With wide availability of CT scans the pendulum has swung towards using CT scans for diagnosis of kidney stones. So what now? Should they fail expectant management, CT scan can then be performed. A CT KUB scan can diagnose traumatic injuries. Other diagnoses that may cause ureteral obstruction such as ureteral tumor or ureteral stricture cannot be diagnosed by ultrasound. A new randomized control study published in New England Journal of Medicine compared CT scan to ultrasound in evaluation of patients with symptoms of renal colic. I'm going for a followup KUB X-ray in a few weeks. All stones seen on CT scout were also visible on KUB. The exact location of the stone does not matter all that much as long as the patient is willing to try to pass the stone. Learn about our remote access options, Department of Urology, Christchurch Public Hospital, Christchurch, New Zealand. A CT scan … The CTI looks approximately like a normal kidney-ureter-bladder abdominal radiography (KUB… If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4421. The most common study used to diagnose a kidney stone are CT scans, which are very accurate at detecting a stone, its size, and its location. Smaller stones that are also more likely to pass will not be visible on KUB. In the emergency room situation, in  a patient with renal colic, the finding of kidney stone on ultrasound as well as  hydronephrosis is diagnostic. NYC Kidney Stone Clinic offering lithotripsy, prevention and dietary treatment for kidney stones in New York with offices in Manhattan and Brooklyn serving patients in Long Island, Queens, Staten Island, Westchester and New Jersey. A KUB ultrasound is an examination requested by your doctor to evaluate the urinary tract (which includes the kidneys, ureters, and urinary bladder). Radiation induced cancers typically do not develop immediately but take many years to occur. The other common study for kidney stones are plain x-rays of the abdomen, known as “KUB’s” … This is a case controlled study conducted in the period from June 2000 to July 2003 at a university hospital. View the article PDF and any associated supplements and figures for a period of 48 hours. These patients have been exposed to significant amount of radiation in a very short period of time which is very concerning. There was no correlation between stone location and visibility on KUB or CT scout films. Before a CT scan can be done a CT planning image (CTI) is generated in order to select the exact scanning area. This approach is likely to decrease radiation exposure from CT scans by 70-80%. Importantly, all stones visible on CT scout were also visible on KUB. Combining ultrasound with a KUB, while not as sensitive or specific as a CT scan, does do a pretty good job of picking up clinically significant stones. 2. To assess the sensitivity of computed tomography (CT) scout topograms and kidney‐ureter‐bladder abdominal radiography (KUB) in detecting urinary tract stones. (C) If a  patient with hydronephrosis has fever, severe pain that cannot be controlled with medications, or abnormal renal function, the size or location of the stone do not matter as the patient needs to be taken to the operating room for surgical intervention. A counter-argument for using ultrasound in diagnosing of kidney stones is that ureteral stones are usually difficult to visualize with ultrasound and unless they are located at UPJ or in the distal ureter will not be seen with ultrasound. Almost all kidney stones are CT positive. CT scanning is superior to ultrasonography in identifying renal … Computed tomography (CT) is an excellent tool to evaluate masses, traumatic injury to the kidney, stones, and pyelonephritis. The equipment takes pictures from several angles. Both of these can be evaluated and diagnosed with ultrasound with fairly good confidence. It can also show stones in the urinary tract. The most important advance is the development of low dose CT scan options for the diagnosis and … By far the most common stone is calcium oxalate, however, the exact distribution of stones depends on the population and associated metabolic abnormalities (e.g. In this situation, CT scan will not make any immediate difference. In this situation, CT scan will not make any immediate difference. CT KUB/ CT Scan KUB (Kidney, Ureter & Bladder) is CT Scan of Urinary System. Before a CT scan can be done a CT planning image (CTI) is generated in order to select the exact scanning area. Use of Hounsfield Units to Optimize Care for Kidney Stones: New York Urology Specialists. There was no correlation between stone location and visibility on KUB or CT scout … The KUB is often used to diagnose constipation as stool can be seen readily. A repeat ultrasound in a few weeks documenting resolution of hydronephrosis is all that is needed. CT … A large stone greater than 7-9 mm will most likely be visible on KUB. Therefore, getting a KUB … There were 40/108 radiolucent stones subsequently measured on CT, with a mean length of 4.90 mm. CT scan is easy to perform. For comparison, the annual background radiation most individuals experience is 3.86 mSv just from the environment. As long as the patient is stable and comfortable they can be managed expectantly without exposing them to unnecessary radiation. The most common diagnosis other than kidney stone is musculoskeletal pain or sciatica. The KUB … We suggest CT scout film should be reported before proceeding to KUB. Your doctor may use a CT scan to look for stones … Patient has no hydronephrosis and the stone is not visible on ultrasound. These patients had a very low risk of having another diagnosis that was dangerous. Computed tomography of kidneys, ureters and bladder (CT KUB) is a quick non-invasive technique for diagnosis of urolithiasis.It is usually considered the initial imaging modality for suspected urolithiasis … © 2013-2020 New York Urology Specialists. Scout detected 75% of stones visible on KUB. CT scans … CT KUB Scan … Stones were seen on 47% (51/108) of the CT scouts, with a mean length of 5.22 mm. Patient has a stone visible on renal or bladder ultrasound:  in this situation, ultrasound is diagnostic. CT scan is certainly useful for surgical planning in patients with large stones to define anatomy and decide which approach would be ideal especially when the question is whether the patient needs PCNL. Use the link below to share a full-text version of this article with