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Observers could use the standard PACS tools to make the adjustments they would make during routine interpretation. The reviewers were blinded to all technical parameters. Each study was interpreted independently by three pediatric radiologists with 14-30 years of experience, all fellowship trained with a certificate of added qualification. The images at the three tube current settings were viewed randomly. The purpose of our study was to determine how tube current reduction affects the diagnostic yield in CT examinations for suspected renal or ureteral stones in children. Although this simulation tool has been investigated for systematic reduction in tube current in the adult population with nephroureterolithiasis, similar investigations have not been performed for evaluation of nephroureterolithiasis in the more radiation-sensitive pediatric population. One option is to use a computer to simulate a tube current lower than that used for the original CT examinations. Investigational repeated scanning of children with lower doses is not justifiable. The disadvantage of a decrease in tube current is an increase in noise, which can reduce the radiologist's ability to detect disease. Ī reduction in tube current is one method of lowering radiation exposure during CT. The risks of radiation-related bioeffects are greater among children than among adults, and there is growing concern about the long-term risk of neoplasm development associated with radiation exposure. The main concern with abdominal CT examinations, however, is radiation exposure, especially with the possibility of cumulative doses because renal calculi can be a recurring problem. There is no need for IV contrast media and therefore no risk of side effects related to contrast media. CT has the advantage of a high rate of detection of renal and ureteral stones and shows other pathologic changes that can mimic renal colic.
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Unenhanced abdominal CT examinations have become the preferred diagnostic method for evaluation of nephroureterolithiasis in both adults and children. Keywords: CT, pediatric imaging, radiation, renal stones Use of the 80-mA setting for all children and 40 mA for children weighing 50 kg or less does not significantly affect the diagnosis of pediatric renal stones. Simulated dose reduction is a useful tool for determining diagnostic thresholds for MDCT detection of renal stones in children. Detection of ureteral stones and hydronephrosis was not significantly different at 80 and 40 mA however, disease frequency was low, and no definite conclusion can be made.ĬONCLUSION. At the 40-mA setting, there was no significant difference among the children weighing 50 kg or less ( p = 0.4). Compared with the standard tube current used for the original CT scans, there was no significant reduction ( p = 0.37) in detection of renal stones at the 80-mA setting (mean dose reduction, 67% range, 43-81%) and at the 40-mA setting (mean dose reduction, 82% range, 72-90%), the detection rate was significantly lower ( p = 0.05). Three independent blinded readers ranked random images for stones (confidence scale, 1-5, least to most), hydronephrosis, noise-based image quality, and presence of nonrenal lesions. An investigational computer-simulated tube current reduction tool was used to produce additional 80- and 40-mA examination sets (total number of image sets = 135). Forty-five patients 20 years old or younger divided into two groups weighing 50 kg or less and more than 50 kg underwent unenhanced 16-MDCT in the evaluation of acute flank pain. The purpose of this study was to compare the diagnostic capabilities of standard- and reduced-dose CT in the detection of nephroureterolithiasis in children.