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Judicious CT Imaging Suggested for Kidney Stone Patients

By MedImaging International staff writers
Posted on 28 Aug 2019

A new study reports that patients with active kidney stone disease are exposed to roughly 10 times more annual computed tomography (CT) radiation than those without kidney stones.

Researchers at the University of Washington (UW; Seattle, USA) conducted a study to examine trends in CT use and estimate the radiation exposure among kidney stone formers, based on the MarketScan national insurance claims database. The study included 327,516 active stone patients, 175,228 inactive stone patients, and 502,744 controls. CT utilization was tracked over three years for each group, with annual CT-related radiation exposure estimated using previously published dose values.

The results revealed that on average, active stone patients received nearly ten times as many CTs as controls at three years, and more acute imaging. Overall, 25% of operative and 15% of non-operative patients, respectively, received more than three CTs in three years, with association to female gender. For non-operative patients, this was also associated with age, residence in the North-Central or South regions, and inversely associated with metropolitan residence. Over 10% of active stone patients were estimated to receive more than 20 mSv (the annual occupational limit suggested by the International Commission on Radiological Protection).

Among the factors that may have contributed to the significantly greater CT utilization rates for patients with active stone disease is the persistence of recurrent kidney stones, which results in clinicians being more likely to order repeat CT exams for them. Second, most emergency clinicians continue to offer CT as the initial test for kidney stone patients with renal colic. As a result, many patients with active stone disease who present to the emergency department for pain caused by the same stone often receive multiple duplicate CT scans. The study was published on August 9, 2019, in Urology.

“Despite debate about the risks of CT-related radiation, overall CT utilization remains high among patients with active stone disease,” concluded lead author Jessica Dai, MD, and colleagues of the department of urology. “Over three years of follow-up, these patients received significantly more CT imaging than those with inactive stone disease and controls. ...This has implications on cumulative radiation exposure over time.”

Kidney stones are often no larger than a grain of rice, yet some can grow to a diameter of several centimeters, causing blockage of the ureters. If it cannot be dissolved chemically, the kidney stone is treated using extracorporeal shock-wave therapy or minimally invasive endoscopic modalities. Many of these patients suffer from disease recurrence and need retreatment, but new stone formation might be reduced by adapting dietary habits or the use of particular medication strategies, as based on stone composition.

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72 (49.114227294922): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (42.915344238281): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294779148 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (28.848648071289): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294779148 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (31.948089599609): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

105 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

106 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294779148 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.922134399414): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294779148 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

109 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

110 (49.114227294922): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294779148 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (530.00450134277): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294779148 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (593.90068054199): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (473.97613525391): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

115 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

116 (185.01281738281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

117 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

118 (173.80714416504): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

119 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

120 (273.22769165039): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 18546.104431152): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

123 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

124 (431.06079101562): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294779148 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294779148 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 448431.01501465): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (79.870223999023): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (53.882598876953): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (39.815902709961): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (78.916549682617): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (43.869018554688): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (49.829483032227): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (34.093856811523): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (463.00888061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (360.01205444336): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (203.84788513184): SELECT name FROM jos_deeppockets WHERE id=211

136 (61.03515625): SELECT name FROM jos_deeppockets WHERE id=211

137 (438.92860412598): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (381.9465637207): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

140 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

141 (!!!!! 8793.830871582): TRUNCATE TABLE jos_trademed_module

142 (110.14938354492): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294779148 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (52.928924560547): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294779148 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (812.05368041992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

147 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

148 (!!!!! 1030.9219360352): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

150 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

151 (44.107437133789): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294779148 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294779148 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (30.040740966797): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

153 (27.179718017578): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

154 (31.948089599609): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

156 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294779148 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294779148 AND published='1' LIMIT 1

157 (36.001205444336): select jos_twitters.link from jos_twitters where cat=10

158 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

159 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

160 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

161 (242.94853210449): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1142.0249938965): insert into jos_banners_delta values (14615,'2025-05-02 11:25:47','18.225.175.56','view'),(14202,'2025-05-02 11:25:47','18.225.175.56','view'),(14203,'2025-05-02 11:25:47','18.225.175.56','view')

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