Jarral Farhan, Hamdy Abdelrahman, Mohamed Guleed, Mobayen Rosa, Dave Neil, Eltawil Mohammed, Mohan Anand, Abusand Osama, Tokidis Evripidis, Akbar Jawaid
Urology, Doncaster Royal Infirmary, Doncaster, GBR.
General Surgery, Doncaster Royal Infirmary, Doncaster, GBR.
Cureus. 2024 Dec 15;16(12):e75743. doi: 10.7759/cureus.75743. eCollection 2024 Dec.
Background and aim Non-contrast computed tomography of kidneys, ureters, and bladder (CT KUB) is the gold standard radiological imaging for nephrolithiasis. It significantly contributes to the total radiation exposure of a population. This is well known to be linked to increased cancer risk over time and as such should be minimized in line with Ionising Radiation (Medical Exposure) Regulations (IR{ME}R). Previous works have explored a number of avenues to reduce the total radiation exposure such as the cranial extent of the scan; however, at present, there are no formalized guidelines. This study aimed to compare the cranial extent of local CT KUB imaging with previously established thresholds and assess whether total radiation can be reduced through local intervention. Results In the first cycle, a total of 102 non-contrast CT KUB scans were included. Of these, 51% (n=52) commenced from the superior border of the T10-T12 vertebral levels, 48% (n=49) commenced above the T10 vertebral level, and only 1% (n=1) started below the T12 vertebral level. In the second cycle, a total of 105 non-contrast CT KUB scans were assessed. Of these, 21.9% (n=23) commenced above the T10 vertebral level, and 75.2% (n=79) commenced from the superior border of T10-T12 vertebrae. A further 2.9% (n=3) commenced below T12 vertebral level. The findings of this study demonstrate that starting the upper extent of the CT KUB at the T10 vertebral level showed a reduction in radiation dose in millisievert (mSv) delivered to patients while maintaining adequate diagnostic utility. Conclusion Limiting the cranial extent of CT KUB imaging to T10 has consistently captured the upper pole of both kidneys across different patient cohorts, including ours, thus making it an effective way of limiting radiation exposure without sacrificing diagnostic accuracy. In order to achieve robust evidence-based guidelines, further studies would be beneficial.
背景与目的 肾脏、输尿管和膀胱的非增强计算机断层扫描（CT KUB）是肾结石的金标准放射成像检查。它对人群的总辐射暴露有显著影响。众所周知，随着时间的推移，这与癌症风险增加有关，因此应根据《电离辐射（医疗照射）规例》（IR{ME}R）将其降至最低。先前的研究探索了多种降低总辐射暴露的途径，如扫描的颅端范围；然而，目前尚无正式的指南。本研究旨在比较局部CT KUB成像的颅端范围与先前确定的阈值，并评估是否可以通过局部干预降低总辐射量。结果 在第一个周期中，共纳入102例非增强CT KUB扫描。其中，51%（n = 52）从T10 - T12椎体水平的上缘开始，48%（n = 49）从T10椎体水平以上开始，只有1%（n = 1）从T12椎体水平以下开始。在第二个周期中，共评估了105例非增强CT KUB扫描。其中，21.9%（n = 23）从T10椎体水平以上开始，75.2%（n = 79）从T10 - T12椎体的上缘开始。另有2.9%（n = 3）从T12椎体水平以下开始。本研究结果表明，将CT KUB的上端范围起始于T10椎体水平，在保持足够诊断效用的同时，可降低输送给患者的毫希沃特（mSv）辐射剂量。结论 将CT KUB成像的颅端范围限制在T10，在不同患者队列（包括我们的队列）中始终能捕捉到双肾的上极，因此这是一种在不牺牲诊断准确性的情况下限制辐射暴露的有效方法。为了制定强有力的循证指南，进一步的研究将是有益的。
