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    Study: Ultrasound over CT for initial stone Dx

    Ultrasound should be the initial diagnostic imaging test utilized for diagnosing kidney stones in order to reduce the higher radiation exposure associated with computed tomography, say the authors of a recent study.

    Related - Stone patients at greater risk for CHD, stroke

    In the randomized controlled trial, which was published in the New England Journal of Medicine (2014; 371:1100-10), the authors assigned 2,759 patients who came to hospital emergency departments with suspected cases of kidney stones into one of three groups: initial diagnostic testing by point-of-care ultrasound (in the ED), radiology ultrasound, or abdominal CT scan.

    After 30 days, the authors found no significant differences among the three groups in the rate of high-risk diagnoses of kidney stones with complications that could have been related to missed or delayed diagnoses, according to a press release from the Agency for Healthcare Research & Quality, which funded the study. After 6 months, they found that the proportion of patients with confirmed diagnoses of kidney stones was similar for all three study groups, but patients who initially received a CT scan had significantly higher radiation exposure than patients in the two ultrasound groups.

    Some patients in the ultrasound groups went on to have additional testing, some of which included CT scans. This resulted in an average radiation exposure of about half that of the CT group.

    The authors found no significant differences among the three groups in the rates of serious adverse events, pain, return trips to the ED, or hospitalizations.

    Although CT scans are currently favored by ED physicians for diagnosing stones, ultrasound should be used initially instead, said senior author Rebecca Smith-Bindman, MD, of the University of California, San Francisco, in a press release from that institution.

     

    Next: "Ultrasound is the right place to start"

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    Benjamin P. Saylor
    Benjamin P. Saylor is associate editor of Urology Times, an Advanstar Communications publication.

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