Raskolnikov Dima, Tzou David T, Ahn Justin S, Bechis Seth K, Chi Thomas L, Sorensen Mathew D, Stoller Marshall L, Harper Jonathan D
Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA.
Department of Urology, University of Arizona College of Medicine, Tucson, Arizona, USA.
J Endourol. 2022 Oct;36(10):1377-1381. doi: 10.1089/end.2022.0008. Epub 2022 Jun 22.
Guidelines from the American Urological Association (AUA) and American College of Radiology (ACR) recommend that patients with suspected nephrolithiasis undergo low-dose CT of the kidney, ureter, and bladder (LD CT KUB) as opposed to higher dose conventional imaging. We hypothesized that even at institutions with established LD protocols, higher dose imaging is common. We identified four academic medical centers where LD CT KUB protocols were implemented to yield an effective dose (EDose) consistent with national guidelines. Fifty consecutive adult patients who underwent CT KUB specifically for the evaluation of nephrolithiasis were retrospectively reviewed at each site. Patient age, sex, body mass index (BMI), imaging location, and EDose (millisieverts [mSv]) were recorded. Two hundred patients with a mean age of 54 years were identified. Forty-six patients (23%) underwent CT KUB with an EDose 4 mSv, accounting for 10% to 48% of each institution's cohort. One hundred sixteen patients had a BMI <30, and would have been expected to receive LD CTs by the AUA criteria for LD CT KUB. Within this subset, only 37 patients (32%) actually underwent LD CT KUB. The highest dose CT KUB at each institution resulted in an EDose of 33.8 to 44.6 mSv, exceeding the recommended exposure of LD CT KUB by 10-fold. At academic institutions where LD CT KUB was implemented for the evaluation of nephrolithiasis, a minority of patients with BMI <30 received guideline-concordant imaging. Differences in patient BMI did not account for the variation in radiation exposure. Further research is necessary to elucidate barriers to LD CT implementation.
美国泌尿外科学会（AUA）和美国放射学会（ACR）的指南建议，疑似肾结石的患者应接受肾脏、输尿管和膀胱低剂量CT（LD CT KUB）检查，而非更高剂量的传统成像检查。我们推测，即使在已制定低剂量方案的机构中，高剂量成像检查也很常见。我们确定了四个实施LD CT KUB方案以产生与国家指南一致的有效剂量（EDose）的学术医疗中心。在每个中心，对连续50例专门为评估肾结石而接受CT KUB检查的成年患者进行了回顾性研究。记录患者的年龄、性别、体重指数（BMI）、成像部位和EDose（毫西弗特[mSv]）。共确定了200例平均年龄为54岁的患者。46例患者（23%）接受的CT KUB检查EDose≥4 mSv，占每个机构队列的10%至48%。116例患者的BMI<30，根据AUA的LD CT KUB标准，他们本应接受低剂量CT检查。在这一亚组中，只有37例患者（32%）实际接受了LD CT KUB检查。每个机构剂量最高的CT KUB检查的EDose为33.8至44.6 mSv，比LD CT KUB建议的暴露剂量高出10倍。在为评估肾结石而实施LD CT KUB检查的学术机构中，BMI<30的患者中只有少数接受了符合指南的成像检查。患者BMI的差异并不能解释辐射暴露的差异。有必要进行进一步研究以阐明低剂量CT实施的障碍。
