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1.
Clin Imaging ; 55: 126-131, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30818162

RESUMEN

INTRODUCTION: The purpose of this study was to evaluate the radiation dose and image quality of computed tomography urograms (CTU) using tin-filtration compared to conventional CTU (without tin-filtration) examinations in patients with suspected urolithiasis. METHODS: Group 1 consisted of 100 patients who were examined using the tin-filtered CTU protocols (Sn100kVp or Sn150kVp); Group 2 consisted of 100 patients who were examined using the same protocols but without tin-filtration (GE-NI41 or GE-NI43). The scanning protocol was based on the patients' body weight (<80 kg and ≥80 kg). The effective doses of all scans were compared between the two groups. Subjective image quality was evaluated by two blinded radiologists. The objective image quality was assessed for noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and figure-of-merit (FOM) using the CTU scans acquired from both the tin-filtered and non-tin-filtered protocols. RESULTS: Tin-filtration resulted in the reduction of effective radiation dose ranging between 72% to 88% for the ≥80 kg and <80 kg patient groups respectively. For both groups, tin-filtration resulted in no significant differences in SNR and a significant increase in FOM. For the <80 kg group, tin-filtration resulted in significantly noisier images but with no significant difference in CNR. For the ≥80 kg group, tin-filtration resulted in significantly higher CNR. There was no significant difference in subjective image quality when assessed by the radiologists in terms of diagnostic confidence for urolithiasis. CONCLUSION: Tin-filtration significantly reduces patient dose while maintaining diagnostic image quality of CTUs for patients with suspected urolithiasis.


Asunto(s)
Protectores contra Radiación/uso terapéutico , Estaño/uso terapéutico , Tomografía Computarizada por Rayos X/métodos , Urolitiasis/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Dosis de Radiación , Protección Radiológica/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Radiólogos , Relación Señal-Ruido , Tomografía Computarizada por Rayos X/normas , Urografía/métodos , Urografía/normas
3.
J Urol ; 199(3): 831-836, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-28866466

RESUMEN

PURPOSE: To prevent over diagnosis and overtreatment of vesicoureteral reflux the 2007 NICE (National Institute for Health and Care Excellence) and 2011 AAP (American Academy of Pediatrics) guidelines recommended against routine voiding cystourethrograms in children presenting with first febrile urinary tract infections. The impact of these guidelines on clinical practice is unknown. MATERIALS AND METHODS: Using an administrative claims database (Clinformatics™ Data Mart) children who underwent voiding cystourethrogram studies or had a diagnosis of vesicoureteral reflux between 2001 and 2015 were identified. The cohort was divided into children age 0 to 2 and 3 to 10 years. Single and multiple group interrupted time series analyses (difference-in-difference) were performed with the guidelines as intervention points. The incidence of vesicoureteral reflux was compared across each period. RESULTS: Of the 51,649 children who underwent voiding cystourethrograms 19,422 (38%) were diagnosed with vesicoureteral reflux. In children 0 to 2 years old voiding cystourethrogram use did not decrease after the 2007 NICE guidelines were announced (-0.37, 95% CI -1.50 to 0.77, p = 0.52) but did decrease significantly after the 2011 AAP guidelines were announced (-2.00, 95% CI -3.35 to -0.65, p = 0.004). Among children 3 to 10 years old voiding cystourethrogram use decreased during the entire study period. There was a decrease in the incidence of vesicoureteral reflux in both groups that mirrored patterns of voiding cystourethrogram use. CONCLUSIONS: The 2011 AAP guidelines led to a concurrent decrease in voiding cystourethrogram use and incidence of vesicoureteral reflux among children 0 to 2 years old. Further studies are needed to assess the risks and benefits of reducing the diagnosis of vesicoureteral reflux in young children.


Asunto(s)
Guías de Práctica Clínica como Asunto , Vejiga Urinaria/fisiopatología , Micción/fisiología , Urografía/normas , Reflujo Vesicoureteral/epidemiología , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Uso Excesivo de los Servicios de Salud/prevención & control , Uso Excesivo de los Servicios de Salud/tendencias , Michigan/epidemiología , Estudios Retrospectivos , Vejiga Urinaria/diagnóstico por imagen , Reflujo Vesicoureteral/diagnóstico , Reflujo Vesicoureteral/terapia
4.
Emerg Med J ; 34(11): 749-754, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28720719

RESUMEN

BACKGROUND: Patients presenting to the ED with suspected renal colic are frequently imaged with CT urography (CTU), which rarely alters diagnosis or management. To reduce use of CTU in this population, we instigated a new imaging and management guideline in our ED. METHODS: This was a quasi-experimental prospective study, whereby a new guideline was commenced at the intervention site (Monash Medical Centre) and the existing guideline continued at the control site (Dandenong Hospital). The new guideline promotes focused ultrasound for diagnosing renal colic and restricts CT to those with poor response to analgesia or 'red flags'. A consecutive series of patients with suspected renal colic were prospectively enrolled and outcomes compared between the sites. The primary outcome was CTU utilisation and secondary outcomes were radiation exposure, stone rate on CTU, admission, ED length of stay and rates of urological intervention and returns to ED at 4-week follow-up. RESULTS: Preintervention CTU rates were 76.7% at Monash and 72.1% at Dandenong. 324 patients were enrolled; 148 at Monash and 176 at Dandenong. Median age 47 years vs 49 years, males 76.4% vs 66.5% and medianSex, Timing, Origin, Nausea, Erythrocytes (STONE) score 10 vs 10 for Monash and Dandenong, respectively. CTU was performed in 54.1% vs 75.0% (p<0.001), median radiation exposure 2.8 vs 4.0 mSv (p<0.001) and urological intervention occurred in 16.4% vs 15.7% for Monash and Dandenong, respectively. CONCLUSIONS: We found that use of CTU for renal colic was significantly reduced by introduction of a guideline promoting ultrasound and encouraging selective CTU. Although intervention rates were similar between the two sites, further prospective study is needed to ensure other patient-centred outcomes do not differ.


Asunto(s)
Guías como Asunto/normas , Cólico Renal/diagnóstico , Urografía/estadística & datos numéricos , Urografía/normas , Adulto , Estudios de Cohortes , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Ultrasonografía/métodos
6.
J Pediatr Urol ; 12(6): 362-366, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27939178

RESUMEN

The voiding cystourethrogram (VCUG) is a frequently performed test to diagnose a variety of urologic conditions, such as vesicoureteral reflux (VUR). The test results determine whether continued observation or an interventional procedure is indicated. VCUGs are ordered by many specialists and primary care providers, including pediatricians, family practitioners, nephrologists, hospitalists, emergency room physicians, and urologists. Current protocols for performing and interpreting a VCUG are based on the International Reflux Study in 1985. However, more recent information provided by many national and international institutions suggests a need to refine those recommendations. The lead author of the 1985 study, R.L. Lebowitz, agreed to and participated in the current protocol. In addition, a recent survey directed to the chairpersons of pediatric radiology of 65 children's hospitals throughout the United States and Canada showed that VCUG protocols vary substantially. Recent guidelines from the American Academy of Pediatrics (AAP) recommend a VCUG for children between 2 and 24 months of age with urinary tract infections but did not specify how this test should be performed. To improve patient safety and to standardize the data obtained when a VCUG is performed, the AAP Section on Radiology and the AAP Section on Urology initiated the current VCUG protocol to create a consensus on how to perform this test.


Asunto(s)
Protocolos Clínicos , Uretra/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Urografía/normas , Reflujo Vesicoureteral/diagnóstico por imagen , Niño , Humanos , Guías de Práctica Clínica como Asunto , Uretra/fisiopatología , Vejiga Urinaria/fisiopatología , Micción , Reflujo Vesicoureteral/fisiopatología
7.
Pediatrics ; 138(5)2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27940792

RESUMEN

The voiding cystourethrogram (VCUG) is a frequently performed test to diagnose a variety of urologic conditions, such as vesicoureteral reflux. The test results determine whether continued observation or an interventional procedure is indicated. VCUGs are ordered by many specialists and primary care providers, including pediatricians, family practitioners, nephrologists, hospitalists, emergency department physicians, and urologists. Current protocols for performing and interpreting a VCUG are based on the International Reflux Study in 1985. However, more recent information provided by many national and international institutions suggests a need to refine those recommendations. The lead author of the 1985 study, R.L. Lebowitz, agreed to and participated in the current protocol. In addition, a recent survey directed to the chairpersons of pediatric radiology of 65 children's hospitals throughout the United States and Canada showed that VCUG protocols vary substantially. Recent guidelines from the American Academy of Pediatrics (AAP) recommend a VCUG for children between 2 and 24 months of age with urinary tract infections but did not specify how this test should be performed. To improve patient safety and to standardize the data obtained when a VCUG is performed, the AAP Section on Radiology and the AAP Section on Urology initiated the current VCUG protocol to create a consensus on how to perform this test.


Asunto(s)
Cistografía/normas , Guías de Práctica Clínica como Asunto/normas , Trastornos Urinarios/diagnóstico por imagen , Reflujo Vesicoureteral/diagnóstico por imagen , Niño , Preescolar , Cistografía/métodos , Femenino , Humanos , Masculino , Pediatría/normas , Factores de Riesgo , Sensibilidad y Especificidad , Sociedades Médicas/normas , Uretra/diagnóstico por imagen , Micción/fisiología , Trastornos Urinarios/fisiopatología , Urografía/métodos , Urografía/normas , Reflujo Vesicoureteral/fisiopatología
8.
Curr Opin Urol ; 26(1): 56-62, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26555690

RESUMEN

PURPOSE OF REVIEW: To discuss current trends in imaging for urolithiasis and review the recent scientific literature surrounding this topic. Specifically, to address the efforts urologist should be making to reduce the use of ionizing radiation and to examine alternatives to computerized tomography (CT) scan in diagnosing and managing patients with stones. RECENT FINDINGS: Although CT remains the gold standard for diagnosing urolithiasis, low-dose and ultralow-dose CT scans should be utilized more frequently. Imaging with ultrasound and digital tomosynthesis, especially in follow-up for urolithiasis, offers the dual benefit of reduced patient radiation exposure and acceptable diagnostic ability. SUMMARY: Urolithiasis is a prevalent and recurrent condition and patient radiation exposure throughout diagnosis and management of this disease needs to be considered. Imaging modalities that limit radiation and preserve diagnostic accuracy must be utilized.


Asunto(s)
Dosis de Radiación , Tomografía Computarizada por Rayos X , Urografía , Urolitiasis/diagnóstico por imagen , Administración Intravenosa , Medios de Contraste/administración & dosificación , Humanos , Imagen por Resonancia Magnética , Valor Predictivo de las Pruebas , Pronóstico , Exposición a la Radiación/efectos adversos , Exposición a la Radiación/prevención & control , Exposición a la Radiación/normas , Medición de Riesgo , Factores de Riesgo , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/normas , Tomografía Computarizada por Rayos X/tendencias , Ultrasonografía , Urografía/efectos adversos , Urografía/normas , Urografía/tendencias , Urolitiasis/patología
9.
Urologe A ; 55(1): 27-34, 2016 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-26676728

RESUMEN

BACKGROUND: Vesico-ureteral reflux (VUR) is one of the most common urologic diseases in childhood. About every third child that presents with a urinary tract infection (UTI) has urinary reflux to the ureter or kidney. Demonstration of a backflow of urine into the ureters or kidneys proves vesicoureteral reflux. In unclear cases, a positioned instillation of contrast agent (PIC) cystogram might be performed and is able to prove vesico-ureteral reflux. OBJECTIVES: Since low-grade VUR has a high probability of maturation and self-limitation, infants with VUR should be given prophylactic antibiotics during their first year of life, reevaluating the status of VUR after 12 months. The aim of any treatment is to prevent renal damage. THERAPY: The individual risk of renal scarring is decisive for the choice of adequate therapy. This risk is mainly dependent on reflux grade, age, and gender of the child as well as parental therapy adherence. In principle, therapeutic options include conservative as well as endoscopic or open surgical antireflux therapies. CONCLUSION: Decisions on treatment should be made individually with parents taking into account all the findings available.


Asunto(s)
Endoscopía/normas , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Urografía/normas , Reflujo Vesicoureteral/diagnóstico , Reflujo Vesicoureteral/terapia , Antibacterianos/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Guías de Práctica Clínica como Asunto , Resultado del Tratamiento , Infecciones Urinarias/complicaciones , Procedimientos Quirúrgicos Urológicos/normas , Reflujo Vesicoureteral/etiología
11.
Arch. esp. urol. (Ed. impr.) ; 67(7): 634-637, sept. 2014. ilus
Artículo en Español | IBECS | ID: ibc-128739

RESUMEN

OBJETIVO: Aportación de dos casos de ectopia renal cruzada derecha sin fusión diagnosticada en pacientes varones de alrededor de 30 años que acuden a urgencias con sintomatología de cólico renal. MÉTODO: Presentamos los caso de dos varones que acuden al servicio de urgencias por dolor en fosa lumbar de tipo cólico. Después de realizar varias pruebas analíticas y de imagen, se descubre finalmente con la urografía intravenosa, una ectopia renal cruzada. RESULTADOS/CONCLUSIÓN: La ectopia renal cruzada derecha sin fusión es una anomalía congénita poco frecuente con una mayor incidencia en hombres. Lo más común es encontrar una ectopia renal cruzada con fusión del riñón ortotópico o en el caso que no haya fusión, que éste se encuentre en posición inferior al riñón normal, a diferencia del caso presentado. Ésta malformación no suele ir acompañada de otras alteraciones congénitas. La mayoría de casos se resuelven espontáneamente y no precisan de tratamiento quirúrgico intercurrente


OBJECTIVE: To report two cases of right crossed non-fused renal ectopia diagnosed in male patients about 30 years of age who arrived to emergency centres with symptoms of renal colic. METHODS: We report two cases of male patients who arrived to an emergency centre complaining of colic lumbar pain. Crossed renal ectopia was finally revealed by means of intravenous urogram after several analytical and imaging examinations. RESULTS/CONCLUSION: Right crossed non-fused renal ectopia is an uncommon congenital anomaly with a higher incidence in males. It is much more common to find a crossed fused renal ectopia of the orthotopic kidney. In contrast, if there is no fusion it may be located on the lower portion of the normal kidney, which is not the case in this instance. This malformation is not usually accompanied by other congenital anomalies. Most of cases are spontaneously solved and they do not require an intercurrent surgical intervention


Asunto(s)
Humanos , Masculino , Cólico Renal/complicaciones , Cólico Renal/diagnóstico , Cólico Renal/fisiopatología , Urografía/métodos , Urografía/normas , Urografía , Anomalías Congénitas/diagnóstico , Medicina de Emergencia/métodos , Medicina de Emergencia/tendencias , Enfermedades Urológicas/congénito , Riñón/anomalías
12.
AJR Am J Roentgenol ; 202(6): 1179-86, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24848814

RESUMEN

OBJECTIVE: The purpose of this article is to describe the current consensus guidelines for nonimaging triage and ultimate preferred imaging approach for the patient with unexplained hematuria. CONCLUSION: Numerous consensus guidelines from varying societies have outlined preferred imaging pathways for the patient with unexplained urologic causes of hematuria. Future guidelines will need to take into account disease prevalence, radiation considerations, and cost.


Asunto(s)
Diagnóstico por Imagen/normas , Hematuria/diagnóstico , Hematuria/economía , Guías de Práctica Clínica como Asunto , Urografía/normas , Urología/normas , Control de Costos , Diagnóstico por Imagen/economía , Medicina Basada en la Evidencia , Femenino , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Urografía/economía , Urología/economía
13.
Urology ; 83(5): 1190-3, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24767528

