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MacNevin W, Chua M, Kraus MS, Keefe DT. Radiation exposure associated with computed tomography for pediatric urolithiasis evaluation: A scoping review of the literature. J Pediatr Urol 2024:S1477-5131(24)00155-4. [PMID: 38521719 DOI: 10.1016/j.jpurol.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Computed tomography (CT) imaging is used for assessment of pediatric urolithiasis in cases where ultrasound is inconclusive. The utility of CT imaging must be considered alongside the potential risks of radiation exposure in this patient population due to the increased risk of cancer development. The purpose of this review is to investigate the radiation exposure associated with standard-dose and low-dose computed tomography (CT) imaging for the assessment of pediatric urolithiasis. METHODS A scoping literature review over a 23 year period between 2000 and 2023 was conducted of all English-language studies reporting on the use of non-contrast CT imaging for assessment of pediatric urolithiasis. Patients that were specified as pediatric with age ≤20 years at time of intervention and undergoing standard-dose or low/ultra-low-dose CT were included. Low-dose and ultra-low-dose CT were defined as a radiation dose ≤3.0 mSv and ≤1.9 mSv, respectively. RESULTS A total of 8121 articles were identified and after screening, 6 articles representing 309 patients were included in this scoping review. Of the articles reviewed, standard non-contrast CT radiation doses for pediatric urolithiasis evaluation ranged from 2.9 to 5.5 mSv and low-dose CT radiation dose was reported to be 1.0-2.72 mSv. Only 2 studies directly evaluated low-dose CT imaging compared to standard-dose CT imaging for pediatric urolithiasis assessment. Radiation reduction approaches did not negatively impact urolithiasis detection or characterization in 2 studies reviewed. CONCLUSIONS CT radiation doses for suspected or known pediatric urolithiasis are underreported and vary greatly with underutilization of low-dose/ultra-dose protocols for pediatric urolithiasis especially in comparison to the adult population. Results from this scoping review support that low-dose CTprotocols for pediatric stone disease are feasible to reduce radiation exposure.
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Affiliation(s)
- Wyatt MacNevin
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, M5G 1E8, Canada
| | - Mareen Sarah Kraus
- Department of Diagnostic Radiology, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Daniel T Keefe
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada; Division of Pediatric Urology, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada.
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Prod'homme S, Bouzerar R, Forzini T, Delabie A, Renard C. Detection of urinary tract stones on submillisievert abdominopelvic CT imaging with deep-learning image reconstruction algorithm (DLIR). Abdom Radiol (NY) 2024:10.1007/s00261-024-04223-w. [PMID: 38470506 DOI: 10.1007/s00261-024-04223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Urolithiasis is a chronic condition that leads to repeated CT scans throughout the patient's life. The goal was to assess the diagnostic performance and image quality of submillisievert abdominopelvic computed tomography (CT) using deep learning-based image reconstruction (DLIR) in urolithiasis. METHODS 57 patients with suspected urolithiasis underwent both non-contrast low-dose (LD) and ULD abdominopelvic CT. Raw image data of ULD CT were reconstructed using hybrid iterative reconstruction (ASIR-V 70%) and high-strength-level DLIR (DLIR-H). The performance of ULD CT for the detection of urinary stones was assessed by two readers and compared with LD CT with ASIR-V 70% as a reference standard. Image quality was assessed subjectively and objectively. RESULTS 266 stones were detected in 38 patients. Mean effective dose was 0.59 mSv for ULD CT and 1.96 mSv for LD CT. For diagnostic performance, sensitivity and specificity were 89% and 94%, respectively, for ULDCT with DLIR-H. There was an almost perfect intra-observer concordance on ULD CT with DLIR-H versus LDCT with ASIR-V 70% (ICC = 0.90 and 0.90 for the two readers). Image noise was significantly lower and signal-to-noise ratio significantly higher with DLIR-H compared to ASIR-V 70%. Subjective image quality was also significantly better with ULDCT with DLIR-H. CONCLUSION ULD CT with Deep Learning Image Reconstruction maintains a good diagnostic performance in urolithiasis, with better image quality than hybrid iterative reconstruction and a significant radiation dose reduction.
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Affiliation(s)
- Sarah Prod'homme
- Department of Radiology, Amiens University Hospital, 1 Rond-Point du Professeur Christian Cabrol, 80054, Amiens Cedex 01, France
| | - Roger Bouzerar
- Biophysics and Image Processing Unit, Amiens University Hospital, Amiens, France
| | - Thomas Forzini
- Department of Urology and Transplantation, Amiens University Hospital, Amiens, France
| | - Aurélien Delabie
- Department of Radiology, Amiens University Hospital, 1 Rond-Point du Professeur Christian Cabrol, 80054, Amiens Cedex 01, France
| | - Cédric Renard
- Department of Radiology, Amiens University Hospital, 1 Rond-Point du Professeur Christian Cabrol, 80054, Amiens Cedex 01, France.
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Peters J, Oswald D, Eiben C, Ramesmayer C, Abenhardt M, Sieberer M, Homberg R, Gross AJ, Herrmann TRW, Miernik A, Becker B, Lehrich K, Klein JT, Hatiboglu G, Lusuardi L, Netsch C. [Imaging in nephroureterolithasis]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:295-302. [PMID: 38376761 DOI: 10.1007/s00120-024-02297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/21/2024]
Abstract
In the acute diagnostics of a suspected nephroureterolithiasis, ultrasonography should be the examination modality of choice. In cases of suspected urolithiasis, unclear flank pain with fever or in cases of a solitary kidney, a noncontrast computed tomography (CT) scan should always subsequently be performed. If the sonography findings are inconclusive in pregnant women a magnetic resonance imaging (MRI) examination can be considered. If there are indications for urinary diversion, a retrograde imaging study should be performed as part of the urinary diversion. This or CT imaging is also suitable for preinterventional imaging before shock wave lithotripsy, percutaneous nephrolithotomy or ureteroscopy. Postinterventional imaging is not always necessary and sonography is often sufficient. In a conservative treatment approach an abdominal plain X‑ray can be used for follow-up assessment.
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Affiliation(s)
- Julia Peters
- Universitätsklinikum Salzburg, Salzburg, Österreich.
- , Müllner Hauptstr. 48, 5020, Salzburg, Österreich.
| | - David Oswald
- Universitätsklinikum Salzburg, Salzburg, Österreich
| | | | | | | | | | - Roland Homberg
- St.-Barbara-Klinik Hamm-Hessen, Hamm-Hessen, Deutschland
| | | | | | | | | | | | | | | | - Lukas Lusuardi
- Universitätsklinikum Salzburg, Salzburg, Österreich.
- , Müllner Hauptstr. 48, 5020, Salzburg, Österreich.
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Choi MH, Lee SW, Pak S. Low-dose versus conventional CT urography using dual-source CT with different time-current product values and the same tube voltage: image quality and diagnostic performance in various diagnoses. Br J Radiol 2024; 97:399-407. [PMID: 38308025 DOI: 10.1093/bjr/tqad029] [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: 04/27/2023] [Revised: 10/05/2023] [Accepted: 11/14/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To compare the image quality and diagnostic performance of low-dose CT urography to that of concurrently acquired conventional CT using dual-source CT. METHODS This retrospective study included 357 consecutive CT urograms performed by third-generation dual-source CT in a single institution between April 2020 and August 2021. Two-phase CT images (unenhanced phase, excretory phase with split bolus) were obtained with two different tube current-time products (280 mAs for the conventional-dose protocol and 70 mAs for the low-dose protocol) and the same tube voltage (90 kVp) for the two X-ray tubes. Iterative reconstruction was applied for both protocols. Two radiologists independently performed quantitative and qualitative image quality analysis and made diagnoses. The correlation between the noise level or the effective radiation dose and the patients' body weight was evaluated. RESULTS Significantly higher noise levels resulting in a significantly lower liver signal-to-noise ratio and contrast-to-noise ratio were noted in low-dose images compared to conventional images (P < .001). Qualitative analysis by both radiologists showed significantly lower image quality in low-dose CT than in conventional CT images (P < .001). Patient's body weight was positively correlated with noise and effective radiation dose (P < .001). Diagnostic performance for various diseases, including urolithiasis, inflammation, and mass, was not different between the two protocols. CONCLUSIONS Despite inferior image quality, low-dose CT urography with 70 mAs and 90 kVp and iterative reconstruction demonstrated diagnostic performance equivalent to that of conventional CT for identifying various diseases of the urinary tract. ADVANCES IN KNOWLEDGE Low-dose CT (25% radiation dose) with low tube current demonstrated diagnostic performance comparable to that of conventional CT for a variety of urinary tract diseases.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Sheen-Woo Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Seongyong Pak
- Siemens Healthineers Ltd, Seoul 06620, Republic of Korea
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De Coninck V, Skolarikos A, Juliebø-Jones P, Joris M, Traxer O, Keller EX. Advancements in stone classification: unveiling the beauty of urolithiasis. World J Urol 2024; 42:46. [PMID: 38244083 DOI: 10.1007/s00345-023-04746-9] [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: 09/23/2023] [Accepted: 11/02/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Urolithiasis has become increasingly prevalent, leading to higher disability-adjusted life years and deaths. Various stone classification systems have been developed to enhance the understanding of lithogenesis, aid urologists in treatment decisions, and predict recurrence risk. The aim of this manuscript is to provide an overview of different stone classification criteria. METHODS Two authors conducted a review of literature on studies relating to the classification of urolithiasis. A narrative synthesis for analysis of the studies was used. RESULTS Stones can be categorized based on anatomical position, size, medical imaging features, risk of recurrence, etiology, composition, and morphoconstitutional analysis. The first three mentioned offer a straightforward approach to stone classification, directly influencing treatment recommendations. With the routine use of CT imaging before treatment, precise details like anatomical location, stone dimensions, and Hounsfield Units can be easily determined, aiding treatment planning. In contrast, classifying stones based on risk of recurrence and etiology is more complex due to dependencies on multiple variables, including stone composition and morphology. A classification system based on morphoconstitutional analysis, which combines morphological stone appearance and chemical composition, has demonstrated its value. It allows for the rapid identification of crystalline phase principles, the detection of crystalline conversion processes, the determination of etiopathogenesis, the recognition of lithogenic processes, the assessment of crystal formation speed, related recurrence rates, and guidance for selecting appropriate treatment modalities. CONCLUSIONS Recognizing that no single classification system can comprehensively cover all aspects, the integration of all classification approaches is essential for tailoring urolithiasis patient-specific management.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, Augustijnslei 100, Klina, 2930, Brasschaat, AZ, Belgium.
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands.
| | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Manu Joris
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
| | - Olivier Traxer
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Arnhem, The Netherlands
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Arnhem, The Netherlands
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Hosny M, Chan K, Ibrahim M, Sharma V, Vasdev N. The Management of Symptomatic Hydronephrosis in Pregnancy. Cureus 2024; 16:e52146. [PMID: 38222991 PMCID: PMC10784716 DOI: 10.7759/cureus.52146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 01/16/2024] Open
Abstract
The aim of this article is to provide a literature review on the management of symptomatic physiological hydronephrosis in pregnancy and compare different modalities of intervention when needed. In this review, we conducted an electronic literature search of peer-reviewed journal articles. The PubMed, Research Gate, and Google Scholar databases were queried with the following search terms: "pregnancy", "obstruction," and "hydronephrosis"; the terms "urolithiasis" and "kidney stone" were excluded. As a result, conservative treatment was successful and more favored for most of the patients and the clinicians in the different studies we found. Conservative management will usually include regular analgesia, positioning, and antibiotics. Close follow-up with ultrasound is always recommended. Intervention with ureteric stent insertion or nephrostomy tube insertion was less favored and only triggered by certain clinical criteria. In conclusion, symptomatic hydronephrosis in pregnancy can be safely treated conservatively. However, ureteral double-J stenting or percutaneous nephrostomy are effective and safe treatment methods in the minority of patients with persistent symptoms not responding to conservative management.
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Affiliation(s)
- Mohannad Hosny
- Urology, Lister Hospital - East and North Hertfordshire NHS Trust, Stevenage, GBR
| | - Kimberley Chan
- Urology, Lister Hospital - East and North Hertfordshire NHS Trust, Stevenage, GBR
| | - Mohamed Ibrahim
- Urology, Lister Hospital - East and North Hertfordshire NHS Trust, Stevenage, GBR
| | - Vishali Sharma
- Urology, Lister Hospital - East and North Hertfordshire NHS Trust, Stevenage, GBR
| | - Nikhil Vasdev
- Urology, Lister Hospital - East and North Hertfordshire NHS Trust, Stevenage, GBR
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Kandasamy M, Chan M, Xiang H, Chan L, Ridley L. Comparison of diagnostic accuracy of ultra low-dose computed tomography and X-ray of the kidneys, ureters and bladder for urolithiasis in the follow-up setting. J Med Imaging Radiat Oncol 2023. [PMID: 37997533 DOI: 10.1111/1754-9485.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Urolithiasis is frequently followed up with a low-dose computed tomography of the kidneys ureters and bladder (LD-CTKUB) with doses typically less than 3 millisieverts. Although X-ray is a lower dose (0.5-1.1 mSv) alternative for follow up, it has lower diagnostic accuracy and is limited to radiopaque calculi. This study aims to compare the diagnostic accuracy of sub-millisievert ultra-low dose CT (ULD-CTKUB) against X-ray KUB for the follow up of urolithiasis when both are compared against the standard of care of a low-dose CT KUB (LD-CTKUB). METHODS This prospective study included patients with a known diagnosis of urolithiasis on prior CTKUB presenting for follow up. Each patient underwent a repeat reference LD-CTKUB, ULD-CTKUB and X-ray KUB. All imaging studies were interpreted by three readers. The radiation dose and quantitative noise was calculated for each CT. Both CT and X-ray were assessed for the presence, number and size of all calculi ≥2 mm. RESULTS A total of 58 patients were included in this study. LD-CTKUB identified 197 calculi. ULD-CTKUB in our study had a mean effective dose of 0.5 mSv compared to X-ray KUB where doses range in the literature from 0.5 to 1.1 mSv. Per-patient pooled analysis for intrarenal calculi when comparing ULD-CTKUB versus X-ray KUB against a reference LD-CTKUB found a sensitivity of 90% versus 67% (P < 0.01) and specificity of 93% versus 98% (P = 0.18) respectively. For ureteric calculi, the sensitivity was 67% versus 33% (P < 0.01) and specificity 94% versus 94% (P = 1.00) respectively. Per-stone pooled analysis detection rate was 79% for ULD-CTKUB versus 48% for X-ray (P < 0.01) when each was compared to the reference LD-CTKUB. Interobserver agreement was high for intrarenal calculi and moderate for ureteric calculi. CONCLUSION Sub-millisievert ULD-CTKUB had lower doses and higher sensitivity than X-ray in patients requiring follow up of known urolithiasis.
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Affiliation(s)
- Mayooran Kandasamy
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael Chan
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Lewis Chan
- Department of Urology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Lloyd Ridley
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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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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Shim JH, Choi SY, Chang IH, Park SB. Dose Optimization Using a Deep Learning Tool in Various CT Protocols for Urolithiasis: A Physical Human Phantom Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1677. [PMID: 37763796 PMCID: PMC10538199 DOI: 10.3390/medicina59091677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: We attempted to determine the optimal radiation dose to maintain image quality using a deep learning application in a physical human phantom. Materials and Methods: Three 5 × 5 × 5 mm3 uric acid stones were placed in a physical human phantom in various locations. Three tube voltages (120, 100, and 80 kV) and four current-time products (100, 70, 30, and 15 mAs) were implemented in 12 scans. Each scan was reconstructed with filtered back projection (FBP), statistical iterative reconstruction (IR, iDose), and knowledge-based iterative model reconstruction (IMR). By applying deep learning to each image, we took 12 more scans. Objective image assessments were calculated using the standard deviation of the Hounsfield unit (HU). Subjective image assessments were performed by one radiologist and one urologist. Two radiologists assessed the subjective assessment and found the stone under the absence of information. We used this data to calculate the diagnostic accuracy. Results: Objective image noise was decreased after applying a deep learning tool in all images of FBP, iDose, and IMR. There was no statistical difference between iDose and deep learning-applied FBP images (10.1 ± 11.9, 9.5 ± 18.5 HU, p = 0.583, respectively). At a 100 kV-30 mAs setting, deep learning-applied FBP obtained a similar objective noise in approximately one third of the radiation doses compared to FBP. In radiation doses with settings lower than 100 kV-30 mAs, the subject image assessment (image quality, confidence level, and noise) showed deteriorated scores. Diagnostic accuracy was increased when the deep learning setting was lower than 100 kV-30 mAs, except for at 80 kV-15 mAs. Conclusions: At the setting of 100 kV-30 mAs or higher, deep learning-applied FBP did not differ in image quality compared to IR. At the setting of 100 kV-30 mAs, the radiation dose can decrease by about one third while maintaining objective noise.
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Affiliation(s)
- Jae Hun Shim
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
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Efthymiou FO, Metaxas VI, Dimitroukas CP, Delis HB, Zikou KD, Ntzanis ES, Zampakis PE, Panayiotakis GS, Kalogeropoulou CP. A retrospective survey to establish institutional diagnostic reference levels for CT urography examinations based on clinical indications: preliminary results. Biomed Phys Eng Express 2023; 9:065005. [PMID: 37651989 DOI: 10.1088/2057-1976/acf582] [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: 03/14/2023] [Accepted: 08/31/2023] [Indexed: 09/02/2023]
Abstract
Objective. To establish institutional diagnostic reference levels (IDRLs) based on clinical indications (CIs) for three- and four-phase computed tomography urography (CTU).Methods. Volumetric computed tomography dose index (CTDIvol), dose-length product (DLP), patients' demographics, selected CIs like lithiasis, cancer, and other diseases, and protocols' parameters were retrospectively recorded for 198 CTUs conducted on a Toshiba Aquilion Prime 80 scanner. Patients were categorised based on CIs and number of phases. These groups' 75th percentiles of CTDIvoland DLP were proposed as IDRLs. The mean, median and IDRLs were compared with previously published values.Results. For the three-phase protocol, the CTDIvol(mGy) and DLP (mGy.cm) were 22.7/992 for the whole group, 23.4/992 for lithiasis, 22.8/1037 for cancer, and 21.2/981 for other diseases. The corresponding CTDIvol(mGy) and DLP (mGy.cm) values for the four-phase protocol were 28.6/1172, 30.6/1203, 27.3/1077, and 28.7/1252, respectively. A significant difference was found in CTDIvoland DLP between the two protocols, among the phases of three-phase (except cancer) and four-phase protocols (except DLP for other diseases), and in DLP between the second and third phases (except for cancer group). The results are comparable or lower than most studies published in the last decade.Conclusions. The CT technologist must be aware of the critical dose dependence on the scan length and the applied exposure parameters for each phase, according to the patient's clinical background and the corresponding imaging anatomy, which must have been properly targeted by the competent radiologist. When clinically feasible, restricting the number of phases to three instead of four could remarkably reduce the patient's radiation dose. CI-based IDRLs will serve as a baseline for comparison with CTU practice in other hospitals and could contribute to national DRL establishment. The awareness and knowledge of dose levels during CTU will prompt optimisation strategies in CT facilities.
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Affiliation(s)
- Fotios O Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Christos P Dimitroukas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
| | - Harry B Delis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Kiriaki D Zikou
- Department of Radiology, University Hospital of Patras, 26504 Patras, Greece
| | | | - Petros E Zampakis
- Department of Radiology, University Hospital of Patras, 26504 Patras, Greece
- Department of Radiology, School of Medicine, University of Patras, 26504 Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
| | - Christina P Kalogeropoulou
- Department of Radiology, University Hospital of Patras, 26504 Patras, Greece
- Department of Radiology, School of Medicine, University of Patras, 26504 Patras, Greece
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Kavoussi NL, Da Silva A, Floyd C, McCoy A, Koyama T, Hsi RS. Feasibility of stone recurrence risk stratification using the recurrence of kidney stone (ROKS) nomogram. Urolithiasis 2023; 51:73. [PMID: 37067633 DOI: 10.1007/s00240-023-01446-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/03/2023] [Indexed: 04/18/2023]
Abstract
This study seeks to evaluate the recurrence of kidney stones (ROKS) nomogram for risk stratification of recurrence in a retrospective study. To do this, we analyzed the performance of the 2018 ROKS nomogram in a case-control study of 200 patients (100 with and 100 without subsequent recurrence). All patients underwent kidney stone surgery between 2013 and 2015 and had at least 5 years of follow-up. We evaluated ROKS performance for prediction of recurrence at 2- and 5-year via area under the receiver operating curve (ROC-AUC). Specifically, we assessed the nomogram's potential for stratifying patients based on low or high risk of recurrence at: a) an optimized cutoff threshold (i.e., optimized for both sensitivity and specificity), and b) a sensitive cutoff threshold (i.e., high sensitivity (0.80) and low specificity). We found fair performance of the nomogram for recurrence prediction at 2 and 5 years (ROC-AUC of 0.67 and 0.63, respectively). At the optimized cutoff threshold, recurrence rates for the low and high-risk groups were 20 and 45% at 2 years, and 50 and 70% at 5 years, respectively. At the sensitive cutoff threshold, the corresponding recurrence rates for the low and high-risk groups were of 16 and 38% at 2 years, and 42 and 66% at 5 years, respectively. Kaplan-Meier analysis revealed a recurrence-free advantage between the groups for both cutoff thresholds (p < 0.01, Fig. 2). Therefore, we believe that the ROKS nomogram could facilitate risk stratification for stone recurrence and adherence to risk-based surveillance protocols.
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Affiliation(s)
- Nicholas L Kavoussi
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA.
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Alexandre Da Silva
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chase Floyd
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allison McCoy
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Grunz JP, Halt D, Schüle S, Beer M, Hackenbroch C. Thermoluminescence Dosimetry in Abdominal CT for Urinary Stone Detection: Effective Radiation Dose Reduction With Tin Prefiltration at 100 kVp. Invest Radiol 2023; 58:231-238. [PMID: 36070523 DOI: 10.1097/rli.0000000000000924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Spectral shaping via tin prefiltration has gained recognition for dose saving in high-contrast imaging tasks. The aim of this phantom dosimetry study was to investigate whether the use of tin filters can also reduce the effective radiation dose in 100 kVp abdominal computed tomography (CT) compared with standard low-dose scans for suspected urolithiasis. METHODS Using a third-generation dual-source CT scanner, 4 scan protocols each were used on a standard (P1-P4) and a modified obese Alderson-Rando phantom (P5-P8), in which 11 urinary stones of different compositions were placed. Hereby 1 scan protocol represented standard low-dose settings (P1/P5: 110 kVp/120 kVp), whereas 3 experimental protocols used low-kilovoltage spectral shaping (P2/P3/P4 and P6/P7/P8: 100 kVp with tin prefiltration). Radiation dose was recorded by thermoluminescent dosimeters at 24 measurement sites. For objective assessment of image quality, dose-weighted contrast-to-noise ratios were calculated and compared between scan protocols. Additional subjective image quality analysis was performed by 2 radiologists using equidistant 5-point scales for estimation image noise, artifacts, kidney stone detectability, and delineation of bone and soft tissue. RESULTS Both conventional low-dose protocols without tin prefiltration were associated with the highest individual equivalent doses and the highest effective radiation dose in the experimental setup (P1: 0.29-6.43 mGy, 1.45-1.83 mSv; P5: 0.50-9.35 mGy, 2.33-2.79 mSv). With no false-positive diagnoses, both readers correctly detected each of the 11 urinary calculi irrespective of scan protocol and phantom configuration. Protocols using spectral shaping via tin prefiltration allowed for effective radiation dose reduction of up to 38% on the standard phantom and 18% on the modified obese phantom, while maintaining overall diagnostic image quality. Effective dose was approximately 10% lower in a male versus female anatomy and could be reduced by another 10% if gonadal protection was used ( P < 0.001). CONCLUSIONS Spectral shaping via tin prefiltration at 100 kVp is a suitable means to reduce the effective radiation dose in abdominal CT imaging of patients with suspected urolithiasis. The dose reduction potential is slightly less pronounced in a modified phantom emulating an obese body composition compared with a standard phantom.