your friends and colleagues. Meanwhile 3 CT scans, 2 at the doctor and one at the ER didn't show that. If the stone is visible on CT scout film, then the decision to use KUB for follow‐up can be made. Stones were identified in 63% (68/108) of patients with KUB, with a mean length of 4.93 mm. CT showing stone: CT scan images are far more precise than plain KUB xray. Unlimited viewing of the article PDF and any associated supplements and figures. A CT scan for kidney stones can detect tiny pieces that other imaging tests might miss. I have seen patients who had 5-10 CAT scans in a period of 1-2 years for evaluation of kidney stones. In practice, any patient with symptoms of acute renal colic who demonstrates a urine pH lower than 6.0 should be considered at risk for a possible uric acid stone. [ 1] in 1995 showed CT … However, this test makes the patient wait her turn for the CT scan, sends her down the hall to Radiology and thus away from physicians/nurses, and exposes her abdomen to the side effects of ionizing radiation. This minimizes radiation exposure and other costs. The other possibility is that the pain is not caused by a stone but has a different etiology. Location, size and length of stone were recorded. and you may need to create a new Wiley Online Library account. In all, 108 of 163 patients had both CT and KUB imaging on the same day. There is significant evidence that accumulated radiation from exposure to multiple CT scans can have detrimental effect on life and may be associated with a small risk of developing certain cancers. Patient has hydronephrosis and the stone is not visible on ultrasound. Most patients tend to present between 30-60 years of age 1. Acute undiagnosed abdominopelvic pain without a clear etiology, and accompanied by symptoms such as nausea, vomiting, diarrhea and/or issues with passing urine, is the primary indication for a CT KUB. 2. All patients had both US and UHCT scan… If the patient is comfortable, has no fever and has normal renal function, an optimal approach is for patient to try to pass the stone. In addition they are  likely to have a need for CT scan for evaluation of other symptoms at some point in their life. If you have previously obtained access with your personal account, please log in. This is a challenging situation. While a single CT scan in adults is fairly safe and is associated with fairly small amount of radiation, many patients with kidney stones will have multiple recurrent episodes of kidney stones requiring multiple CT scans during their life. (A) that the stone is in the ureter or that it has passed. 3. Learn more. Many conditions may be associated with signs and symptoms in this region.These include, but are not limited to, intestinal blockage, gall or urinary bladder stones, malignancies, and complications of inflammation and/ or infecti… For patients with large kidney stones renal ultrasound is essentially equivalent to CT scan in diagnosis of kidney stones. KUB is typically used to investigate gastrointestinal conditions such as a bowel obstruction and gallstones, and can detect the presence of kidney stones. It did not show up on a KUB X-ray. There were 40/108 radiolucent stones subsequently measured on CT, with a mean length of 4.90 mm. Kidney stone rates are increasing, and in a 2010 National Health and Nutrition Examination Survey, one in 11 people reported having had at least one kidney stone. The CT scan can … There are 2 possibilities. Two tests are available for diagnosing kidney stones, CT scan or renal ultrasound. While sometimes CT scan provides valuable information that cannot be obtained with other methods, in my practice over the past 5 years the use of CT scans for evaluation and management of patients with kidney stones has decreased while the use of ultrasound has increased. A plain x-ray (KUB) carries a dose of 0.7 mSv as compared to a much higher dose of 15 mSv from a CT scan. A CT scan of the urinary tract can show infections, cysts, tumors, or obstructions in the urinary tract. Computed tomography of kidneys, ureters and bladder (CT KUB) is a quick non-invasive technique for diagnosis of stone disease. Such a stone is more likely if the urine pH indicates very acidic urine. Please check your email for instructions on resetting your password. KUB & Ultrasound vs CT My first ultrasound and my most recent KUB showed "possible" stones in both kidneys. struvite stones are more frequently encountered in women, like urinary tract infection as more common) 8. Stones were seen on 47% (51/108) of the CT scouts, with a mean length of 5.22 mm. First the patient has a renal colic due to a ureteral stone that has not produced hydronephrosis yet. KUB could be used for follow‐up in 63% of cases. Almost all kidney stones are CT positive. I have a kidney stone in my upper ureter (verified by CT scan). The CTI looks approximately like a normal kidney-ureter-bladder abdominal radiography (KUB… Two urology registrars examined the films independently. US vs. CT for Kidney Stones There is 3 possibilities: 1. The use of CT to diagnose kidney stones has risen 10-fold in the last 15 years. Working off-campus? The Article Provide Complete Guide on Its Meaning, Purpose, Procedure, Use of Contrast, Urography Comparison, Cost & Discount. I would like to maxmize the chances that the stone will show up in the KUB so that I do not have to follow up with a CT. Now, I know the stone … This study found no significant difference in terms of diagnostic efficacy and more importantly ultrasound did not miss significantly more dangerous diagnosis then did CT scan. The lifetime incidence of renal stones is high, seen in as many as 5% of women and 12% of males. If a stone of adequate size is visible on a CT scan but not visible on KUB, then uric stones … Unlimited viewing of the article/chapter PDF and any associated supplements and figures. A more in-depth type of scan is called computed tomography, or CT scan. Computed Tomography (CT) Scan for Kidney Stones. If you do not receive an email within 10 minutes, your email address may not be registered, Without definite hydronephrosis, a CT scan may not be able to isolate a specific stone, although secondary signs, such as perinephric streaking and nephromegaly, may be present. The 2 most common dangerous diagnosis that could be mistaken for renal colic are appendicitis and cholecystitis. 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