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Ultrasound Equals CT In Possible ED Kidney Stone Cases

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Ultrasound performs as well as CT in evaluating emergency department patients suspected of having kidney stones, according to new research presented last month at the American Urological Association annual meeting in Orlando, Florida.

Marshall Stoller, MD, professor and vice chair of urology at the University of California, San Francisco, and colleagues reported on a randomized trial. At 15 U.S. academic medical centers, patients appearing at the ED with pain that might be a symptom of kidney stones were randomly assigned to one of three imaging strategies: ultrasound performed by emergency physicians, radiologist-performed ultrasound, or abdominal CT.

“We saw no difference in pain at three or seven days, no difference in return to the emergency department, and ultrasound decreased cumulative radiation exposure at one day and at six months,” said Dr. Stoller, lead author of a paper about the research. Therefore, he came to this conclusion:

Ultrasound should be used as the initial imaging test. Further imaging should be at physician discretion and based on clinical judgment.

The decreased radiation exposure may be a key factor in adoption of ultrasound as the preferred imaging modality in such cases, according to Margaret Pearle, MD, PhD, professor of urology and internal medicine at UT Southwestern Medical Center in Dallas.

“There is a tremendous amount of fear of radiation exposure,” she said, “and a lot of patients say they don’t want to be exposed to any radiation, even though the cancer risk with this amount of radiation is pretty insignificant. Emergency physicians are very attuned to the fact that a lot of X-ray has been overutilized and patients are paying the price for it.”

Dr. Pearle, who was not involved in the research, was quoted by MedPage TodayThe research has not yet been published or peer-reviewed; You can find an abstract here.

There were no statistically significant differences in outcomes among the three imaging strategies. However, radiologist-performed ultrasound did come out slightly ahead by most measures. For example, serious adverse events, as defined by the Food and Drug Administration, occurred in 12.3 percent of the patients assigned to emergency physician–performed ultrasound, 11.1 percent of those assigned to CT, and 10.9 percent of those assigned to radiologist-performed ultrasound.

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Related CME seminar (up to 20 AMA PRA Category 1 credits™): Emergency Radiology


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