RESUMEN

OBJECTIVE: To compare the accuracy of retrograde urethrogram (RUG) interpretation between the primary physician performing the procedure and the independent physician interpreting the films to evaluate the suitability of relying on independent physician interpretations for the purposes of preoperative urethral stricture surgery planning. METHODS: A retrospective review was performed on a cohort of 397 patients undergoing anterior urethroplasty over a 7-year period at a single center. Preoperative RUG findings as reported at the time by both the urologist performing the urethrography and the independent interpreter (radiologist) were abstracted and compared with stricture location and length as measured intraoperatively. RUG adequacy was defined as a comment on the presence, location, and length of the urethral stricture. RESULTS: Only 49% of independently reported RUG studies were deemed adequate, and 87% of independently reported studies correctly diagnosed the presence of a stricture. Forty-nine percent of independently reported studies correctly identified stricture location compared with 96% of primary physician-reported cases (P <.001). The reported stricture lengths were 3.23 ± 2.25, 4.19 ± 2.49, and 4.51 ± 2.65 cm for the independently reported RUGs, primary physician-reported RUGs, and the intraoperative measurements, respectively. Differences between all the groups were statistically significant (P <.001). Independently reported length had a 0.47 R(2) coefficient of correlation to the intraoperative length (P <.001) compared with a 0.93 R(2) coefficient of correlation between primary physician-reported length and intraoperative length (P <.001). CONCLUSION: Independently reported RUGs are not as accurate as primary physician-reported RUGs, and caution should be used when they are used for preoperative planning.


Asunto(s)
Uretra/diagnóstico por imagen , Estrechez Uretral/diagnóstico por imagen , Competencia Clínica , Humanos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Urografía/métodos , Urografía/normas , Urología
14.
World J Urol ; 32(1): 137-42, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23615746

RESUMEN

PURPOSE: An opportunity exists to evaluate the quality of care in patients undergoing intravenous pyelogram (IVP) imaging and to define the role of IVP in the computed tomography scan era. METHODS: Medical records were reviewed for patient demographics, inpatient versus outpatient setting, indication for IVP, physician/specialty who ordered IVP, and the need for subsequent imaging within a 30-day period in patients who underwent IVP from October 2007 to December 2011. Chi-square test was used to compare the number of additional radiologic examinations ordered within 30 days of the initial IVP across the different specialties ordering IVPs. RESULTS: Six hundred and eighty patients underwent IVP imaging during the study period. The primary reason to order an IVP was the evaluation of urolithiasis/flank pain (50%), followed by urologic evaluation after surgery (23%). Three hundred and twenty-five patients (48%) subsequently had an additional 547 radiologic studies within 30 days of the IVP to further evaluate their condition. Of the 325 patients undergoing additional imaging studies, 36% had differing or additional diagnostic information noted that could change medical decision-making. CONCLUSIONS: Inferior imaging of the urologic patient by IVP leads to the acquisition of additional imaging studies to render a diagnosis. IVP has a limited clinical role, and thus, its use should be strictly limited to highly select cases.


Asunto(s)
Tomografía Computarizada por Rayos X/estadística & datos numéricos , Urografía/estadística & datos numéricos , Enfermedades Urológicas/diagnóstico por imagen , Enfermedades Urológicas/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico por Imagen/métodos , Femenino , Florida , Humanos , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/normas , Urografía/normas , Adulto Joven
15.
Radiat Prot Dosimetry ; 158(2): 170-4, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24084519

RESUMEN

The aim of this study was to test the feasibility of using Gafchromic XR-QA2 films in the measurements of patient entrance surface dose (ESD) during the micturating cystourethrogram (MCUG) examination in paediatric patients. Radiochromic films were used to map the entrance dose and to identify the location of peak surface dose (PSD). Direct in vivo measurements of entrance dose were conducted by placing a radiochromic film between the patient and the examination table. The measured ESD values for the commonly performed MCUG fluoroscopic examinations at the authors' institution was in the range of 1.2-7.8 mGy and the PSD in the range of 1.2-8.5 mGy per MCUG procedure for patients with age ranging from 1 to 12 y old. Gafchromic films (XR-QA2) were found to be an efficient and practical dosimetry method that can be easily used to measure clinical patient entrance doses during fluoroscopically guided procedures and potentially in other diagnostic investigations.


