JAMA Intern Med 2019; 179:1352-1362. [PMID: 31355874 PMCID: PMC6664383 DOI: 10.1001/jamainternmed.2019.2280] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Existing recommendations for the diagnostic testing of hematuria range from uniform evaluation of varying intensity to patient-level risk stratification. Concerns have been raised about not only the costs and advantages of computed tomography (CT) scans but also the potential harms of CT radiation exposure. OBJECTIVE To compare the advantages, harms, and costs associated with 5 guidelines for hematuria evaluation. DESIGN, SETTING, AND PARTICIPANTS A microsimulation model was developed to assess each of the following guidelines (listed in order of increasing intensity) for initial evaluation of hematuria: Dutch, Canadian Urological Association (CUA), Kaiser Permanente (KP), Hematuria Risk Index (HRI), and American Urological Association (AUA). Participants comprised a hypothetical cohort of patients (n = 100 000) with hematuria aged 35 years or older. This study was conducted from August 2017 through November 2018. EXPOSURES Under the Dutch and CUA guidelines, patients received cystoscopy and ultrasonography if they were 50 years or older (Dutch) or 40 years or older (CUA). Under the KP and HRI guidelines, patients received different combinations of cystoscopy, ultrasonography, and CT urography or no evaluation on the basis of risk factors. Under the AUA guidelines, all patients 35 years or older received cystoscopy and CT urography. MAIN OUTCOMES AND MEASURES Urinary tract cancer detection rates, radiation-induced secondary cancers (from CT radiation exposure), procedural complications, false-positive rates per 100 000 patients, and incremental cost per additional urinary tract cancer detected. RESULTS The simulated cohort included 100 000 patients with hematuria, aged 35 years or older. A total of 3514 patients had urinary tract cancers (estimated prevalence, 3.5%; 95% CI, 3.0%-4.0%). The AUA guidelines missed detection for the fewest number of cancers (82 [2.3%]) compared with the detection rate of the HRI (116 [3.3%]) and KP (130 [3.7%]) guidelines. However, the simulation model projected 108 (95% CI, 34-201) radiation-induced cancers under the KP guidelines, 136 (95% CI, 62-229) under the HRI guidelines, and 575 (95% CI, 184-1069) under the AUA guidelines per 100 000 patients. The CUA and Dutch guidelines missed detection for a larger number of cancers (172 [4.9%] and 251 [7.1%]) but had 0 radiation-induced secondary cancers. The AUA guidelines cost approximately double the other 4 guidelines ($939/person vs $443/person for Dutch guidelines), with an incremental cost of $1 034 374 per urinary tract cancer detected compared with that of the HRI guidelines. CONCLUSIONS AND RELEVANCE In this simulation study, uniform CT imaging for patients with hematuria was associated with increased costs and harms of secondary cancers, procedural complications, and false positives, with only a marginal increase in cancer detection. Risk stratification may optimize the balance of advantages, harms, and costs of CT.
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Affiliation(s)
- Mihaela V Georgieva
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill
| | - Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | - Daniel Erim
- Division of eHealth, Quality and Analytics, Social Policy, Health and Economics Research Unit, RTI International, Research Triangle Park, North Carolina
| | - Rebecca Smith-Bindman
- Departments of Radiology, Epidemiology and Biostatistics, University of California at San Francisco, San, Francisco
| | - Ronald Loo
- Department of Urology, Kaiser Permanente Southern California, Los Angeles, California
| | - Casey Ng
- Department of Urology, Kaiser Permanente Southern California, Los Angeles, California
| | - Tullika Garg
- Department of Urology, Geisinger Health, Danville, Pennsylvania
| | - Mathew Raynor
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill
| | - Matthew E Nielsen
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill.,Department of Urology, University of North Carolina School of Medicine, Chapel Hill.,Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill.,Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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18
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Tzou DT, Zetumer S, Usawachintachit M, Taguchi K, Bechis SK, Duty BD, Harper JD, Hsi RS, Sorensen M, Sur RL, Reliford-Titus S, Chang HC, Isaacson D, Bayne DB, Wang ZJ, Stoller ML, Chi T. Computed Tomography Radiation Exposure Among Referred Kidney Stone Patients: Results from the Registry for Stones of the Kidney and Ureter. J Endourol 2019; 33:619-624. [PMID: 31030576 DOI: 10.1089/end.2019.0091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Kidney stone patients routinely have CT scans during diagnostic work-up before being referred to a tertiary center. How often these patients exceed the recommended dose limits for occupational radiation exposure of >100 mSv for 5 years and >50 mSv in a single year from CT alone remains unknown. This study aimed to quantify radiation doses from CTs received by stone patients before their evaluation at a tertiary care stone clinic. Methods: From November 2015 to March 2017, consecutive new patients enrolled into the Registry for Stones of the Kidney and Ureter (ReSKU™) had the dose-length product of every available CT abdomen/pelvis within 5 years of their initial visit recorded, allowing for an effective dose (EDose) calculation. Multivariate logistic regression analysis identified factors associated with exceeding recommended dose limits. Models were created to test radiation reducing effects of low-dose and phase-reduction CT protocols. Results: Of 343 noncontrast CTs performed, only 29 (8%) were low-dose CTs (calculated EDose <4 mSv). Among 389 total patients, 101 (26%) and 25 (6%) had an EDose >20 mSv and >50 mSv/year, respectively. Increased body mass index, number of scans, and multiphase scans were associated with exceeding exposure thresholds (p < 0.01). The implementation of a low-dose CT protocol decreased the estimated number of scans contributing to overexposure by >50%. Conclusions: Stone patients referred to a tertiary stone center may receive excessive radiation from CT scans alone. Unnecessary phases and underutilization of low-dose CT protocols continue to take place. Enacting new approaches to CT protocols may spare stone patients from exceeding recommended dose limits.
