Ultrasound vs CT for Diagnosis of Kidney Stones
December 1, 2014 less than 1 minute read
There may be greater consequences attendant to our frequent use of CT examinations that readily meets the eye. Whenever I have queried a resident physician about the dose of X-ray produced by an abdominal CT, they consistently underestimate from the literature-documented burden: a single standard abdominal CT is equivalent to the radiation of 500 chest X-rays. Hence, springs forth our enthusiasm for more radiation-friendly tools.
Identification of nephrolithiasis is a commonplace emergency room scenario during which CT may be called upon. Smith-Bindman et al performed a multicenter study to compare the effectiveness of point-of-care ultrasound vs radiologist-performed ultrasound, versus abdominal CT. Patients who presented to emergency rooms (n = 2759) were randomized to receive one of these three initial evaluations. The primary outcome of the study was the number of missed or delayed serious diagnoses. Additional endpoints included cumulative radiation dose over 6 months (to take into account that some initially-ultrasounded patients would require followup radiographic investigation) and pain.
Ultrasound compared very favorably with CT, demonstrating similar efficacy for not missing high-risk diagnoses, complications, and requirement for return visits to the emergency room. Of course, the radiation exposure incurred in the ultrasound groups was substantially less than the CT group. Clinicians skilled at performing ultrasound, or working at sites with skilled ultrasonographers, may wish to consider ultrasound as an attractive alternative to CT for diagnosis of suspected nephrolithiasis.
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