Asunto(s)
Dosimetría por Película/métodos , Fluoroscopía/métodos , Uretra/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Micción , Urografía/normas , Película para Rayos X , Aire , Calibración , Humanos , Dosis de Radiación , Piel/efectos de la radiación , Urografía/métodos
16.
Tohoku J Exp Med ; 231(4): 251-5, 2013 12.
Artículo en Inglés | MEDLINE | ID: mdl-24270100

RESUMEN

Vesicoureteral reflux (VUR) is common condition in infants with febrile urinary tract infections (UTIs). Both VUR and febrile UTIs are risk factors for renal scars, characterized by glomerular hypertrophy with global or segmental sclerosis as cardinal features in pathology. Because renal scars may cause hypertension or chronic kidney diseases in later life, voiding cystourethrography (VCUG) has been mandatory for infants following their first febrile UTIs to identify VUR. However, increasing evidence suggests that the presence of VUR may not represent a direct risk factor for renal scars, which has led to an increase in the use of a stratified approach, in which VCUG is not performed for all patients. This study was conducted to verify whether the stratified approach is justified to identify infants at risk for renal scarring. The medical records of 306 infants with first febrile UTIs (median age, 4 months; 0-72 months) were reviewed. VUR was detected in 40.4% (67/166) of patients by the non-stratified approach, in which VCUG was performed in all patients. In contrast, VUR was identified in only 27.1% (38/140) of patients by the stratified approach, in which VCUG was performed only in the patients with high risk of developing renal scars. This difference in the discovery rate was significant (p = 0.02). Renal bladder ultrasonography had the sensitivities of as low as 45.7% and 52.9% in detecting VUR and in predicting renal scarring assessed by renal scintigraphy, respectively. In conclusion, VCUG should be performed in all infants after their first febrile UTIs.


Asunto(s)
Fiebre/diagnóstico , Vejiga Urinaria/diagnóstico por imagen , Infecciones Urinarias/diagnóstico por imagen , Urografía/métodos , Reflujo Vesicoureteral/diagnóstico por imagen , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Riñón/patología , Masculino , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Ultrasonografía , Urografía/normas
17.
Radiat Prot Dosimetry ; 157(3): 355-62, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23765072

RESUMEN

The estimation of the radiological risk in the case of children is of particular importance due to their enhanced radiosensitivity when compared with that of adult patients. The purpose of this study is to estimate the organ and effective doses of paediatric patients undergoing micturating cystourethrography examinations. Since direct measurements of the dose in each organ are very difficult, dose-area products of 90 patients undergoing cystourethrography examinations were recorded and used with two Monte Carlo codes, MCNP5 and PCXMC2.0, to assess the organ doses in these procedures. The organs receiving the highest radiation doses were the urinary bladder (ranging from 1.9 mSv in the newborn to 4.7 mSv in a 5-y old patient) and the large intestines (ranging from 1.5 mSv in the newborn to 3.1 mSv in the 5-y old patient). For all ages the main contributors to the total organ or effective doses are the fluoroscopy projections compared with the radiographs. There was a reasonable agreement between the dose estimates provided by PCXMC v2.0 and MCNP5 for most of the organs considered in this study. In special cases, there were systematic disagreements in organ doses such as in the skeleton, gonads and oesophagus due to the anatomical differences between patient anatomic models employed by the two codes.


Asunto(s)
Método de Montecarlo , Dosis de Radiación , Enfermedades de la Vejiga Urinaria/diagnóstico por imagen , Urografía/normas , Adolescente , Adulto , Niño , Preescolar , Simulación por Computador , Femenino , Fluoroscopía/métodos , Humanos , Lactante , Recién Nacido , Modelos Teóricos , Fantasmas de Imagen , Medición de Riesgo , Urografía/métodos
18.
Rofo ; 185(3): 262-7, 2013 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-23154862

RESUMEN

PURPOSE: To compare the dose area products of pediatric VCUG in daily practice with the dramatically reduced official German diagnostic reference levels, which are based on selected data. MATERIALS AND METHODS: 413 consecutive pediatric VCUG examinations were analyzed. RESULTS: The mean dose area product of all examinations was 0.97 dGycm². This is below the lowest reference level that is valid for neonates. In 12 cases (5.6 %) the achieved dose area product was higher than the corresponding reference level. CONCLUSION: Using the available techniques for radiation protection, it is possible in the daily routine to meet the official diagnostic reference levels for children, which have been reduced by up to 80 %, even though these levels are based on a selected, possibly non-representative data set.


Asunto(s)
Fluoroscopía/métodos , Dosis de Radiación , Monitoreo de Radiación/legislación & jurisprudencia , Monitoreo de Radiación/métodos , Protección Radiológica/legislación & jurisprudencia , Protección Radiológica/métodos , Urodinámica/fisiología , Urografía/métodos , Reflujo Vesicoureteral/diagnóstico por imagen , Adolescente , Factores de Edad , Niño , Preescolar , Relación Dosis-Respuesta en la Radiación , Femenino , Fluoroscopía/normas , Alemania , Humanos , Lactante , Recién Nacido , Masculino , Monitoreo de Radiación/normas , Protección Radiológica/normas , Valores de Referencia , Estudios Retrospectivos , Urografía/normas
19.
Ann R Coll Surg Engl ; 94(5): 340-3, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22943230

RESUMEN

INTRODUCTION: Urologists perform retrograde contrast studies of the ureters and pelvicalyceal systems in the operating theatre, both for diagnostic purposes and to guide instrumentation. We describe the development of a set of guidelines that aim to standardise the diagnostic quality of these studies and to reduce radiation dose to the patient and theatre staff. The guidelines incorporate a reporting template that allows a urologist's written report to be made available on the picture archiving and com- munication system (PACS) for subsequent multidisciplinary review. METHODS: Three cycles of audit were conducted to assess the implementation of the guidelines. An independent reviewer rated image quality and screening times. During the audit cycle, the presentation of the guidelines was honed. The end prod- uct is a flowchart and reporting template for use by urologists in the operating theatre. RESULTS: Phase 1 of the audit included 63 studies, phase 2 included 42 studies and phase 3 included 46 studies. The results demonstrate significant improvements in the number of good quality studies and in the recording of control, contrast and post-procedure images. The mean screening time decreased from 5.0 minutes in phase 1 to 3.2 minutes in phase 3. In phase 3, when in-theatre reporting of the studies by the urologist was added, the handwritten report was scanned in and made available on PACS in 43 of 46 cases (93%). CONCLUSIONS Introduction of guidelines improved retrograde contrast study quality and reduced screening times. A system has been developed to store appropriate pictures and a urologist's report of the study on PACS.


Asunto(s)
Guías de Práctica Clínica como Asunto , Dosis de Radiación , Urografía/normas , Medios de Contraste , Humanos , Tiempo de Internación , Auditoría Médica , Cuerpo Médico de Hospitales , Exposición Profesional/prevención & control , Estudios Prospectivos , Servicio de Radiología en Hospital , Sistemas de Información Radiológica
20.
J Urol ; 186(4 Suppl): 1668-71, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21855922

RESUMEN

PURPOSE: Voiding cystourethrogram is the gold standard for evaluating and diagnosing vesicoureteral reflux. Reflux detection can potentially be affected by many parameters during voiding cystourethrogram. MATERIALS AND METHODS: A 29-item survey was sent via e-mail through SurveyMonkey® to the chairperson of pediatric radiology at 65 national pediatric hospitals. This survey included questions on institutional protocols for performing voiding cystourethrogram. RESULTS: Responses were received from 41 institutions from across North America, including 17 of 19 Randomized Intervention for Children with Vesicoureteral Reflux study sites. Many aspects of the reports of voiding cystourethrogram protocols were similar with 90% or greater agreement in allowing parents in the room, contrast infusion by gravity, catheter or feeding tube use without balloons, no contrast dilution and voiding without a catheter in place. The height at which contrast medium was raised for infusion was 40, 60, 80, 100 and greater than 100 cm at 2.4%, 17.1%, 17.1%, 39.0% and 12.2% of sites, respectively, while the height was not measured or it varied at 12.2%. The infilling phase stopped when the bladder appeared full at 2.4% of sites, infusion stopped itself at 12.2%, patient voided at 61.0%, volume attained age expected capacity at 12.2%, the patient was uncomfortable at 4.9% and results varied at 7.3%. CONCLUSIONS: Data reveal that voiding cystourethrogram is performed differently across North America and no standard protocol exists for the procedure. These differences could significantly impact voiding cystourethrogram results among institutions and taint our ability to compare results in the literature.


Asunto(s)
Protocolos Clínicos/normas , Micción , Urografía/métodos , Reflujo Vesicoureteral/diagnóstico por imagen , Preescolar , Humanos , América del Norte , Reproducibilidad de los Resultados , Urografía/normas , Urografía/estadística & datos numéricos , Reflujo Vesicoureteral/fisiopatología
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