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Affiliation(s)
- David T Tzou
- 1 Department of Urology, University of California, San Francisco, San Francisco, California.,2 Division of Urology, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Samuel Zetumer
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
| | - Manint Usawachintachit
- 1 Department of Urology, University of California, San Francisco, San Francisco, California.,3 Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand
| | - Kazumi Taguchi
- 1 Department of Urology, University of California, San Francisco, San Francisco, California.,4 Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Seth K Bechis
- 5 Department of Urology, University of California, San Diego, San Diego, California
| | - Brian D Duty
- 6 Department of Urology, Oregon Health & Science University, Portland, Oregon
| | - Jonathan D Harper
- 7 Department of Urology, University of Washington, Seattle, Washington
| | - Ryan S Hsi
- 8 Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mathew Sorensen
- 7 Department of Urology, University of Washington, Seattle, Washington
| | - Roger L Sur
- 5 Department of Urology, University of California, San Diego, San Diego, California
| | | | - Helena C Chang
- 7 Department of Urology, University of Washington, Seattle, Washington
| | - Dylan Isaacson
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
| | - David B Bayne
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
| | - Zhen J Wang
- 9 Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Marshall L Stoller
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
| | - Thomas Chi
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
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19
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Impact of the Image Gently® Campaign on Computerized Tomography Use for Evaluation of Pediatric Nephrolithiasis. J Urol 2019; 201:996-1004. [PMID: 30694933 DOI: 10.1097/ju.0000000000000030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The Image Gently® campaign was launched by several radiological societies in 2007 to promote safe imaging in children. A goal of the campaign was to reduce ionizing radiation exposure in children. Given the recurrent nature of kidney stones, affected children are at risk for unnecessary ionizing radiation exposure from computerized tomography. We sought to determine whether the Image Gently campaign led to a decrease in the use of computerized tomography for evaluating children with nephrolithiasis. We hypothesized that the campaign was the primary cause of a reduction in the use of computerized tomography. MATERIALS AND METHODS We analyzed medical claims data from 2001 to 2015 identifying children with nephrolithiasis covered by the same commercial insurance provider. Using a difference in differences design, we estimated changes in computerized tomography use after the campaign started among patients less than 18 years old compared to a control group age 18 years or older with nephrolithiasis. RESULTS We identified 12,734 children and 787,720 adults diagnosed with nephrolithiasis. Before 2007 quarterly rates of computerized tomography use during a stone episode (per 1,000 patients) were increasing at a parallel rate in children and adults (5.1 in children vs 7.2 in adults, p = 0.123). After the Image Gently campaign started the use of computerized tomography decreased in both groups but at a slightly higher rate in adults (difference in differences 2.96, 95% CI 0.00 to 5.91, p = 0.050). CONCLUSIONS Although there has been a reduction in the use of computerized tomography among children with nephrolithiasis, given a similar trend seen in adults this change cannot be primarily attributed to the Image Gently campaign.