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Affiliation(s)
| | - Daniel Halt
- From the Department of Radiology, German Armed Forces Hospital Ulm, Ulm
| | - Simone Schüle
- From the Department of Radiology, German Armed Forces Hospital Ulm, Ulm
| | - Meinrad Beer
- Department of Radiology, University Hospital Ulm, Ulm, Germany
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13
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Chan K, Shakir T, El-Taji O, Patel A, Bycroft J, Lim CP, Vasdev N. Management of urolithiasis in pregnancy. Curr Urol 2023; 17:1-6. [PMID: 37692143 PMCID: PMC10487296 DOI: 10.1097/cu9.0000000000000181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023] Open
Abstract
Urolithiasis is the most common cause of nonobstetric abdominal pain, resulting in 1.7 admissions per 1000 deliveries. Urolithiasis most commonly occurs in the second and third trimesters, with an incidence between 1:125 and 1:2000. Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in pathological outcomes. The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging. In addition, a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery. Affected pregnancies are conservatively managed; however, 1 in 4 requires surgical intervention. Indications for surgical interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy. Therefore, a multidisciplinary approach is required to optimize patient care. The diagnosis and management of urolithiasis in pregnancy are complex. We reviewed the role, safety, advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.
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Affiliation(s)
- Kimberley Chan
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Taner Shakir
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Omar El-Taji
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Amit Patel
- Radiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - John Bycroft
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Chou Phay Lim
- Gynaecology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Nikhil Vasdev
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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14
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Aggarwal G, Adhikary SD. Assessment of the efficacy of reduced-radiation noncontrast computed tomography scan compared with the standard noncontrast computed tomography scan for detecting urolithiasis: A prospective single-center study. Curr Urol 2023; 17:18-24. [PMID: 37692141 PMCID: PMC10487294 DOI: 10.1097/cu9.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/09/2022] [Indexed: 11/09/2022] Open
Abstract
Background Noncontrast computed tomography (CT) scan of the kidneys, ureter and bladder is the standard investigative modality for diagnosing and following up patients with urolithiasis. With each scan, a patient receives radiation of 18-34 mGy. Dose considerations become pertinent because of a 10% lifetime incidence rate and higher than 50% risk of recurrence, necessitating repeated imaging in the lifetime of a stone former. Hence, this study aimed to assess the sensitivity of "reduced-radiation" CT imaging by altering scan settings to lower than the "standard" norms. Materials and methods Altogether, 222 patients (255 "kidney-ureter" stone-bearing units or "renal units") with urolithiasis and patients undergoing CT for other reasons with incidental findings of renal/ureteric calculi between 2017 and 2019 were included. All patients were subjected to 3 sequential scans at tube current settings of 250 mA (CT-N/Standard), 100 mA (CT-100), and 50 mA (CT-50) at a constant voltage of 120 kV. Their clinicodemographic and radiological findings were recorded and assessed for significance. Results Of the 255 renal units, 117 were between 30 and 44 years of age, 75% were men. Of the 255 patients, 178 (70.1%) reported a first stone episode and 77 had recurrence. Lower ureteric calculi were predominant (40.4%). All calculi were identified on CT-N; CT-100 failed to detect calculi in 1 patient, and CT-50 failed in 3 patients, where all calculi were <3 mm in size. Meanwhile, none were undetected among patients with obesity. The sensitivity was 99.61% for the CT-100 and 98.82% for the CT-50, which indicated a 2.5 and 5 times lower radiation and dose/length, respectively, than CT-N. Conclusions The reduced-radiation CT scan is safe, sensitive, and accurate for the diagnosis and follow-up of patients with urolithiasis with significantly lower radiation exposures. Our study lays the foundation to accept low-dose CT in general and CT-50 in particular, as the new "standard of care," and attempt further dose reduction without loss of diagnostic efficacy.
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Affiliation(s)
- Gaurav Aggarwal
- Department of Uro-Oncology, Tata Medical Center, Kolkata, India
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15
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Bonny O, Fuster D, Seeger H, Ernandez T, Buchkremer F, Wuerzner G, Dhayat N, Ritter A, Stoermann C, Segerer S, Häusermann T, Pasch A, Kim M, Mayr M, Krapf R, Roth B, Bochud M, Mohebbi N, Wagner CA. The Swiss Kidney Stone Cohort: A Longitudinal, Multicentric, Observational Cohort to Study Course and Causes of Kidney Stone Disease in Switzerland. Kidney Blood Press Res 2023; 48:194-201. [PMID: 36780886 DOI: 10.1159/000529094] [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: 10/16/2022] [Accepted: 12/22/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Kidney stone disease has a high prevalence worldwide of approximately 10% of the population and is characterized by a high recurrence rate. Kidney stone disease results from a combination of genetic, environmental, and lifestyle risk factors, and the dissection of these factors is complex. METHODS The Swiss Kidney Stone Cohort (SKSC) is an investigator-initiated prospective, multicentric longitudinal, observational study in patients with kidney stones followed with regular visits over a period of 3 years after inclusion. Ongoing follow-ups by biannual telephone interviews will provide long-term outcome data. SKSC comprises 782 adult patients (age >18 years) with either recurrent stones or a single stone event with at least one risk factor for recurrence. In addition, a control cohort of 207 individuals without kidney stone history and absence of kidney stones on a low-dose CT scan at enrolment has also been recruited. SKSC includes extensive collections of clinical data, biochemical data in blood and 24-h urine samples, and genetic data. Biosamples are stored at a dedicated biobank. Information on diet and dietary habits was collected through food frequency questionnaires and standardized recall interviews by trained dieticians with the Globodiet software. CONCLUSION SKSC provides a unique opportunity and resource to further study cause and course of kidney disease in a large population with data and samples collected of a homogeneous collective of patients throughout the whole Swiss population.
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Affiliation(s)
- Olivier Bonny
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
- Service of Nephrology, Fribourg State Hospital, Fribourg, Switzerland
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Daniel Fuster
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
- Department of Nephrology and Hypertension, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Harald Seeger
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Ernandez
- Service of Nephrology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - Nasser Dhayat
- Department of Nephrology and Hypertension, University Hospital Bern and University of Bern, Bern, Switzerland
- Nephrology & Renal Care Center, B. Braun Medical Care AG, Hochfelden, Switzerland
| | - Alexander Ritter
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | | | - Stephan Segerer
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Tanja Häusermann
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Andreas Pasch
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
- Calciscon AG, Biel, Switzerland
| | - Minjeong Kim
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland
- Medical Outpatient Clinic, Basel University Hospital, Basel, Switzerland
| | - Michael Mayr
- Medical Outpatient Clinic, Basel University Hospital, Basel, Switzerland
| | - Reto Krapf
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Beat Roth
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - Murielle Bochud
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nilufar Mohebbi
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
- Department of Nephrology and Hypertension, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Carsten A Wagner
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
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16
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Rawashdeh M, Saade C. Establishment of diagnostic reference levels in low-dose renal computed tomography. Acta Radiol 2023; 64:829-836. [PMID: 35505591 DOI: 10.1177/02841851221095238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increased radiation doses from computed tomography (CT) examinations is well known with proven risks of inducing cancers for effective dose >100 mSv (according to some studies >50 mSvs). PURPOSE To establish the diagnostic reference level (DRL) for low-dose renal CT examinations in the evaluation of renal stones. MATERIAL AND METHODS Patient demographics, CT parameters, and dosimetric indices (CTDIvol and dose length product [DLP]) were collected from 12 tertiary hospitals that routinely perform renal CT in the detection and evaluation of renal stones over a period of 12 weeks. Data obtained from 1418 average-sized patients in each category were recorded. The median values of dosimetric indices for each site were calculated. The DRL values were defined as the 75th percentile of the distribution of the median values of CTDIvol and DLP. RESULTS There were no significant differences between patient demographics. Mean kVp and mAs for protocols were 121.67 ± 11.56 and 226.91 ± 78.44, respectively. The CTDIvol values were in the range of 2-36.2 mGy, while the DLP values were in the range of 43-1942 mGy.cm. The DRL for the CTDIvol was 16.15 mGy and for the DLP 851.77 mGy.cm. The local median values of CDTIvol and DLP are higher than DRL in two hospitals. CONCLUSION Comparison of local median values of CDTIvol and DLP with DRL suggests the needs of an optimization strategy in some hospitals.
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Affiliation(s)
- Mohammad Rawashdeh
- Department of Allied Medical Sciences, 108612Jordan University of Science and Technology, Irbid, Jordan
| | - Charbel Saade
- Medical Imaging Sciences, Faculty of Health Sciences, University College Cork, Cork, Ireland
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17
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Kazemi Z, Hajimiri K, Saghatchi F, Molazadeh M, Rezaeejam H. Assessment of the knowledge level of radiographers and CT technologists regarding computed tomography parameters in Iran. RADIATION MEDICINE AND PROTECTION 2023. [DOI: 10.1016/j.radmp.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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18
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Gauhar V, Castellani D, Chew BH, Smith D, Chai CA, Fong KY, Teoh JYC, Traxer O, Somani BK, Tailly T. Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group. Ther Adv Urol 2023; 15:17562872231198629. [PMID: 37701535 PMCID: PMC10493056 DOI: 10.1177/17562872231198629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. Objective To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. Design A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021). Methods Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs. Results A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p < 0.001) and after matching (43.1% versus 23.9%, p < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% versus 47.6%, p < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009-1.020, p < 0.001], stone size (OR 1.028 95% CI 1.017-1.040, p < 0.001), multiple stones (OR 1.171 95% CI 1.025-1.339, p = 0.021), lower pole stone (OR 1.853 95% CI 1.557-2.204, p < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094-7.037, p < 0.001) had significantly higher odds of having CSRFs. Conclusions CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona 60126, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
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19
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Barsoum NR, Khodair AA, Morsy SS, Shokralla SY. Importance of the hounsfield unit value measured by computed tomography in the differentiation of hydronephrosis and pyonephrosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute or chronic obstruction of the urinary tract can be due to a lot of different causes. Patients with pyonephrosis usually complain of a triad of fever, loin pain and elevated white blood cell count in cases of acute obstruction; and they may also have hypotension in severe cases of the disease. These patients have to be treated with appropriate decompression, or they may develop septic shock. The urgency of the need for treatment greatly depends on the differentiation between hydronephrosis and pyonephrosis.
There is a lack of reliable clinical prognosticators of pyonephrosis in patients with obstructive hydronephrosis. Hounsfield unit (HU) measurement is considered as an adequate predictor of pyonephrosis and may aid in the diagnosis and management of this disease that may be fatal.
The use of HU values in differentiation between pyonephrosis from hydronephrosis depends on the fact that the pyonephrotic fluid contains infected material, urine, cellular particles and microorganisms, which when combined can increase the HU values on a computed tomography (CT) study.
