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UPJ INSIGHT Use of Low-Dose Computed Tomography in Children With Nephrolithiasis

By: Ashley Pittman, BS, Medical College of Wisconsin, Milwaukee; Neil Paloian, MD, University of Wisconsin School of Medicine and Public Health, Wisconsin; Amy Y. Pan, PhD, Medical College of Wisconsin, Milwaukee; Liyun Zhang, MS, Medical College of Wisconsin, Milwaukee; Andrea Moyer, MD, Medical College of Wisconsin, Milwaukee; Robert Medairos, MD, Medical College of Wisconsin, Milwaukee, Duke University School of Medicine, Durham, North Carolina; Pooja Thakrar, MD, Medical College of Wisconsin, Milwaukee; Jonathan Ellison, MD, Medical College of Wisconsin, Milwaukee, Children’s Wisconsin, Milwaukee | Posted on: 19 Jan 2024

Pittman A, Paloian N, Pan AY, et al. Use of low-dose computed tomography in children with nephrolithiasis: an analysis from 2 tertiary pediatric centers. Urol Pract. 2024;11(1):163-170.

Study Need and Importance

Nephrolithiasis has steadily risen in the pediatric population, necessitating a greater need for diagnostic imaging studies. Although ultrasound (US) is the preferred first-line imaging for pediatric nephrolithiasis, CT may be necessary in cases of a nondiagnostic US or when US is not available. As children are more susceptible to the risks of ionizing radiation and may present commonly at adult facilities, we investigated the use of low-dose CTs (LDCTs) for children presenting with nephrolithiasis to 2 pediatric facilities as well as those referred by outside facilities with images already obtained.

What We Found

Across 2 tertiary pediatric centers, we reviewed imaging studies and charts of 155 individuals, with 126 (81.3%) receiving standard-dose and 29 (18.7%) receiving LDCT (<3 mGy). Pediatric facilities were more likely to utilize LDCT as compared to referral centers (P < .05; Figure). Older age and higher BMI were also found to be associated with increased radiation dose exposure.

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Figure. Facility vs radiation dose. Pediatric facilities were 2.04 times more likely to administer low-dose CT compared to other facilities.

Limitations

This retrospective study was unable to determine indications for CT, which may have included a nondiagnostic US or a broader differential such as appendicitis or ovarian torsion that would influence CT protocol. Furthermore, while these results arise from referrals to 2 tertiary pediatric institutions within our state, they may not be broadly generalizable to other practice settings.

Interpretation for Patient Care

LDCTs for children with nephrolithiasis are utilized with greater frequency in pediatric health centers. Nonetheless, opportunities exist across health care settings to improve upon LDCT utilization for children with nephrolithiasis.

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