Trends in Imaging Use for the Evaluation and Followup of Kidney Stone Disease: A Single Center Experience.

Abstract

Recent reports support renal ultrasound as the initial imaging study to evaluate patients with suspected renal colic. However, urologists often advocate for computerized tomography to better define stone size and location, especially before proceeding with endourological intervention. One concern with using ultrasound as initial imaging is that computerized tomography may be required later, obviating the reduction in costs and radiation gained by using ultrasound. We retrospectively reviewed the electronic health records of 10,680 episodes of stone disease in a total of 7,659 patients who presented to the emergency department or walk-in clinic with a chief complaint or visit diagnosis of urolithiasis from 2009 to 2015 at a single institution. Images obtained during the index encounter and in the following 90 days were recorded. The index encounter included computerized tomography in 47% of episodes, ultrasound in 20%, plain x-ray of the kidneys, ureters and bladder in 12% and no imaging in 29%. Of the index visits 49% included multiple testing. If no computerized tomography was obtained during the index visit, 10% of patients underwent computerized tomography later in the episode. Total imaging costs and radiation exposure during 90 days were significantly higher when computerized tomography was done at the index visit. If the initial image obtained during an episode was ultrasound, computerized tomography was performed in 20% of cases within 90 days. Of patients who underwent an initial ultrasound 80% avoided computerized tomography imaging. Avoiding computerized tomography at the index visit was associated with substantial reductions in radiation exposure and imaging costs.