This study was done to assess the diagnostic value of the HU measured CT in differentiation between hydronephrosis and pyonephrosis.
Results
Thirty-nine patients were included in this study. All patients had loin pain and were diagnosed with pelvicalyceal dilatation by ultrasonographic examination. They then underwent non-contrast CT examination.
Using CT scan, the degree of PC dilatation was significantly higher among hydronephrosis group as hydronephrosis group had 63.1% severe dilatation of PCs versus 30.8% in pyonephrosis group with p value 0.0001.
Pelvic wall thickness > 2 mm was reported in 10 (76.9%) patients of pyonephrosis group versus in three (7.9%) patients among hydronephrosis group with p value 0.0001.
The mean Hounsfield units were significantly higher among pyonephrosis group compared to hydronephrosis group (16 ± 5.2 versus 1.7 ± 5.5) with p value 0.0001.
Sensitivity analysis showed that Hounsfield units can significantly diagnose pyonephrosis using the cutoff point 6.2 units, with sensitivity 92.3%, specificity 93.3%, area under the curve (AUC) 96.9% and p value 0.0001.
Conclusions
Measuring HU in a NCECT scan of the kidney might be helpful for differentiating between hydronephrosis and pyonephrosis especially upon considering 6.2 HU as a cutoff point.
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McGeorge S, Loh B, Shibu R, Dobeli K, Brown NJ, Esler R, Hacking C, Purvey M, Roberts MJ. Plain x-ray misses many ureteric calculi: Time to challenge the old dogma? BJUI COMPASS 2022; 4:59-61. [PMID: 36569499 PMCID: PMC9766866 DOI: 10.1002/bco2.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Stephen McGeorge
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Brendon Loh
- Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Ryan Shibu
- Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Karen Dobeli
- Department of Medical ImagingRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Nathan J. Brown
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Rachel Esler
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Craig Hacking
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Department of Medical ImagingRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Megan Purvey
- Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Matthew J. Roberts
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchBrisbaneQueenslandAustralia
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21
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Yoon S, Yoo KH, Park SH, Kim H, Lee JH, Park J, Park SH, Kim HJ. Low-dose abdominopelvic computed tomography in patients with lymphoma: An image quality and radiation dose reduction study. PLoS One 2022; 17:e0272356. [PMID: 35951525 PMCID: PMC9371255 DOI: 10.1371/journal.pone.0272356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to evaluate image quality, the detection rate of enlarged lymph nodes, and radiation dose exposure of ultralow-dose and low-dose abdominopelvic computed tomography (CT) in patients with lymphoma. Patients with lymphoma who underwent abdominopelvic CT using dual-source scanner were retrospectively recruited from a single center. CT images were obtained at 90 kVp dual-source mode reformatted in three data sets using the advanced modelled iterative reconstruction algorithm: 100% (standard-dose CT), 66.7% (low-dose CT), and 33.3% (ultralow-dose CT). Two radiologists analyzed subjective image quality and detection of abdominal enlarged lymph nodes on ultralow-dose, low-dose, and standard-dose CT blindly and independently. The results were compared with reference standards. Three readers (two radiologists and one hematologist) reviewed overall image quality and spleen size. In total, 128 consecutive CT scans (77 complete response, 44 partial response, 6 progressive disease, and 1 initial evaluation) from 86 patients (64 B-cell lymphoma, 14 T/NK-cell lymphoma, and 8 Hodgkin’s lymphoma cases) were assessed. The enlarged lymph node-based detection rates for two readers were 97.0% (96/99) and 94.0% (93/99) on standard-dose CT, 97.0% (96/99) and 94.0% (93/99) on low-dose CT, and 94.0% (93/99) and 89.9% (89/99) on ultralow-dose CT. Overall image quality was 3.8 ± 0.5, 3.9 ± 0.5, and 4.1 ± 0.5 on ultralow-dose CT; 4.7 ± 0.4, 4.6 ± 0.5, and 4.8 ± 0.3 on low-dose CT; and 4.8 ± 0.4, 4.7 ± 0.4, and 4.9 ± 0.2 on standard-dose CT, according to two radiologists and one hematologist, respectively. Intraclass correlation coefficients of spleen size were 0.90 (95% confidence interval [CI], 0.87–0.93), 0.91 (95% CI, 0.88–0.93), and 0.91 (95% CI, 0.88–0.93) on ultralow-dose, low-dose, and standard-dose CT, respectively. Mean effective radiation doses of standard-dose, low-dose, and ultralow-dose CT were 5.7 ±1.8 mSv, 3.8 ± 1.2 mSv, and 1.9 ± 0.6 mSv, respectively. Our findings suggest that ultralow-dose and low-dose CT, even with radiation doses reduced by 66.7% and 33.3%, respectively, maintained adequate image quality. These imaging modalities may be employed for follow-up lymphoma evaluation in consideration of the long surveillance periods.
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Affiliation(s)
- Sungjin Yoon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kwai Han Yoo
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
- * E-mail:
| | - Hawk Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae Hoon Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jinny Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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Niehoff JH, Carmichael AF, Woeltjen MM, Boriesosdick J, Lopez Schmidt I, Michael AE, Große Hokamp N, Piechota H, Borggrefe J, Kroeger JR. Clinical Low Dose Photon Counting CT for the Detection of Urolithiasis: Evaluation of Image Quality and Radiation Dose. Tomography 2022; 8:1666-1675. [PMID: 35894003 PMCID: PMC9326560 DOI: 10.3390/tomography8040138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was the evaluation of image quality and radiation dose parameters of the novel photon counting CT (PCCT, Naeotom Alpha, Siemens Healthineers) using low-dose scan protocols for the detection of urolithiasis. Standard CT scans were used as a reference (S40, Somatom Sensation 40, Siemens Healthineers). Sixty-three patients, who underwent CT scans between August and December 2021, were retrospectively enrolled. Thirty-one patients were examined with the PCCT and 32 patients were examined with the S40. Radiation dose parameters, as well as quantitative and qualitative image parameters, were analyzed. The presence of urolithiasis, image quality, and diagnostic certainty were rated on a 5-point-scale by 3 blinded readers. Both patient groups (PCCT and S40) did not differ significantly in terms of body mass index. Radiation dose was significantly lower for examinations with the PCCT compared to the S40 (2.4 ± 1.0 mSv vs. 3.4 ± 1.0 mSv; p < 0.001). The SNR was significantly better on images acquired with the PCCT (13.3 ± 3.3 vs. 8.2 ± 1.9; p < 0.001). The image quality of the PCCT was rated significantly better (4.3 ± 0.7 vs. 2.8 ± 0.6; p < 0.001). The detection rate of kidney or ureter calculi was excellent with both CT scanners (PCCT 97.8% and S40 99%, p = 0.611). In high contrast imaging, such as the depiction of stones of the kidney and the ureter, PCCT allows a significant reduction of radiation dose, while maintaining excellent diagnostic confidence and image quality. Given this image quality with our current protocol, further adjustments towards ultra-low-dose CT scans appear feasible.
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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; (M.M.W.); (J.B.); (I.L.S.); (A.E.M.); (J.B.); (J.R.K.)
- Correspondence: ; Tel.: +49-571-790-4601
| | - Alexandra Fiona Carmichael
- Department of Urology, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany; (A.F.C.); (H.P.)
| | - Matthias Michael Woeltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany; (M.M.W.); (J.B.); (I.L.S.); (A.E.M.); (J.B.); (J.R.K.)
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany; (M.M.W.); (J.B.); (I.L.S.); (A.E.M.); (J.B.); (J.R.K.)
| | - Ingo Lopez Schmidt
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany; (M.M.W.); (J.B.); (I.L.S.); (A.E.M.); (J.B.); (J.R.K.)
| | - Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany; (M.M.W.); (J.B.); (I.L.S.); (A.E.M.); (J.B.); (J.R.K.)
| | - Nils Große Hokamp
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, 50937 Cologne, Germany;
| | - Hansjuergen Piechota
- Department of Urology, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany; (A.F.C.); (H.P.)
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany; (M.M.W.); (J.B.); (I.L.S.); (A.E.M.); (J.B.); (J.R.K.)
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, 44801 Bochum, Germany; (M.M.W.); (J.B.); (I.L.S.); (A.E.M.); (J.B.); (J.R.K.)
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Value of deep learning reconstruction at ultra-low-dose CT for evaluation of urolithiasis. Eur Radiol 2022; 32:5954-5963. [PMID: 35357541 DOI: 10.1007/s00330-022-08739-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy and image quality of ultra-low-dose computed tomography (ULDCT) with deep learning reconstruction (DLR) to evaluate patients with suspected urolithiasis, compared with ULDCT with hybrid iterative reconstruction (HIR) by using low-dose CT (LDCT) with HIR as the reference standard. METHODS Patients with suspected urolithiasis were prospectively enrolled and underwent abdominopelvic LDCT, followed by ULDCT if any urinary stone was observed. Radiation exposure, stone characteristics, image noise, signal-to-noise ratio (SNR), and subjective image quality on a 5-point Likert scale were evaluated and compared. RESULTS The average effective radiation dose of ULDCT was significantly lower than that of LDCT (1.28 ± 0.34 vs. 5.49 ± 1.00 mSv, p < 0.001). According to the reference standard (LDCT-HIR), 148 urinary stones were observed in 85.0% (51/60) of patients. ULDCT-DLR detected 143 stones with a rate of 96.6%, and ULDCT-HIR detected 142 stones with a rate of 95.9%. The urinary stones that were not observed with ULDCT-DLR or ULDCT-HIR were renal calculi smaller than 3 mm. There were no significant differences in the detection of clinically significant calculi (≥ 3 mm) or stone size estimation among ULDCT-DLR, ULDCT-HIR, and LDCT-HIR. The image quality of ULDCT-DLR was better than that of ULDCT-HIR and LDCT-HIR with lower image noise, higher SNR, and higher average subjective score. CONCLUSIONS ULDCT-DLR performed comparably to LDCT-HIR in urinary stone detection and size estimation with better image quality and decreased radiation exposure. ULDCT-DLR may have potential to be considered the first-line choice to evaluate urolithiasis in practice. KEY POINTS • Ultra-low-dose computed tomography (ULDCT) has been investigated for diagnosis of urolithiasis, but stone evaluation may be adversely impacted by compromised image quality. • This study evaluated the value of novel deep learning reconstruction (DLR) at ULDCT by comparing the stone evaluation and image quality of ULDCT-DLR to the reference standard of low-dose CT (LDCT) with hybrid iterative reconstruction (HIR). • ULDCT-DLR performed comparably to LDCT-HIR in urinary stone detection and size estimation with better image quality and reduced radiation exposure.
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Keenan RA, Hegarty N, Davis N. Symptomatic hydronephrosis and ureteric calculi in pregnancy - a narrative review with a proposed management protocol. J Endourol 2022; 36:1099-1112. [DOI: 10.1089/end.2021.0876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert Anthony Keenan
- Beaumont Hospital, 57978, Transplant, Urology & Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Nicholas Hegarty
- Mater Misericordiae University Hospital, 8881, Urology, Dublin, Ireland
| | - Niall Davis
- Royal College of Surgeons in Ireland, 8863, Dublin, Ireland
- Beaumont Hospital, 57978, Transplant, Urology & Nephrology, Dublin, Ireland
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Singh A, Sakalecha AK. Role of Multi-Detector Computed Tomography Indices in Predicting Extracorporeal Shockwave Lithotripsy Outcome in Patients With Nephrolithiasis. Cureus 2022; 14:e22745. [PMID: 35371859 PMCID: PMC8970410 DOI: 10.7759/cureus.22745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background Nephrolithiasis is one of the most common renal pathologies and is routinely encountered in daily practice. Non-contrast computed tomography (NCCT) is the gold standard diagnostic imaging modality for urolithiasis. The role of HU (Hounsfield units) in calculus as a predictor of extracorporeal shock wave lithotripsy (ESWL) has been studied in the past. This study aims to evaluate the role of HU value and various other NCCT indices in predicting the outcome of ESWL. Material and methods This was a prospective observational study that included 45 patients suffering from nephrolithiasis who underwent NCCT-KUB (kidney, ureter, and bladder) followed by ESWL. The NCCT indices were evaluated and correlated with the outcome of ESWL. NCCT-KUB was performed using multidetector SIEMENS® SOMATOM EMOTION 16-slice CT scanner (SIEMENS, Munich, Germany). Results In our study, the HU value turned out to be a statistically significant predictor of ESWL success (p <0.05), and the renal pelvis also proved to be a good prognostic indicator for ESWL success. The cut-off value of <1179 HU favored a successful outcome of ESWL, while if >1179 HU, ESWL is likely to fail. Hence, the successful outcome of ESWL is inversely proportional to the HU value. Renal pelvic calculi (n=14) showed a 100% success rate, which was better than all other calculus locations (p<0.05). However, the rest of the indices did not show any statistical significance. Conclusion Multi-detector NCCT-KUB indices can help in the selection of patients with a good prognosis for ESWL, which will prevent the patient from undergoing undesired invasive procedures.
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Cole AP, Langbein BJ, Giganti F, Fennessy FM, Tempany CM, Emberton M. Is perfect the enemy of good? Weighing the evidence for biparametric MRI in prostate cancer. Br J Radiol 2022; 95:20210840. [PMID: 34826223 PMCID: PMC8978228 DOI: 10.1259/bjr.20210840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The role of multiparametric MRI in diagnosis, staging and treatment planning for prostate cancer is well established. However, there remain several challenges to widespread adoption. One such challenge is the duration and cost of the examination. Abbreviated exams omitting contrast-enhanced sequences may help address this challenge. In this review, we will discuss the rationale for biparametric MRI for detection and characterization of clinically significant prostate cancer prior to biopsy and synthesize the published literature. We will weigh up the advantages and disadvantages to this approach and lay out a conceptual cost/benefit analysis regarding adoption of biparametric MRI.
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Affiliation(s)
| | | | | | | | - Clare M. Tempany
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ultra-low-dose CTKUB: the new standard of follow-up of ureteric calculi not visible on plain radiograph? Int Urol Nephrol 2022; 54:781-787. [PMID: 35129775 DOI: 10.1007/s11255-022-03134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE With sensitivities over 95%, non-contrast computer tomography of kidney, ureter and bladder (CTKUB) is the investigation of choice in renal colic to diagnose or exclude ureteric calculi. CTKUB delivers an average effective radiation dose of 5.4 millisievert (mSv) and is used to follow-up calculi not visible on plain X-ray, whereas plain radiography has a radiation exposure of 0.7 mSv and is used to follow-up radio-opaque calculi. We assessed the effectiveness of using ultra-low-dose CTKUB (ULDCTKUB) for the follow-up of ureteric calculi not visible on plain radiograph of the kidneys, ureter and bladder (KUB), as an emerging option to reduce radiation exposure compared to standard dose CTKUB. METHODS Between 2013 and 2016 we retrospectively analysed 86 patients who underwent ULDCTKUB for CTKUB-confirmed ureteric calculi that were not visible on plain radiography. Patients were identified from our Radiology Management System with additional information from electronic patient records. RESULTS 98% of ULDCTKUBs were of diagnostic quality; two patients required further cross-sectional imaging. 67% of patients had passed their calculi after the initial diagnostic CTKUB. In the remaining 33% who had persistent calculi on ULDCTKUB, 20% required surgical intervention and 13% required no intervention. The mean ULDCTKUB effective radiation dose was six times lower than conventional CTKUB (0.8 vs 5.4 mSv). 67% of patients had a radiation dose equivalent to X-ray KUB (< 1 mSv). CONCLUSION ULDCTKUB is a reliable and safe follow-up investigation of ureteric calculi and has absorbed radiation doses similar to plain radiography and lower than annual background radiation. We advocate ULDCTKUB as the primary imaging modality in the follow-up of ureteric calculi not visible on plain radiograph.
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Dorantes-Carrillo LA, Basulto-Martínez M, Suárez-Ibarrola R, Heinze A, Proietti S, Flores-Tapia JP, Esqueda-Mendoza A, Giusti G. Retrograde Intrarenal Surgery Versus Miniaturized Percutaneous Nephrolithotomy for Kidney Stones >1cm: A Systematic Review and Meta-analysis of Randomized Trials. Eur Urol Focus 2022; 8:259-270. [PMID: 33627307 DOI: 10.1016/j.euf.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Although miniaturized percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) are both options for treating >1cm kidney stones, controversies exist on whether one is more effective and safer than the other. OBJECTIVE To systematically appraise randomized trials comparing the effectiveness and safety of mPCNL and RIRS for treating >1cm kidney stones. EVIDENCE ACQUISITION A systematic search on PubMed/Medline, Web of Science, Embase, and ClinicalTrials.gov was conducted in August 2020 following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). Randomized trials comparing mPCNL and RIRS for >1cm kidney stones, and reporting stone-free rate (SFR), hemoglobin drop, transfusion rate, length of hospital stay (LOS), and/or complications, were included. EVIDENCE SYNTHESIS Eight studies compared mPCNL and RIRS, but one was not included due to its high risk of bias. SFR was higher for mPCNL (RR: 1.06 [95% coefficient interval {CI}, 1.01-1.10], p=0.008). Hemoglobin drop was higher for mPCNL (mean difference [MD]: 0.35 [95% CI, 0.05-0.65] g/dl, p=0.02); however, transfusion rates were similar (p=0.44). Complication rate was similar between mPCNL and RIRS (p=0.39), and the LOS was higher for mPCNL (MD: 1.11 [95% CI, 0.06-2.16] d, p=0.04). A subgroup analysis of lower pole stones showed that SFR was higher for mPCNL (RR: 1.09 [95% CI, 1.00-1.19], p=0.05). CONCLUSIONS Both approaches are effective and safe. Among these approaches, mPCNL has a higher SFR than RIRS for overall >1cm renal and lower pole stones, but longer LOS, and a higher hemoglobin drop that does not translate into higher transfusion rates. Complications are comparable. PATIENT SUMMARY Randomized trials have evaluated whether miniaturized percutaneous nephrolithotomy (mPCNL) or retrograde intrarenal surgery is more effective and safer for treating >1cm stones. After comparing the stone-free rate, hemoglobin drop, transfusion rate, length of hospital stay, and complications between both the approaches, mPCNL was found to be slightly more effective, but both were equally safe.
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Affiliation(s)
| | - Mario Basulto-Martínez
- European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy; Department of Urology, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico.
| | - Rodrigo Suárez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | | | - Silvia Proietti
- European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Juan Pablo Flores-Tapia
- Division of Nephrology, Urology and Transplant Surgery, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico
| | - Antonio Esqueda-Mendoza
- Department of Urology, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico
| | - Guido Giusti
- European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
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Thapaliya S, Brady SL, Somasundaram E, Anton CG, Coley BD, Towbin AJ, Zhang B, Dillman JR, Trout AT. Detection of urinary tract calculi on CT images reconstructed with deep learning algorithms. Abdom Radiol (NY) 2022; 47:265-271. [PMID: 34605964 DOI: 10.1007/s00261-021-03274-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Deep learning Computed Tomography (CT) reconstruction (DLR) algorithms promise to improve image quality but the impact on clinical diagnostic performance remains to be demonstrated. We aimed to compare DLR to standard iterative reconstruction for detection of urolithiasis by unenhanced CT in children and young adults. METHODS This was an IRB approved retrospective study involving post-hoc reconstruction of clinically acquired unenhanced abdomen/pelvis CT scans. Images were reconstructed with six different manufacturer-standard DLR algorithms and reformatted in 3 planes (axial, sagittal, and coronal) at 3 mm intervals. De-identified reconstructions were loaded as independent examinations for review by 3 blinded radiologists (R1, R2, R3) tasked with identifying and measuring all stones. Results were compared to the clinical iterative reconstruction images as a reference standard. IntraClass correlation coefficients and kappa (k) statistics were used to quantify agreement. RESULTS CT data for 14 patients (mean age: 17.3 ± 3.4 years, 5 males and 9 females, weight class: 31-70 kg (n = 6), 71-100 kg (n = 7), > 100 kg (n = 1)) were reconstructed into 84 total exams. 7 patients had urinary tract calculi. Interobserver agreement on the presence of any urinary tract calculus was substantial to almost perfect (k = 0.71-1) for all DLR algorithms. Agreement with the reference standard on number of calculi was excellent (ICC = 0.78-0.96) and agreement on the size of the largest calculus was fair to excellent (ICC = 0.51-0.97) depending on reviewer and DLR algorithm. CONCLUSION Deep learning reconstruction of unenhanced CT images allows similar renal stone detectability compared to iterative reconstruction.
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Affiliation(s)
- Samjhana Thapaliya
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
| | - Samuel L Brady
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elanchezhian Somasundaram
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christopher G Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian D Coley
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Bourcier JE, Gallard E, Redonnet JP, Abillard M, Billaut Q, Fauque L, Jouanolou A, Garnier D. Ultrasound at the patient's bedside for the diagnosis and prognostication of a renal colic. Ultrasound J 2021; 13:45. [PMID: 34807330 PMCID: PMC8608963 DOI: 10.1186/s13089-021-00246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Diagnosing a ureteral colic is sometimes difficult; however, clinicians should not fail to detect a surgical emergency. This is why diagnostic strategies depend on the imaging examinations, especially ultrasound. Prior studies have investigated the accuracy of Point of Care Ultrasound (PoCUS), but there are relatively few. This study aimed to evaluate the performance of the PoCUS in the diagnosis of renal colic. The secondary objective was to evaluate the relationship between the imaging results and the treatment performed. Methods After the clinical evaluation of patients aged > 18 years with suspected ureteral colic, the Emergency Physician (EP) trained in ultrasound performed PoCUS to conclude whether a diagnosis of “renal colic” should be made. A computed tomography (CT) examination was subsequently performed, to determine whether ureteral or bladder lithiasis was present to diagnose a ureteral colic. The patient’s management was decided according to the to degree of urinary tract dilatation, presence of perinephric fluid, size, and localization of stones. Results Of the 12 Eps in our units, seven met the training criteria for the inclusion of patients. A total of 103 patients were analyzed, and the renal colic diagnosis was retained in 85 cases after the CT examination. The accuracy of PoCUS was 91% (86; 95%) for detecting urinary tract dilatation, 83% (76; 90%) for detecting perinephric fluid, and 54% (44; 64%) for detecting lithiasis. Only high urinary tract stones with ≥ 6 mm diameter were surgically managed (p < 0.01). Conversely, distal ureteral stones with a diameter of < 6 mm were managed with medical ambulatory treatment (p < 0.05). Conclusion PoCUS is a good diagnostic tool, for renal colic, and could help reduce the requirement for the CT examinations and, hence, reduce induced radiation exposure.
