Computed Tomography Radiation Exposure among Referred Kidney Stone Patients

Results from the Registry for Stones of the Kidney and Ureter

David T. Tzou, Samuel Zetumer, Manint Usawachintachit, Kazumi Taguchi, Seth K. Bechis, Brian Duty, Jonathan D. Harper, Ryan S. Hsi, Mathew Sorensen, Roger L. Sur, Shalonda Reliford-Titus, Helena C. Chang, Dylan Isaacson, David B. Bayne, Zhen J. Wang, Marshall L. Stoller, Thomas Chi

Research output: Contribution to journalArticle

Abstract

Purpose: Kidney stone patients routinely have CT scans during diagnostic work-up before being referred to a tertiary center. How often these patients exceed the recommended dose limits for occupational radiation exposure of >100 mSv for 5 years and >50 mSv in a single year from CT alone remains unknown. This study aimed to quantify radiation doses from CTs received by stone patients before their evaluation at a tertiary care stone clinic. Methods: From November 2015 to March 2017, consecutive new patients enrolled into the Registry for Stones of the Kidney and Ureter (ReSKU™) had the dose-length product of every available CT abdomen/pelvis within 5 years of their initial visit recorded, allowing for an effective dose (EDose) calculation. Multivariate logistic regression analysis identified factors associated with exceeding recommended dose limits. Models were created to test radiation reducing effects of low-dose and phase-reduction CT protocols. Results: Of 343 noncontrast CTs performed, only 29 (8%) were low-dose CTs (calculated EDose <4 mSv). Among 389 total patients, 101 (26%) and 25 (6%) had an EDose >20 mSv and >50 mSv/year, respectively. Increased body mass index, number of scans, and multiphase scans were associated with exceeding exposure thresholds (p < 0.01). The implementation of a low-dose CT protocol decreased the estimated number of scans contributing to overexposure by >50%. Conclusions: Stone patients referred to a tertiary stone center may receive excessive radiation from CT scans alone. Unnecessary phases and underutilization of low-dose CT protocols continue to take place. Enacting new approaches to CT protocols may spare stone patients from exceeding recommended dose limits.

Original languageEnglish (US)
Pages (from-to)619-624
Number of pages6
JournalJournal of Endourology
Volume33
Issue number7
DOIs
StatePublished - Jul 1 2019

Fingerprint

Kidney Calculi
Ureter
Registries
Tomography
Radiation
Radiation Effects
Tertiary Healthcare
Occupational Exposure
Pelvis
Abdomen
Radiation Exposure
Body Mass Index
Logistic Models
Regression Analysis
CT protocol

Keywords

  • CT
  • effective dose
  • ionizing radiation
  • kidney stones
  • low-dose CT
  • radiation dose limit

ASJC Scopus subject areas

  • Urology

Cite this

Computed Tomography Radiation Exposure among Referred Kidney Stone Patients : Results from the Registry for Stones of the Kidney and Ureter. / Tzou, David T.; Zetumer, Samuel; Usawachintachit, Manint; Taguchi, Kazumi; Bechis, Seth K.; Duty, Brian; Harper, Jonathan D.; Hsi, Ryan S.; Sorensen, Mathew; Sur, Roger L.; Reliford-Titus, Shalonda; Chang, Helena C.; Isaacson, Dylan; Bayne, David B.; Wang, Zhen J.; Stoller, Marshall L.; Chi, Thomas.

In: Journal of Endourology, Vol. 33, No. 7, 01.07.2019, p. 619-624.

