Standardized CT KUB Protocols for Nephrolithiasis: A Retrospective Analysis of Radiation Exposure and Cranial Extent Guidelines.

Autor:	Jarral F; Urology, Doncaster Royal Infirmary, Doncaster, GBR., Hamdy A; General Surgery, Doncaster Royal Infirmary, Doncaster, GBR., Mohamed G; Urology, Doncaster Royal Infirmary, Doncaster, GBR., Mobayen R; Urology, Doncaster Royal Infirmary, Doncaster, GBR., Dave N; Anesthesiology, Royal Stoke University Hospital, Stoke on Trent, GBR., Eltawil M; Otolaryngology, Doncaster Royal Infirmary, Doncaster, GBR., Mohan A; Urology, Doncaster Royal Infirmary, Doncaster, GBR., Abusand O; Urology, Chesterfield Royal Hospital, Chesterfield, GBR., Tokidis E; General Surgery, Doncaster Royal Infirmary, Doncaster, GBR., Akbar J; Radiology, Doncaster Royal Infirmary, Doncaster, GBR.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Dec 15; Vol. 16 (12), pp. e75743. Date of Electronic Publication: 2024 Dec 15 (Print Publication: 2024).
DOI:	10.7759/cureus.75743
Abstrakt:	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. Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Doncaster Royal Infirmary Audit Department and Surgical Division issued approval #0049/2024/URO/KD. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Jarral et al.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu