title: Radiation dosing in the investigation and follow-up of urolithiasis: Comparison between historical and contemporary practices.
abstract: OBJECTIVE
  Computed tomography (CT) is the gold standard imaging modality for the diagnosis and follow-up of urolithiasis. Before the use of CT, intravenous urography (IVU) was the imaging modality of choice. CT remains contentious because of the cancer risk related to radiation exposure above a threshold level. We aimed to compare the radiation exposure dose to the average patient with urolithiasis in the era of CT with that of IVU.
  
  
  METHODS
  Our hospital medical records database was searched for patients who presented to the Emergency Department over a 1-month period in 1990 with a diagnosis of renal colic. Patients with the same presentation, from the same month, in 2013 were also identified. A total of 14 patients from each year fulfilled the inclusion criteria. The estimated effective radiation exposure dose for each patient was calculated by using data from population-based studies.
  
  
  RESULTS
  The median effective radiation dose per patient in the 1990 group, for initial diagnosis and subsequent follow-up, was 4.05 mSv (interquartile range [IQR], 3.7-4.4 mSv). The corresponding median dose in the 2013 group was 4.2 mSv (IQR, 4.2-4.9 mSv), and there was no evidence of a statistical difference between the groups (p=0.8).
  
  
  CONCLUSIONS
  Despite the contentiousness related to the use of serial CT scanning, our study demonstrated that for radiological investigation and follow-up of urolithiasis, the estimated effective radiation exposure dose to each patient is only marginally higher than in the era of IVU, with improvements in length of hospital stay and time to definitive diagnosis.
authors.affiliation: Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia.; Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Kane
authors.affiliation: Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Frank T
authors.initials: FT
authors.lastname: D'Arcy
authors.affiliation: Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Papa
authors.affiliation: Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Smith
authors.affiliation: Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Scott
authors.initials: S
authors.lastname: McClintock
authors.affiliation: Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
authors.affiliation: Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Damien M
authors.initials: DM
authors.lastname: Bolton
mesh_terms: D000328:Adult; D016208:Databases, Factual; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008134:Long-Term Care / Q000379:methods; D008875:Middle Aged; D011364:Professional Practice / Q000639:trends; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000379:methods; D014567:Urography / Q000379:methods; D052878:Urolithiasis / Q000000981:diagnostic imaging*
keywords: Radiation; Urolithiasis; X-ray computed tomography