Research output: Contribution to journalArticle

Tzou, DT, Zetumer, S, Usawachintachit, M, Taguchi, K, Bechis, SK, Duty, B, Harper, JD, Hsi, RS, Sorensen, M, Sur, RL, Reliford-Titus, S, Chang, HC, Isaacson, D, Bayne, DB, Wang, ZJ, Stoller, ML & Chi, T 2019, 'Computed Tomography Radiation Exposure among Referred Kidney Stone Patients: Results from the Registry for Stones of the Kidney and Ureter', Journal of Endourology, vol. 33, no. 7, pp. 619-624. https://doi.org/10.1089/end.2019.0091
Tzou, David T. ; Zetumer, Samuel ; Usawachintachit, Manint ; Taguchi, Kazumi ; Bechis, Seth K. ; Duty, Brian ; Harper, Jonathan D. ; Hsi, Ryan S. ; Sorensen, Mathew ; Sur, Roger L. ; Reliford-Titus, Shalonda ; Chang, Helena C. ; Isaacson, Dylan ; Bayne, David B. ; Wang, Zhen J. ; Stoller, Marshall L. ; Chi, Thomas. / Computed Tomography Radiation Exposure among Referred Kidney Stone Patients : Results from the Registry for Stones of the Kidney and Ureter. In: Journal of Endourology. 2019 ; Vol. 33, No. 7. pp. 619-624.
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abstract = "Purpose: Kidney stone patients routinely have CT scans during diagnostic work-up before being referred to a tertiary center. How often these patients exceed the recommended dose limits for occupational radiation exposure of >100 mSv for 5 years and >50 mSv in a single year from CT alone remains unknown. This study aimed to quantify radiation doses from CTs received by stone patients before their evaluation at a tertiary care stone clinic. Methods: From November 2015 to March 2017, consecutive new patients enrolled into the Registry for Stones of the Kidney and Ureter (ReSKU™) had the dose-length product of every available CT abdomen/pelvis within 5 years of their initial visit recorded, allowing for an effective dose (EDose) calculation. Multivariate logistic regression analysis identified factors associated with exceeding recommended dose limits. Models were created to test radiation reducing effects of low-dose and phase-reduction CT protocols. Results: Of 343 noncontrast CTs performed, only 29 (8{\%}) were low-dose CTs (calculated EDose <4 mSv). Among 389 total patients, 101 (26{\%}) and 25 (6{\%}) had an EDose >20 mSv and >50 mSv/year, respectively. Increased body mass index, number of scans, and multiphase scans were associated with exceeding exposure thresholds (p < 0.01). The implementation of a low-dose CT protocol decreased the estimated number of scans contributing to overexposure by >50{\%}. Conclusions: Stone patients referred to a tertiary stone center may receive excessive radiation from CT scans alone. Unnecessary phases and underutilization of low-dose CT protocols continue to take place. Enacting new approaches to CT protocols may spare stone patients from exceeding recommended dose limits.",
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T1 - Computed Tomography Radiation Exposure among Referred Kidney Stone Patients

T2 - Results from the Registry for Stones of the Kidney and Ureter

AU - Tzou, David T.

AU - Zetumer, Samuel

AU - Usawachintachit, Manint

AU - Taguchi, Kazumi

AU - Bechis, Seth K.

AU - Duty, Brian

AU - Harper, Jonathan D.

AU - Hsi, Ryan S.

AU - Sorensen, Mathew

AU - Sur, Roger L.

AU - Reliford-Titus, Shalonda

AU - Chang, Helena C.

AU - Isaacson, Dylan

AU - Bayne, David B.

AU - Wang, Zhen J.

AU - Stoller, Marshall L.

AU - Chi, Thomas

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N2 - Purpose: Kidney stone patients routinely have CT scans during diagnostic work-up before being referred to a tertiary center. How often these patients exceed the recommended dose limits for occupational radiation exposure of >100 mSv for 5 years and >50 mSv in a single year from CT alone remains unknown. This study aimed to quantify radiation doses from CTs received by stone patients before their evaluation at a tertiary care stone clinic. Methods: From November 2015 to March 2017, consecutive new patients enrolled into the Registry for Stones of the Kidney and Ureter (ReSKU™) had the dose-length product of every available CT abdomen/pelvis within 5 years of their initial visit recorded, allowing for an effective dose (EDose) calculation. Multivariate logistic regression analysis identified factors associated with exceeding recommended dose limits. Models were created to test radiation reducing effects of low-dose and phase-reduction CT protocols. Results: Of 343 noncontrast CTs performed, only 29 (8%) were low-dose CTs (calculated EDose <4 mSv). Among 389 total patients, 101 (26%) and 25 (6%) had an EDose >20 mSv and >50 mSv/year, respectively. Increased body mass index, number of scans, and multiphase scans were associated with exceeding exposure thresholds (p < 0.01). The implementation of a low-dose CT protocol decreased the estimated number of scans contributing to overexposure by >50%. Conclusions: Stone patients referred to a tertiary stone center may receive excessive radiation from CT scans alone. Unnecessary phases and underutilization of low-dose CT protocols continue to take place. Enacting new approaches to CT protocols may spare stone patients from exceeding recommended dose limits.

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KW - effective dose

KW - ionizing radiation

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