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Affiliation(s)
- Jean-Eudes Bourcier
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France. .,Pôle Anesthésie-Réanimation-Urgences, Hôpital de Lourdes, 2 Avenue Alexandre Marqui, 65100, Lourdes, France.
| | - Emeric Gallard
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Jean-Philippe Redonnet
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Morgan Abillard
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Quentin Billaut
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Laura Fauque
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Anna Jouanolou
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Didier Garnier
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
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Kobayashi M, Ishioka J, Matsuoka Y, Fukuda Y, Kohno Y, Kawano K, Morimoto S, Muta R, Fujiwara M, Kawamura N, Okuno T, Yoshida S, Yokoyama M, Suda R, Saiki R, Suzuki K, Kumazawa I, Fujii Y. Computer-aided diagnosis with a convolutional neural network algorithm for automated detection of urinary tract stones on plain X-ray. BMC Urol 2021; 21:102. [PMID: 34353306 PMCID: PMC8340490 DOI: 10.1186/s12894-021-00874-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/27/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recent increased use of medical images induces further burden of their interpretation for physicians. A plain X-ray is a low-cost examination that has low-dose radiation exposure and high availability, although diagnosing urolithiasis using this method is not always easy. Since the advent of a convolutional neural network via deep learning in the 2000s, computer-aided diagnosis (CAD) has had a great impact on automatic image analysis in the urological field. The objective of our study was to develop a CAD system with deep learning architecture to detect urinary tract stones on a plain X-ray and to evaluate the model's accuracy. METHODS We collected plain X-ray images of 1017 patients with a radio-opaque upper urinary tract stone. X-ray images (n = 827 and 190) were used as the training and test data, respectively. We used a 17-layer Residual Network as a convolutional neural network architecture for patch-wise training. The training data were repeatedly used until the best model accuracy was achieved within 300 runs. The F score, which is a harmonic mean of the sensitivity and positive predictive value (PPV) and represents the balance of the accuracy, was measured to evaluate the model's accuracy. RESULTS Using deep learning, we developed a CAD model that needed 110 ms to provide an answer for each X-ray image. The best F score was 0.752, and the sensitivity and PPV were 0.872 and 0.662, respectively. When limited to a proximal ureter stone, the sensitivity and PPV were 0.925 and 0.876, respectively, and they were the lowest at mid-ureter. CONCLUSION CAD of a plain X-ray may be a promising method to detect radio-opaque urinary tract stones with satisfactory sensitivity although the PPV could still be improved. The CAD model detects urinary tract stones quickly and automatically and has the potential to become a helpful screening modality especially for primary care physicians for diagnosing urolithiasis. Further study using a higher volume of data would improve the diagnostic performance of CAD models to detect urinary tract stones on a plain X-ray.
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Affiliation(s)
- Masaki Kobayashi
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yuichi Fukuda
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Yusuke Kohno
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Keizo Kawano
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Shinji Morimoto
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Rie Muta
- Department of Urology, JA Toride Medical Center, Toride, Japan
| | | | - Naoko Kawamura
- Department of Urology, JA Toride Medical Center, Toride, Japan
| | - Tetsuo Okuno
- Department of Urology, JA Toride Medical Center, Toride, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Rumi Suda
- Department of Information and Communications Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Ryota Saiki
- Department of Information and Communications Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Kenji Suzuki
- Laboratory for Future, Interdisciplinary Research of Science and Technology, Institute of Innovative Research, Tokyo Institute of Technology, Tokyo, Japan
| | - Itsuo Kumazawa
- Laboratory for Future, Interdisciplinary Research of Science and Technology, Institute of Innovative Research, Tokyo Institute of Technology, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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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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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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Sood A, Wong P, Borchert A, Budzyn J, Keeley J, Heilbronn C, Eilender B, Littleton R, Leavitt DA. Use of ultra-low dose computed tomography versus abdominal plain film for assessment of stone-free rates after shock-wave lithotripsy: implications on emergency room visits, surgical procedures, and cost-effectiveness. Urolithiasis 2021; 49:591-598. [PMID: 33993338 DOI: 10.1007/s00240-021-01273-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
The aims of this investigation were: (1) to compare residual stone-fragment (RSF) detection rates of ultra-low dose computed tomography (ULD-CT) and abdominal plain film (KUB) in urolithiasis patients undergoing shock-wave lithotripsy (SWL), and (2) to evaluate the downstream sequelae of utilizing these two disparate imaging pathways of differing diagnostic fidelity. A retrospective chart-review of patients undergoing SWL at two high-volume surgical centers was undertaken (2013-2016). RSF diagnostic rates of ULD-CT and KUB were assessed, and the impact of imaging modality used on subsequent emergency room (ER) visits, unplanned procedures, and cost-effectiveness was investigated. Adjusted analyses examined association between imaging modality used and outcomes, and Markov decision-tree analysis was performed to identify a cost advantageous scenario for ULD-CT over KUB. Of 417 patients studied, 57 (13.7%) underwent ULD-CT while the remaining 360 underwent KUB. The RSF rates were 36.8% and 22.8% in the ULD-CT and KUB groups, respectively (p = 0.019). A 5.6% and 18% of the patients deemed stone-free on ULD-CT and KUB, respectively, returned to the ER (p = 0.040). Similarly, 2.8% and 15.1% needed an unplanned surgery (p = 0.027). These findings were confirmed on multivariable analyses, Odds ratios CT-ULD versus KUB: 0.19 and 0.10, respectively, p < 0.05. With regards to cost-effectiveness, at low ULD-CT charges, the ULD-CT follow-up pathway was economically more favorable, but with increasing ULD-CT charges, the KUB follow-up pathway superseded. ULD-CT seems to provide a more 'true' estimate of stone-free status, and in consequence mitigates unwanted emergency and operating room visits by reducing untimely stent removals and false patient reassurances. Further, at low ULD-CT costs, it may also be economically more favorable.
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Affiliation(s)
- Akshay Sood
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA. .,Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
| | - Philip Wong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Alex Borchert
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jeff Budzyn
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jacob Keeley
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA
| | - Chase Heilbronn
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.,Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ben Eilender
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.,Department of Urology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | | | - David A Leavitt
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
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Lam JP, Alexander LF, Haley WE, Hodge DO, Kofler JM, Morin RL, Thiel DD, Cernigliaro JC. In Vivo Comparison of Radiation Exposure in Third Generation versus Second Generation Dual-Source Dual-Energy CT for Imaging Urinary Calculi. J Endourol 2021; 35:1581-1585. [PMID: 33858196 DOI: 10.1089/end.2021.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the potential for decreasing radiation dose when utilizing a third generation versus second generation dual-source dual-energy CT scanner, while maintaining diagnostic image quality and acceptable image noise. MATERIALS AND METHODS Retrospective analysis of patients who underwent dual-source dual-energy CT (dsDECT) for clinical suspicion of urolithiasis from 10/2/2017 - 9/5/2018. Patient demographics, body mass index, abdominal diameter, scanning parameters, and CT dose index volume (CTDIvol) were recorded. Image quality was assessed by measuring the attenuation and standard deviation (SD) regions of interest in the aorta and in the bladder. Image noise was determined by averaging the SD at both levels. Patients were excluded if they had not undergone both 3rd and 2nd generation DECT, time between DECT was more than 2 years, or scan parameters were outside standard protocol. RESULTS 117 patients met inclusion criteria. Examinations performed on a 3rd generation DECT had an average CTDIvol 12.3 mGy, while examinations performed on a 2nd generation DECT had an average CTDIvol 13.3 mGy (p<0.001). Average image noise was significantly lower for the 3rd generation DECT (SD=10.3) as compared to the 2nd generation DECT (SD=13.9) (p<0.001). CONCLUSIONS The third generation dsDECT scanners can simultaneously decrease patient radiation dose and decrease image noise as compared to second generation DECT. These reductions in radiation exposure can be particularly important in patients with urinary stone disease who often require repeated imaging to evaluate for stone development and recurrence as well as treatment assessment.
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Affiliation(s)
- Jonathan P Lam
- Mayo Clinic Florida, 23389, Radiology, Jacksonville, Florida, United States;
| | - Lauren F Alexander
- Mayo Clinic Florida, 23389, Radiology, Jacksonville, Florida, United States;
| | - William E Haley
- Mayo Clinic Florida, 23389, Nephrology, Jacksonville, Florida, United States;
| | - David O Hodge
- Mayo Clinic Florida, 23389, Biomedical Statistics and Informatics, Jacksonville, Florida, United States;
| | - James M Kofler
- Mayo Clinic Florida, 23389, Radiology, Jacksonville, Florida, United States;
| | - Richard L Morin
- Mayo Clinic Florida, 23389, Radiology, Jacksonville, Florida, United States;
| | - David D Thiel
- Mayo Clinic Florida, 23389, Urology, Jacksonville, Florida, United States;
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Bo S, Sedaghat F, Pavuluri K, Rowe SP, Cohen A, Kates M, McMahon MT. Dynamic Contrast Enhanced-MR CEST Urography: An Emerging Tool in the Diagnosis and Management of Upper Urinary Tract Obstruction. Tomography 2021; 7:80-94. [PMID: 33801533 PMCID: PMC8103243 DOI: 10.3390/tomography7010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 02/04/2023] Open
Abstract
Upper urinary tract obstructions (UTOs) are blockages that inhibit the flow of urine through its normal course, leading to impaired kidney function. Imaging plays a significant role in the initial diagnosis of UTO, with anatomic imaging (primarily ultrasound (US) and non-contrast computed tomography (CT)) serving as screening tools for the detection of the dilation of the urinary collecting systems (i.e., hydronephrosis). Whether hydronephrosis represents UTO or a non-obstructive process is determined by functional imaging (typically nuclear medicine renal scintigraphy). If these exams reveal evidence of UTO but no discernable source, multiphase contrast enhanced CT urography and/or dynamic contrast enhanced MR urography (DCE-MRU) may be performed to delineate a cause. These are often performed in conjunction with direct ureteroscopic evaluation. While contrast-enhanced CT currently predominates, it can induce renal injury due to contrast induced nephropathy (CIN), subject patients to ionizing radiation and is limited in quantifying renal function (traditionally assessed by renal scintigraphy) and establishing the extent to which hydronephrosis is due to functional obstruction. Traditional MRI is similarly limited in its ability to quantify function. DCE-MRU presents concerns regarding nephrogenic systemic fibrosis (NSF), although decreased with newer gadolinium-based contrast agents, and regarding cumulative gadolinium deposition in the basal ganglia. DCE-MR CEST urography is a promising alternative, employing new MRI contrast agents and imaging schemes and allowing for concurrent assessment of renal anatomy and functional parameters. In this review we highlight clinical challenges in the diagnosis and management of UTO, identify key advances in imaging agents and techniques for DCE-MR CEST urography and provide perspective on how this technique may evolve in clinical importance.
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Affiliation(s)
- Shaowei Bo
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Farzad Sedaghat
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - KowsalyaDevi Pavuluri
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Andrew Cohen
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Max Kates
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Michael T. McMahon
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
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Miller DT, Semins MJ. Minimizing radiation dose in management of stone disease: how to achieve 'ALARA'. Curr Opin Urol 2021; 31:115-119. [PMID: 33394609 DOI: 10.1097/mou.0000000000000845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Exposure to radiation is known to have adverse effects such as secondary malignancies. Patients with nephrolithiasis are exposed to radiation in the workup and treatment of their condition. Furthermore, exposure to radiation is often repeated due to the high recurrence rate of nephrolithiasis. RECENT FINDINGS We discuss practices inside and outside of the operating room to strive to keep radiation exposure as low as reasonably achievable (ALARA) for patients being treated for nephrolithiasis. These efforts include reduced dose computed tomography scans, fluoroless surgical techniques and new alternative technologies. SUMMARY Maintaining radiation exposure ALARA for our patients is increasingly practical. The urologist must make every effort to adhere to ALARA principles to protect patients from the stochastic effects of radiation.
