title: Cost-effective filming sequence for intravenous urography.
abstract: To define an intravenous urography (IVU) film sequence that maximizes sensitivity and minimizes filming costs, we evaluated the effect of omitting films from a standard IVU sequence. We reviewed 82 IVU series that demonstrated abnormalities. Each series comprised 11 films: preliminary abdominal radiograph and nephrotomogram, three 1-minute nephrotomograms, 5-minute abdominal film, 10-minute radiograph with abdominal compression, one frontal and two oblique 15-minute films, and postvoid film. Sensitivity was determined for each film. Eighty-two standard IVUs showed 120 abnormalities. Omitting any one film from the sequence decreased sensitivity by 0% to 12%. Omitting the preliminary film resulted in failure to detect 15 abnormalities (12%). Omitting any nephrotomogram, the 10-minute compression view, or either 15-minute oblique film did not decrease sensitivity. Omitting combinations of these films lowered overall sensitivity. The postvoid film was essential in only one case. We conclude that a sequence of nine radiographs decreases film and processing expenses by 18% without sacrificing sensitivity. Sequences with fewer films substantially reduce detection of common urinary tract abnormalities.
authors.affiliation: Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1088.
authors.forename: R J
authors.initials: RJ
authors.lastname: Zagoria
authors.forename: D L
authors.initials: DL
authors.lastname: Donati
authors.forename: M Y
authors.initials: MY
authors.lastname: Chen
authors.forename: D W
authors.initials: DW
authors.lastname: Gelfand
authors.forename: D J
authors.initials: DJ
authors.lastname: Ott
authors.forename: R B
authors.initials: RB
authors.lastname: Dyer
mesh_terms: D003362:Cost-Benefit Analysis; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D009657:North Carolina; D012680:Sensitivity and Specificity; D013997:Time Factors; D014567:Urography / Q000191:economics* / Q000379:methods; D014570:Urologic Diseases / Q000000981:diagnostic imaging*; D014962:X-Ray Film / Q000191:economics*