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Ann Emerg Med. 2015 Feb;65(2):189-98.e2. doi: 10.1016/j.annemergmed.2014.09.008. Epub 2014 Nov 4.      5/26/2016

Accuracy of reduced-dose computed tomography for ureteral stones in emergency department patients.
Moore CL1, Daniels B2, Ghita M3, Gunabushanam G3, Luty S2, Molinaro AM4, Singh D5, Gross CP6.
Author information
1Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT. Electronic address:
2Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
3Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT.
4Departments of Neurosurgery and Epidemiology and Biostatistics, University of San Francisco School of Medicine, San Francisco, CA.
5Department of Urology, Yale University School of Medicine, New Haven, CT.
6Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
Reduced-dose computed tomography (CT) scans have been recommended for diagnosis of kidney stone but are rarely used in the emergency department (ED) setting. Test characteristics are incompletely characterized, particularly in obese patients. Our primary outcome is to determine the sensitivity and specificity of a reduced-dose CT protocol for symptomatic ureteral stones, particularly those large enough to require intervention, using a protocol stratified by patient size.
This was a prospective, blinded observational study of 201 patients at an academic medical center. Consenting subjects underwent both regular- and reduced-dose CT, stratified into a high and low body mass index (BMI) protocol based on effective abdominal diameter. Reduced-dose CT scans were interpreted by radiologists blinded to regular-dose interpretations. Follow-up for outcome and intervention was performed at 90 days.
CT scans with both regular and reduced doses were conducted for 201 patients, with 63% receiving the high BMI reduced-dose protocol. Ureteral stone was identified in 102 patients (50.7%) of those receiving regular-dose CT, with a ureteral stone greater than 5 mm identified in 26 subjects (12.9%). Sensitivity of the reduced-dose CT for any ureteral stone was 90.2% (95% confidence interval [CI] 82.3% to 95.0%), with a specificity of 99.0% (95% CI 93.7% to 100.0%). For stones greater than 5 mm, sensitivity was 100% (95% CI 85.0% to 100.0%). Reduced-dose CT identified 96% of patients who required intervention for ureteral stone within 90 days. Mean reduction in size-specific dose estimate was 18.6 milligray (mGy), from 21.7 mGy (SD 9.7) to 3.4 mGy (SD 0.9).
CT with substantial dose reduction was 90.2% (95% CI 82.3% to 95.0%) sensitive and 98.9% (95% CI 85.0% to 100.0%) specific for ureteral stones in ED patients with a wide range of BMIs. Reduced-dose CT was 96.0% (95% CI 80.5% to 99.3%) sensitive for ureteral stones requiring intervention within 90 days.


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