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Raja AS, Pourjabbar S, Ip IK, Baugh CW, Sodickson AD, O'Leary M, Khorasani R. Impact of a Health Information Technology–Enabled Appropriate Use Criterion on Utilization of Emergency Department CT for Renal Colic. AJR Am J Roentgenol 2019; 212:142-145. [DOI: 10.2214/ajr.18.19966] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Ali S. Raja
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sarvenaz Pourjabbar
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Ivan K. Ip
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Christopher W. Baugh
- Harvard Medical School, Boston, MA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Aaron D. Sodickson
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Michael O'Leary
- Harvard Medical School, Boston, MA
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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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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Weisenthal K, Karthik P, Shaw M, Sengupta D, Bhargavan-Chatfield M, Burleson J, Mustafa A, Kalra M, Moore C. Evaluation of Kidney Stones with Reduced-Radiation Dose CT: Progress from 2011-2012 to 2015-2016-Not There Yet. Radiology 2017; 286:581-589. [PMID: 28858562 DOI: 10.1148/radiol.2017170285] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To determine if the use of reduced-dose computed tomography (CT) for evaluation of kidney stones increased in 2015-2016 compared with that in 2011-2012, to determine variability in radiation exposure according to facility for this indication, and to establish a current average radiation dose for CT evaluation for kidney stones by querying a national dose registry. Materials and Methods This cross-sectional study was exempt from institutional review board approval. Data were obtained from the American College of Radiology dose registry for CT examinations submitted from July 2015 to June 2016. Study descriptors consistent with single-phase unenhanced CT for evaluation of kidney stones and associated RadLex® Playbook identifiers (RPIDs) were retrospectively identified. Facilities actively submitting data on kidney stone-specific CT examinations were included. Dose metrics including volumetric CT dose index, dose-length product, and size-specific dose estimate, when available, were reported, and a random effects model was run to account for clustering of CT examinations at facilities. A z-ratio was calculated to test for a significant difference between the proportion of reduced-radiation dose CT examinations (defined as those with a dose-length product of 200 mGy · cm or less) performed in 2015-2016 and the proportion performed in 2011-2012. Results Three hundred four study descriptors for kidney stone CT corresponding to data from 328 facilities that submitted 105 334 kidney stone CT examinations were identified. Reduced-dose CT examinations accounted for 8040 of 105 334 (7.6%) CT examinations, a 5.6% increase from the 1010 of 49 903 (2%) examinations in 2011-2012 (P < .001). Mean overall dose-length product was 689 mGy · cm (95% confidence interval: 667, 712), decreased from the mean of 746 mGy · cm observed in 2011-2012. Median facility dose-length product varied up to sevenfold, from less than 200 mGy · cm to greater than 1600 mGy · cm. Conclusion Use of reduced-radiation dose CT for evaluation of kidney stones has increased since 2011-2012, but remains low; variability of radiation dose according to facility continues to be wide. National mean CT radiation exposure for evaluation of renal colic during 2015-2016 decreased relative to 2011-2012 values, but remained well above what is reasonably achievable. © RSNA, 2017.
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Affiliation(s)
- Karrin Weisenthal
- From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.)
| | - Priyadarshini Karthik
- From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.)
| | - Melissa Shaw
- From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.)
| | - Debapriya Sengupta
- From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.)
| | - Mythreyi Bhargavan-Chatfield
- From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.)
| | - Judy Burleson
- From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.)
| | - Adel Mustafa
- From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.)
| | - Mannudeep Kalra
- From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.)
| | - Christopher Moore
- From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.)
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Harrison JD, Balonov M, Martin CJ, Ortiz Lopez P, Menzel HG, Simmonds JR, Smith-Bindman R, Wakeford R. Use of effective dose. Ann ICRP 2016; 45:215-224. [PMID: 26980800 DOI: 10.1177/0146645316634566] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
International Commission on Radiological Protection (ICRP) Publication 103 provided a detailed explanation of the purpose and use of effective dose and equivalent dose to individual organs and tissues. Effective dose has proven to be a valuable and robust quantity for use in the implementation of protection principles. However, questions have arisen regarding practical applications, and a Task Group has been set up to consider issues of concern. This paper focusses on two key proposals developed by the Task Group that are under consideration by ICRP: (1) confusion will be avoided if equivalent dose is no longer used as a protection quantity, but regarded as an intermediate step in the calculation of effective dose. It would be more appropriate for limits for the avoidance of deterministic effects to the hands and feet, lens of the eye, and skin, to be set in terms of the quantity, absorbed dose (Gy) rather than equivalent dose (Sv). (2) Effective dose is in widespread use in medical practice as a measure of risk, thereby going beyond its intended purpose. While doses incurred at low levels of exposure may be measured or assessed with reasonable reliability, health effects have not been demonstrated reliably at such levels but are inferred. However, bearing in mind the uncertainties associated with risk projection to low doses or low dose rates, it may be considered reasonable to use effective dose as a rough indicator of possible risk, with the additional consideration of variation in risk with age, sex and population group.
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Affiliation(s)
- J D Harrison
- Oxford Brookes University, Faculty of Health and Life Sciences, Oxford OX3 0BP, UK
| | - M Balonov
- St. Petersburg Institute of Radiation Hygiene, Russia
| | | | | | - H-G Menzel
- European Organisation for Nuclear Research, Switzerland
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Cohen A, Hughes K, Fahey N, Caldwell B, Wang CH, Park S. Wide Variation in Radiation Exposure During Computerized Tomography. Urology 2016; 95:47-53. [PMID: 27233928 DOI: 10.1016/j.urology.2016.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the variance in computeed tomography (CT) radiation measured via dose-length product (DLP) and effective dose (ED) during stone protocol CT scans. METHODS We retrospectively examined consecutive records of patients receiving stone protocol diagnostic CT scans (n = 1793) in 2010 and 2014 in our health system. Patient age, body mass index (BMI), and gender were recorded, along with the hospital, machine model, year, DLP, and ED of each scan. Multivariate regression was performed to identify predictive factors for increased DLP. We also collected data on head (n = 837) CT scans to serve as a comparison. RESULTS For stone CT scans, mean patient age was 55.1 ± 18.4 years with no significant difference in age (P=.2557) or BMI (P=.1794) between 2010 and 2014. Gender, BMI, and machine model were independent predictors of radiation dosage (P < .0001). Within each BMI class, there was an inexplicable 6-fold variation in the ED for the same imaging test when comparing the lowest and highest CT dose patients. There was no significant change in DLP over time for stone CT scans, but head scan patients in 2014 received lower radiation doses than those in 2010 (P < .0001). Low-dose scans for renal colic (defined as <4 mSv) were underutilized. Substantial variation exists for head scan radiation doses. CONCLUSION Our data demonstrate large variations in diagnostic CT radiation dosage. Such differences within a single institution suggest similar trends elsewhere, warranting more stringent dosage guidelines and regulations for diagnostic CT scans within institutions.
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Affiliation(s)
- Andrew Cohen
- Section of Urology, University of Chicago, Chicago, IL
| | - Katie Hughes
- Division of Urology, NorthShore University HealthSystem, Evanston, IL
| | - Natalie Fahey
- Division of Urology, NorthShore University HealthSystem, Evanston, IL
| | - Brandon Caldwell
- Division of Urology, NorthShore University HealthSystem, Evanston, IL
| | - Chi Hsiung Wang
- Division of Urology, NorthShore University HealthSystem, Evanston, IL
| | - Sangtae Park
- Division of Urology, NorthShore University HealthSystem, Evanston, IL.
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Abstract
Pediatric stone disease is increasing in incidence and healthcare costs. With more years at-risk for stone recurrence during their lifetimes, children with nephrolithiasis constitute a high-risk patient population that requires focused intervention through both medical and surgical means. Through high-quality future studies to compare methods of stone prevention and treatment, the burden of stone disease on the youngest members of society may be ameliorated.
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Affiliation(s)
- David I Chu
- Fellow, Division of Urology, The Children's Hospital of Philadelphia
| | - Gregory E Tasian
- Assistant Professor of Urology and Epidemiology, Senior Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Division of Urology and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - Lawrence Copelovitch
- Assistant Professor of Clinical Pediatrics, University of Pennsylvania Perelman School of Medicine, Division of Nephrology, The Children's Hospital of Philadelphia
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Sulagaesuan C, Saksobhavivat N, Asavaphatiboon S, Kaewlai R. Reducing emergency CT radiation doses with simple techniques: A quality initiative project. J Med Imaging Radiat Oncol 2015; 60:23-34. [PMID: 26597510 DOI: 10.1111/1754-9485.12410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/20/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Use of indication-specific CT protocols and adjustment of scan parameters to decrease radiation exposure may result in significant dose reduction. We implemented these strategies and compare pre- and post-implementation radiation dose in emergency department (ED) patients. METHOD This was a descriptive, retrospective study. Patients older than 15 years who had undergone emergency CT examinations of the head, chest, abdomen, pelvis and abdominopelvic region in periods before and after dose-reduction implementation were included. The primary outcome was volume CT dose index (CTDIvol ) and dose length products (DLP). RESULTS There were 786 studies in the pre-implementation (group 1) and 955 studies in the post-implementation (group 2) periods. Radiation dose from all CT types significantly reduced in the post-implementation period. Average CTDIvol for head, chest, abdomen, pelvis and abdominopelvic region (doses during pre-implementation period in parentheses) were 51.5 (109), 8.1 (30.4), 13.1 (41.8), 11 (38), 11.2 (41.8) mGy, respectively. Average DLP was also significantly lower (pre-implementation dose in parentheses) in all CT types, which were 943 (2232), 324 (2517), 944 (5605), 280 (4024), 809 (7118) mGy●cm, respectively. Patients' age, gender, body mass index and size were not significantly different between the two groups. Image quality decreased but almost all examinations received an acceptable diagnostic subjective image quality. CONCLUSION Simple methods could help significantly reduce CT radiation exposure in ED patients while maintaining an acceptable level of diagnostic image quality.
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Affiliation(s)
- Chakkarat Sulagaesuan
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Nitima Saksobhavivat
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Sawwanee Asavaphatiboon
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Rathachai Kaewlai
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
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