Eryildirim B et al, 2017: Radiologic evaluation of children prior to SWL: to what extent they are exposed to radiation?
Eryildirim B, Turkoglu O, Goktas C, Kavukoglu O, Guzel R, Sarica K.
Lutfi Kirdar Training and Research Hospital, Radiology Clinic, Istanbul, Turkey.
Lutfi Kirdar Training and Research Hospital, Urology Clinic, Kartal, Istanbul, Turkey.
Medistate Hospital Urology Department, Istanbul, Turkey.
The objective of this study is to evaluate the average radiation exposure in children with renal stones before SWL treatment. Mean radiation exposure values were evaluated in 110 children before SWL treatment. While some children referred to the emergency department (ED) with colic pain, remaining cases referred to outpatient department (OD). Although low-dose NCCT was performed in ED; KUB and abdominal sonography were first performed in other cases referring to OD where CT has been applied if needed. The type of imaging modality used and the mean radiation exposure were evaluated and comparatively evaluated with respect to the department referred, patient as well as stone related parameters. 49 children referred to ED and 61 children referred to OD. Mean stone size was 7.24 ± 0.29 mm. 62 cases had opaque stones. Mean radiation exposure values were higher in children referring to ED than the other cases. However, there was no significant difference between the two groups regarding the mean number of KUB, IVU and sonographic evaluation performed prior to SWL management. There was a significant correlation between the mean radiation exposure and the stone size as well degree of hydonephrosis in a positive manner. Although a significant correlation was present between the mean radiation exposure and stone opacity in a negative manner; there was no correlation with respect to the other related parameters. Unnecessary use of X-ray based imaging modalities in children could be effectively avoided using KUB and US combination beginning from the diagnostic phase of stone disease.
Urolithiasis. 2017 Oct 26. doi: 10.1007/s00240-017-1008-8. [Epub ahead of print]
During the past decades CT-examinations have been used increasingly in the diagnosis as well as follow-up of adult patients with urinary tract stones.
This report puts our attention to excessive use of NCCT also in children examined at the emergency department. It is important to reduce exposure to radiation for all patients, but particularly so for children. This is a group of patients with a risk of several future stone episodes requiring repeated imaging. In this report it is suggested that too many imaging procedures are the result of insufficient recording, patient history and collaboration between radiologists and urologists/paediatricians. A basic and easily accessible computerized recording system that summarizes imaging procedures and radiation doses seems highly desirable.
Such a system should definitely be of clinical value in order to avoid unnecessary examinations. The result shown in this report is, however, a clear reflection of how poorly computers have been utilized in the clinical work with obvious shortcomings for our patients. This is one part of our clinical routines that both can and should be improved!
One interesting observation in this clinical report was the large proportion of children with radio-lucent stones (48/110 = 44%). It might accordingly be difficult to follow the recommendation to use KUB + US as general imaging techniques.
This article is an important reminder always to strictly apply the ALARA principle, particularly when treating children with urinary stones, but also generally for all patients.
It is of note that the authors find it necessary to use anaesthesia when carrying out low-dose NCCT-examinations in children in order to get a reasonable image quality.