title: Reduction in voiding cystourethrographies after the introduction of contrast enhanced sonographic reflux diagnosis.
abstract: BACKGROUND
  Voiding urosonography (VUS) using the intravesical application of an US contrast medium (Levovist) has been shown to have very high sensitivity and specificity in the diagnosis of vesicoureteric reflux (VUR) compared to voiding cystourethrography (VCUG).
  
  
  OBJECTIVE
  To determine the extent of reduction of VCUGs after adding VUS to the diagnostic algorithm of VUR.
  
  
  METHODS
  Over 2 years, 449 children (162 boys, 287 girls) were referred for diagnosis of possible VUR. The selection of a particular reflux examination was based on pre-defined criteria. VUS was performed primarily in girls and follow-up cases. The indications for VCUG were as follows: (a) boys - first examination for VUR, (b) specific request for urethra or bladder imaging, (c) girls - when VUR was diagnosed in the VUS and no VCUG had been done previously, and (d) inadequate VUS.
  
  
  RESULTS
  VCUGs were primarily carried out in 141 cases. VUSs were performed in 308 patients. In 69 of these patients a VCUG followed during the same examination session. Thus 239 of 449 patients underwent only VUS, resulting in reduction of the VCUGs by 53 %.
  
  
  CONCLUSIONS
  The number of VCUGs was significantly reduced as a result of the implementation of VUS as part of the routine diagnostic imaging modality for VUR. Consequently, the number of children that would have been exposed to ionising radiation was reduced by over half.
authors.affiliation: Department of Paediatric Radiology, Radiological Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 153, 69 120 Heidelberg, Germany. Kassa_Darge@med.uni-heidelberg.de
authors.forename: K
authors.initials: K
authors.lastname: Darge
authors.forename: S
authors.initials: S
authors.lastname: Ghods
authors.forename: B
authors.initials: B
authors.lastname: Zieger
authors.forename: W
authors.initials: W
authors.lastname: Rohrschneider
authors.forename: J
authors.initials: J
authors.lastname: Troeger
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011134:Polysaccharides / Q000008:administration & dosage; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508