January 23, 2015

The bell tolls for renal colic CT scans

16 minutes

Use of CT scans for the evaluation of renal colic increased 10 fold between 1996 to 2007. Is this good for patients? Have they benefitted from the detailed information that CT scanning? The answer is no. Several studies have revealed that we are not only irradiatiting patients at an increasingly alarming rate, their outcomes are not improving because of it. In this episode, recorded at the Cabo CME retreat, ERCast meets up with Matt Dawson and Mike Mallin from The Ultrasound Podcast to discuss the article Ultrasonography versus computed tomography for suspected nephrolithiasis.

Study Breakdown

About 3ooo patients with suspected renal colic divided into 3 groups defined by initial diagnostic study

CT scan

Radiology Ultrasound

Point of Care Ultrasound

Results: Using CT as the initial study increased radiation exposure but did not reduce adverse outcomes.

ERCast editorial: Another way to look at: Starting with ultrasound as the initial imaging modality decreased radiation exposure and did not increase adverse outcomes. Whether you see the cup as half full or half empty, starting with US in an uncomplicated case of suspected renal colic seems like the right call. If you start with CT on everybody, then everybody gets irradiated.

For a more detailed discussion on this topic, check out the Broomedocs Podcast.

References

Smith-Bindman, Rebecca, et al. "Ultrasonography versus computed tomography for suspected nephrolithiasis." New England Journal of Medicine371.12 (2014): 1100-1110.

Westphalen, Antonio C., et al. "Radiological imaging of patients with suspected urinary tract stones: national trends, diagnoses, and predictors." Academic Emergency Medicine 18.7 (2011): 699-707.

Moore, Christopher L., and Leslie Scoutt. "Sonography first for acute flank pain?." Journal of Ultrasound in Medicine 31.11 (2012): 1703-1711.

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By Rob Orman, MD

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