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MINIMISING RADIATION DOSE IN PATIENTS UNDERGOING COMPUTED TOMOGRAPHY OF KIDNEYS, URETERS AND BLADDER (CT-KUB)
EP34403
Poster Title: MINIMISING RADIATION DOSE IN PATIENTS UNDERGOING COMPUTED TOMOGRAPHY OF KIDNEYS, URETERS AND BLADDER (CT-KUB)
Submitted on 30 Oct 2020
Author(s): Dr. Joel James, Dr. Vijay Vendra
Affiliations: BIR
This poster was presented at BIR 2020
Poster Views: 324
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Poster Information
Abstract: BACKGROUND

Computed tomography of the kidneys, ureters and bladder (CT KUB) is part of the diagnostic work up for renal calculi along with other clinical markers which has both high sensitivity – 97% and specificity of 95%. It can also determine stone density using Hounsfield Unit (HU).
Royal College of Radiologists and British Association of Urological Surgeons guidelines recommends scanning from T10-T12.
CT KUB scans should commence cranially in order to include both kidneys in their entirety but be well collimated thereafter in order to minimize patient dose.

MATERIAL AND METHOD

We retrospectively reviewed 250 consecutive CT KUB examinations over a 12 week period, in patients over 18 years of age, undergoing CT to rule out renal/ ureteric calculi. PACS image were reviewed to assess the cranial levels of individual scan. Data was collected and Doses monitored in milliGrey (mGy). Follow up CT scans for patients with VUJ stones were also analyzed in this study.

RESULTS

Our initial study showed only 61% of scans commenced above T10-T12 Level (which is above the recommended guidelines) and 39% of scans commenced from superior border of T10- T12 Level as per the guidelines. This indicated that the current practice was not in accordance to the current guidelines. We recommended an amendment to the current imaging protocol stating scanning to start from T10 down to the pubic symphysis. We presented this to the radiology department and shared the information with radiographers, in addition, a poster showing the current guidelines was created. A re-audit in 3 months after making the change will show a significant reduction in the radiation exposure to the patient and we anticipate more than 90% of scans will be commenced as per the guidelines, there by reducing the radiation dose.

CONCLUSION

The equivalent dose was reduced by minimizing the size of the scan field by using the upper border of T10-T12 as an appropriate landmark to commence the examination. However, many scans commence well above this level and thus impart an unnecessarily high radiation dose to the patient. A mean dose reduction from 327.9 mGy to 175.1mGy was demonstrated which in itself shows reduced risk to patients and lower number of images, thereby decreasing storage space on PACS.






Summary: Computed tomography of the kidneys, ureters and bladder (CT KUB) is part of the diagnostic work up for renal calculi along with other clinical markers which has both high sensitivity – 97% and specificity of 95%. It can also determine stone density using Hounsfield Unit (HU).References: •British Association of Urological Surgeons (BAUS) guideline for acute management of first presentation of renal/ureteric lithiasis
•Making best use of a department of Clinical Radiology, Guidelines for Doctors, Sixth Edition 2007,
The Royal College of Radiologist, London
•Fundamentals of Body CT. Third Edition
•Renal or ureteric colic - acute; NICE CKS, April 2015
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