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According to Dr. Remer, there are several ways to reduce radiation exposure:
- Reduce coverage – only image the top of the kidneys to the bladder base
- Increase slice thickness from 1-3 mm to 5 mm and add coronal reformatted imaging (reduces dose 30-50%)
- Decrease tube current (mAs) – use automated modulation, particularly in obese patients. Small retrospectives studies have shown no significant differences with 50% or 75% mAs reduction for detection of >3mm stones.
- Lower tube voltage (kVp) – dose reduction of 35-75%, although with increased degradation (“noise”)
Dr. Remer concluded with several goals moving forward for renal colic imaging: (i) minimizing unnecessary imaging, (ii) shared-decision making, and (iii) facilitate prompt evaluation. Continued refinement of algorithms for acute colic/known stone formers is necessary and important.
Speaker(s): Erick Remer, Cleveland Clinic Foundation, Cleveland, OH, USA
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md, at the AUA Quality Improvement Summit - October 21, 2017- Linthicum, Maryland
1. Moore CL, et al. Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone – the STONE score: retrospective and prospective observational cohort studies. BMJ 2014;348:g2191.`