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Affiliation(s)
- David T Miller
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Yang B, Suhail N, Marais J, Brewin J. Do low dose CT-KUBs really expose patients to more radiation than plain abdominal radiographs? Urologia 2021; 88:362-368. [PMID: 33583356 DOI: 10.1177/0391560321994443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Urolithiasis patients often require frequent urinary tract imaging, leading to high radiation exposure. CT Kidney-Ureter-Bladder (CT-KUB) is the gold standard in urolithiasis detection, however it is thought to harbour significant radiation load. Urologists have therefore utilised abdominal radiographs (XR-KUB) as an alternative, though with markedly lower sensitivity and specificity. We present the first contemporary UK study comparing the effective doses of XR-KUBs with low dose CT-KUBs. METHOD Fifty-three patients were retrospectively identified in a single centre who underwent both a XR-KUB and a CT-KUB in 2018. Effective-Dose was measured by converting the recorded 'Dose Area/Length Product' via the International Commission on Radiological Protection formula. RESULTS The average effective dose of XR-KUBs and low dose CT-KUBs were 5.10 mSv and 5.31 mSv respectively. Thirty-four percent (18/53) of patients had a XR-KUBs with a higher effective dose than their low dose CT-KUB. Patients with higher Weight, BMI and AP diameter had higher effective doses for both their XR and low dose CT-KUBs. All patients in our study weighing over 92 kg or with a BMI greater than 32 had a XR-KUBs with a higher effective dose than their low dose CT-KUB. CONCLUSION This data supports moving away from XR-KUBs for the investigation of urolithiasis, particularly in patients with a high BMI.
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Affiliation(s)
- Bob Yang
- Salisbury District Hospital, Salisbury, UK
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Ghoshal N, Gaikstas G. CT KUB scans for renal colic: Optimisation of scan range to reduce patient radiation burden. Radiography (Lond) 2021; 27:784-788. [PMID: 33451884 DOI: 10.1016/j.radi.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Non-contrast CT KUB scans performed to assess renal colic should be limited to scanning between the upper pole of the highest kidney and the pubic symphysis to minimise unnecessary irradiation. This audit aimed to assess the amount of overscanning in CT KUBs outside this range. METHODS CT KUB scans taken over a 10-day period were assessed. Unnecessary overscan above the highest kidney was measured as a percentage of the total scan range. A target of less than 10% overscanning was set. The vertebral position of the upper pole of the highest kidney was also measured and compared to the actual level of the scan. RESULTS 88 patients were assessed. 89.8% (79/88) of scans didn't meet the target of less than 10% overscanning above the highest kidney, and were associated with a higher radiation dose to the patient. The average overscanning above the highest pole of the kidney was 16.4% of the whole scan. The average overscan below the pubic symphysis was 1.54%. We also found that 100% of scanned kidneys lied below the upper border of the T11 vertebra, in spite of scans starting as high as T7. CONCLUSION A large proportion of scans included unnecessary overscanning above the highest kidney. We have identified the upper border of the T11 vertebral body as a potential location from which to begin the upper margin of a CT KUB scan. IMPLICATIONS FOR PRACTICE By starting CT KUB scans at the upper border of the T11 vertebral body, we can allow the whole kidney to be imaged while minimising unnecessary overscanning above the kidney, thus lowering excess patient irradiation while still producing high quality scans.
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Herts BR, Schreiner A, Dong F, Primak A, Bullen J, Karim W, Nachand D, Hunter S, Baker ME. Effect of obesity on ability to lower exposure for detection of low-attenuation liver lesions. J Appl Clin Med Phys 2020; 22:138-144. [PMID: 33368998 PMCID: PMC7882113 DOI: 10.1002/acm2.13149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/26/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose The purpose of this study was to assess the effect of obesity and iterative reconstruction on the ability to reduce exposure by studying the accuracy for detection of low‐contrast low‐attenuation (LCLA) liver lesions on computed tomography (CT) using a phantom model. Methods A phantom with four unique LCLA liver lesions (5‐ to 15‐mm spheres, –24 to –6 HU relative to 90‐HU background) was scanned without (“thin” phantom) and with (“obese” phantom) a 5‐cm thick fat‐attenuation ring at 150 mAs (thin phantom) and 450 mAs (obese phantom) standard exposures and at 33% and 67% exposure reductions. Images were reconstructed using standard filtered back projection (FBP) and with iterative reconstruction (Adaptive Model‐Based Iterative Reconstruction strength 3, ADMIRE). A noninferiority analysis of lesion detection was performed. Results Mean area under the curve (AUC) values for lesion detection were significantly higher for the thin phantom than for the obese phantom regardless of exposure level (P < 0.05) for both FBP and ADMIRE. At 33% exposure reduction, AUC was noninferior for both FBP and ADMIRE strength 3 (P < 0.0001). At 67% exposure reduction, AUC remained noninferior for the thin phantom (P < 0.0035), but was no longer noninferior for the obese phantom (P ≥ 0.7353). There were no statistically significant differences in AUC between FBP and ADMIRE at any exposure level for either phantom. Conclusions Accuracy for lesion detection was not only significantly lower in the obese phantom at all relative exposures, but detection accuracy decreased sooner while reducing the exposure in the obese phantom. There was no significant difference in lesion detection between FBP and ADMIRE at equivalent exposure levels for either phantom.
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Affiliation(s)
- Brian R Herts
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Andrew Schreiner
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Frank Dong
- Department of Medical Physics - Desk AC-211, Cleveland Clinic, Imaging Institute, Beachwood, OH, USA
| | - Andrew Primak
- c/o Imaging Institute - Desk AC-221, Siemens Healthineers, Beachwood, OH, USA
| | - Jennifer Bullen
- Department of Quantitative Health Sciences - JJN3, Cleveland Clinic, Cleveland, OH, USA
| | - Wadih Karim
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Douglas Nachand
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Sara Hunter
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Mark E Baker
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
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Application of decision rules on diagnosis and prognosis of renal colic: a systematic review and meta-analysis. Eur J Emerg Med 2020; 27:87-93. [PMID: 31356369 DOI: 10.1097/mej.0000000000000610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Renal colic is a prevalent emergency department presentation resulting from urolithiasis. Clinical decision rules for the diagnosis of urolithiasis were developed to help clinicians with better judgment. In this systematic review, we assessed the performance of prediction rules on urolithiasis diagnosis and prognosis. MEDLINE, Embase, Web of Science, and Scopus were searched for studies on the performance of a clinical decision tool for diagnosis or prognosis of urolithiasis. Performance and accuracy of the rules were the key outcomes of interest. Databases were searched from inception to March 2019. Of the 4980 articles reviewed, 28 studies were included in the present analysis. Twenty-one studies were on urolithiasis diagnosis (including eight studies on STONE rule), and 10 studies reported urolithiasis outcomes. Studies were at low to moderate risk of bias. The pooling of data on STONE showed that the prevalence of urolithiasis in low, moderate, and high risk groups were: 12% (95% confidence interval 9%-15%), 53% (95% confidence interval 43%-62%), and 83% (95% confidence interval 75%-91%), respectively. In the high risk score group, prevalence of clinically important alternative diagnosis was 1% (95% confidence interval 0%-2%) and 11% (95% confidence interval 8%-13%) of patients needed intervention. STONE scoring system is useful in estimating the prevalence of urolithiasis but high heterogeneity among the studies makes it unsuitable for application. Other decision tools were poorly studied and cannot be recommended for clinical use.
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Nimesh S, Ashwlayan VD, Rani R, Prakash O. Advantages of Herbal Over Allopathic Medicine in the Management of Kidney and Urinary Stones Disease. BORNEO JOURNAL OF PHARMACY 2020. [DOI: 10.33084/bjop.v3i3.1415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Kidney and urinary stone disease (Nephrolithiasis and urolithiasis) are the condition where urinary stones or calculi are formed in the urinary tract. The problem of urinary stones is very ancient; these stones are found in all parts of the urinary tract, kidney, ureters, and the urinary bladder and may vary considerably in size. It is a common disease estimated to occur in approximately 12% of the population, with a recurrence rate of 70-81% in males and 47-60% in females. The treatment of kidney and urinary stone diseases such as a western (allopathy) medicine and surgery is now in trends. However, most people preferred plant-based (herbal) therapy because of the overuse of allopathic drugs, which results in a higher incidence rate of adverse or severe side effects. Therefore, people every year turn to herbal therapy because they believe plant-based medicine is free from undesirable side effects, although herbal medicines are generally considered to be safe and effective. In the present article, an attempt has been made to emphasize an herbal therapy is better than allopathic therapy for the management of the kidney and urinary stone disease.
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Affiliation(s)
| | | | - Rubi Rani
- NKBR College of Pharmacy and Research Centre
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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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Roberts MJ, Williams J, Khadra S, Nalavenkata S, Kam J, McCombie SP, Arianayagam M, Canagasingham B, Ferguson R, Khadra M, Varol C, Winter M, Sanaei F, Loh H, Thakkar Y, Dugdale P, Ko R. A prospective, matched comparison of ultra-low and standard-dose computed tomography for assessment of renal colic. BJU Int 2020; 126 Suppl 1:27-32. [PMID: 32573114 DOI: 10.1111/bju.15116] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of ultra-low-dose computed tomography (ULDCT) compared with standard-dose CT (SDCT) in the evaluation of patients with clinically suspected renal colic, in addition to secondary features (hydroureteronephrosis, perinephric stranding) and additional pathological entities (renal masses). PATIENTS AND METHODS A prospective, comparative cohort study was conducted amongst patients presenting to the emergency department with signs and symptoms suggestive of renal or ureteric colic. Patients underwent both SDCT and ULDCT. Single-blinded review of the image sets was performed independently by three board-certified radiologists. RESULTS Among 21 patients, the effective radiation dose was lower for ULDCT [mean (SD) 1.02 (0.16) mSv] than SDCT [mean (SD) 4.97 (2.02) mSv]. Renal and/or ureteric calculi were detected in 57.1% (12/21) of patients. There were no significant differences in calculus detection and size estimation between ULDCT and SDCT. A higher concordance was observed for ureteric calculi (75%) than renal calculi (38%), mostly due to greater detection of calculi of <3 mm by SDCT. Clinically significant calculi (≥3 mm) were detected by ULDCT with high specificity (97.6%) and sensitivity (100%) compared to overall detection (specificity 91.2%, sensitivity 58.8%). ULDCT and SDCT were highly concordant for detection of secondary features, while ULDCT detected less renal cysts of <2 cm. Inter-observer agreement for the ureteric calculi detection was 93.9% for SDCT and 87.8% for ULDCT. CONCLUSION ULDCT performed similarly to SDCT for calculus detection and size estimation with reduced radiation exposure. Based on this and other studies, ULDCT should be considered as the first-line modality for evaluation of renal colic in routine practice.
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Affiliation(s)
- Matthew J Roberts
- Nepean Urology Research Group, Kingswood, NSW, Australia.,Discipline of Surgery, Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Julia Williams
- Department of Medical Imaging, Nepean Hospital, Kingswood, NSW, Australia
| | - Sam Khadra
- Nepean Urology Research Group, Kingswood, NSW, Australia
| | | | - Jonathan Kam
- Nepean Urology Research Group, Kingswood, NSW, Australia
| | | | | | | | | | - Mohamed Khadra
- Nepean Urology Research Group, Kingswood, NSW, Australia.,Discipline of Surgery, Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Celi Varol
- Nepean Urology Research Group, Kingswood, NSW, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Kingswood, NSW, Australia
| | - Fardin Sanaei
- Department of Medical Imaging, Nepean Hospital, Kingswood, NSW, Australia
| | - Han Loh
- Discipline of Surgery, Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Medical Imaging, Nepean Hospital, Kingswood, NSW, Australia
| | - Yogesh Thakkar
- Department of Medical Imaging, Nepean Hospital, Kingswood, NSW, Australia
| | - Piers Dugdale
- Department of Medical Imaging, Nepean Hospital, Kingswood, NSW, Australia
| | - Raymond Ko
- Nepean Urology Research Group, Kingswood, NSW, Australia.,Discipline of Surgery, Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Taydas O, Koc U. Evaluation of Hepatic Steatosis with CT and Correlation with Anthropometric Measurements. Curr Med Imaging 2020; 16:452-458. [PMID: 32410546 DOI: 10.2174/1573405614666181029115243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/09/2018] [Accepted: 10/13/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate hepatic steatosis in an asymptomatic group of patients with unenhanced abdominal computed tomography (CT) and to compare the results with anthropometric measurements. METHODS The study included 617 patients aged 18-93 years, who underwent unenhanced abdominopelvic CT between January 2016 and December 2017. Three imaging criteria were used in the assessment of hepatic steatosis on CT: mean region of interest (ROI) value of measured liver lobe (40 HU ≥), mean ROI value of measured liver lobe / measured spleen mean ROI value (1 ≥), mean ROI value of measured liver lobe - mean ROI value of spleen (10 HU≥). The liver fat was quantitatively assessed both visually and using multidetector CT grading. The anthropometric measurements used were the size of the liver and spleen, abdominal anterior-posterior diameter, abdominal transverse diameter, abdominal circumference, subcutaneous adipose tissue area, and anterior, posterior, and posterolateral subcutaneous adipose tissue thickness. RESULTS The prevalence of hepatic steatosis was 29.3% according to the visual evaluation, 29.8% according to the quantitative evaluation, 67.1% according to at least one criterion and 23.3% according to at least two criteria. A positive correlation was determined between hepatic steatosis and anthropometric measurements. Differences between the genders were observed in both hepatic steatosis and anthropometric measurements. CONCLUSION By setting more objective criteria for evaluation, with the possibility of quantitative analysis in particular, non-contrast CT will have a more important role in assessing liver fat in the future.
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Affiliation(s)
- Onur Taydas
- Department of Radiology, Erzincan Binali Yildirim University, Mengücek Gazi Training and Research Hospital, Erzincan 24100, Turkey
| | - Ural Koc
- Department of Radiology, Erzincan Binali Yildirim University, Mengücek Gazi Training and Research Hospital, Erzincan 24100, Turkey
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Gershan V, Homayounieh F, Singh R, Avramova-Cholakova S, Faj D, Georgiev E, Girjoaba O, Griciene B, Gruppetta E, Hadnadjev Šimonji D, Kharuzhyk S, Klepanec A, Kostova-Lefterova D, Kulikova A, Lasic I, Milatovic A, Paulo G, Vassileva J, Kalra MK. CT protocols and radiation doses for hematuria and urinary stones: Comparing practices in 20 countries. Eur J Radiol 2020; 126:108923. [DOI: 10.1016/j.ejrad.2020.108923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
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Caraiani C, Yi D, Petresc B, Dietrich C. Indications for abdominal imaging: When and what to choose? J Ultrason 2020; 20:e43-e54. [PMID: 32320166 PMCID: PMC7266076 DOI: 10.15557/jou.2020.0008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/18/2020] [Indexed: 12/19/2022] Open
Abstract
Imaging has a very important role in evaluating abdominal pathology. A good knowledge of indications is of crucial importance in the management of the patient with abdominal pathology. Ultrasound, which on its own can lead to an accurate diagnosis, plays a pivotal role in the management of abdominal pathology. The use of ultrasound contrast agents has significantly improved ultrasound diagnostic capacities in both hepatic and non-hepatic pathology. The use of computed tomography should be limited due to the potential harmful side effects of ionizing radiation, but it has established roles in evaluating severe abdominal traumatic and non-traumatic emergencies as well as in staging oncologic patients. Magnetic resonance imaging has very limited utility in abdominal emergencies due to difficulty of accessing the scanner and the long duration of the examination compared to computed tomography or ultrasound. However, magnetic resonance imaging has well-established clinical roles particularly for evaluating diffuse or focal hepatic pathology, benign and malignant bile duct pathology, pancreatic tumors, inflammatory bowel disease and rectal tumors. The aims of the following paper are to familiarize the clinician with the indications for imaging in abdominal pathology, to guide the clinician and radiologist in choosing the correct technique for a particular clinical situation, to prevent the overuse of imaging techniques and to prevent misdiagnosis of disease and incorrect therapy resulting from inappropriate imaging. Imaging has a very important role in evaluating abdominal pathology. A good knowledge of indications is of crucial importance in the management of the patient with abdominal pathology. Ultrasound, which on its own can lead to an accurate diagnosis, plays a pivotal role in the management of abdominal pathology. The use of ultrasound contrast agents has significantly improved ultrasound diagnostic capacities in both hepatic and non-hepatic pathology. The use of computed tomography should be limited due to the potential harmful side effects of ionizing radiation, but it has established roles in evaluating severe abdominal traumatic and non-traumatic emergencies as well as in staging oncologic patients. Magnetic resonance imaging has very limited utility in abdominal emergencies due to difficulty of accessing the scanner and the long duration of the examination compared to computed tomography or ultrasound. However, magnetic resonance imaging has well-established clinical roles particularly for evaluating diffuse or focal hepatic pathology, benign and malignant bile duct pathology, pancreatic tumors, inflammatory bowel disease and rectal tumors. The aims of the following paper are to familiarize the clinician with the indications for imaging in abdominal pathology, to guide the clinician and radiologist in choosing the correct technique for a particular clinical situation, to prevent the overuse of imaging techniques and to prevent misdiagnosis of disease and incorrect therapy resulting from inappropriate imaging.
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Affiliation(s)
- Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Dong Yi
- Department of Ultrasound, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Bianca Petresc
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Christoph Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirlsanden Bern Beau Site , Salem und Permanence , Switzerland ; Ultrasound Department, First Affiliated Hospital of Zhengzhou University , China
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Adel H, Sattar A, Rahim A, Aftab A, Adil SO. Diagnostic Accuracy of Doppler Twinkling Artifact for Identifying Urinary Tract Calculi. Cureus 2019; 11:e5647. [PMID: 31700749 PMCID: PMC6822897 DOI: 10.7759/cureus.5647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction Flank pain is a frequent cause of emergency department visits and is often due to renal or ureteric colic. Ultrasound is often the initial imaging study used for the detection of urinary tract calculi. Twinkling artifact is a Doppler artifact usually seen on echogenic rough surfaces such as calculi. Its presence can improve the sensitivity and specificity of ultrasound in stone detection. The objective of the current study was to determine the diagnostic accuracy of the Doppler twinkling artifact for detecting urinary calculi using non-contrast computed tomography as the gold standard. Materials and methods In this cross-sectional study, both male and female patients of any age having flank pain, burning micturition with or without hematuria were included. Ultrasound was performed and the presence or absence of Doppler twinkling artifact on calculus was noted. Following ultrasound, patients underwent plain CT scan and findings of stones were documented. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of Doppler twinkling artifact was calculated considering CT findings as the gold standard. Results Out of the total 221 patients, 146 (66.1%) were males and 75 (33.9%) were females. The mean age of the patients was 45.98 ± 16.30 years. Urinary tract calculi on ultrasound were observed in 74 (33.50%) patients, while on CT urinary tract calculi were observed in 127 (57.50%) patients. Diagnostic accuracy of Doppler twinkling artifact was found to be 71.49% with sensitivity, specificity, positive predictive value, and negative predictive value of 54.33%, 94.68%, 93.24%, and 60.54%, respectively. Conclusion Doppler twinkling artifact has low sensitivity, high specificity, and suboptimal diagnostic accuracy for the diagnosis of urinary tract calculi. Integration of this artifact has a lower sensitivity as compared to non-contrast CT scan. Multicentric studies with larger sample size and focusing on interobserver and intraobserver variability are recommended to have a consensus regarding Doppler twinkling artifact in the evaluation of renal and ureteric calculi.
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Affiliation(s)
- Hatem Adel
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Amjad Sattar
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Anila Rahim
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Anum Aftab
- Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Syed Omair Adil
- Epidemiology and Public Health, Dow University of Health Sciences, Karachi, PAK
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Kataria B, Nilsson Althén J, Smedby Ö, Persson A, Sökjer H, Sandborg M. Image quality and pathology assessment in CT Urography: when is the low-dose series sufficient? BMC Med Imaging 2019; 19:64. [PMID: 31399078 PMCID: PMC6688276 DOI: 10.1186/s12880-019-0363-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/29/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Our aim was to compare CT images from native, nephrographic and excretory phases using image quality criteria as well as the detection of positive pathological findings in CT Urography, to explore if the radiation burden to the younger group of patients or patients with negative outcomes can be reduced. METHODS This is a retrospective study of 40 patients who underwent a CT Urography examination on a 192-slice dual source scanner. Image quality was assessed for four specific renal image criteria from the European guidelines, together with pathological assessment in three categories: renal, other abdominal, and incidental findings without clinical significance. Each phase was assessed individually by three radiologists with varying experience using a graded scale. Certainty scores were derived based on the graded assessments. Statistical analysis was performed using visual grading regression (VGR). The limit for significance was set at p = 0.05. RESULTS For visual reproduction of the renal parenchyma and renal arteries, the image quality was judged better for the nephrogram phase (p < 0.001), whereas renal pelvis/calyces and proximal ureters were better reproduced in the excretory phase compared to the native phase (p < 0.001). Similarly, significantly higher certainty scores were obtained in the nephrogram phase for renal parenchyma and renal arteries, but in the excretory phase for renal pelvis/calyxes and proximal ureters. Assessment of pathology in the three categories showed no statistically significant differences between the three phases. Certainty scores for assessment of pathology, however, showed a significantly higher certainty for renal pathology when comparing the native phase to nephrogram and excretory phase and a significantly higher score for nephrographic phase but only for incidental findings. CONCLUSION Visualisation of renal anatomy was as expected with each post-contrast phase showing favourable scores compared to the native phase. No statistically significant differences in the assessment of pathology were found between the three phases. The low-dose CT (LDCT) seems to be sufficient in differentiating between normal and pathological examinations. To reduce the radiation burden in certain patient groups, the LDCT could be considered a suitable alternative as a first line imaging method. However, radiologists should be aware of its limitations.
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Affiliation(s)
- Bharti Kataria
- Department of Radiology, Linköping University, Linköping, Sweden. .,Department of Medical & Health Sciences, Linköping University, Linköping, Sweden. .,Center for Medical Image Science & Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Jonas Nilsson Althén
- Department of Medical & Health Sciences, Linköping University, Linköping, Sweden.,Department of Medical Physics, Linköping University, Linköping, Sweden
| | - Örjan Smedby
- Department of Biomedical Engineering and Health Systems (MTH), KTH Royal Institute of Technology, Stockholm, Sweden
| | - Anders Persson
- Department of Radiology, Linköping University, Linköping, Sweden.,Department of Medical & Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science & Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Hannibal Sökjer
- Department of Medical & Health Sciences, Linköping University, Linköping, Sweden
| | - Michael Sandborg
- Department of Medical & Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science & Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical Physics, Linköping University, Linköping, Sweden
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Pan S, Su JJ, Syed J, Moore C, Israel G, Singh D. Reduced Dose Computed Tomography: The Effects of Voltage Reduction on Density Measurements of Urolithiasis. J Endourol 2019; 33:682-686. [DOI: 10.1089/end.2019.0149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Shu Pan
- Department of Urology, Yale New-Haven Hospital, New Haven, Connecticut
| | - Jeannie J. Su
- Department of Urology, Yale New-Haven Hospital, New Haven, Connecticut
| | - Jamil Syed
- Department of Urology, Yale New-Haven Hospital, New Haven, Connecticut
| | - Christopher Moore
- Department of Emergency Medicine, Yale New-Haven Hospital, New Haven, Connecticut
| | - Gary Israel
- Department of Radiology, Yale New-Haven Hospital, New Haven, Connecticut
| | - Dinesh Singh
- Department of Urology, Yale New-Haven Hospital, New Haven, Connecticut
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