MP36-15 COMPARISON OF CONVENTIONAL AND TRIPLE BOLUS CT UROGRAPHY PROTOCOLS FOR RADIATION DOSE REDUCTION IN HEMATURIA EVALUATION

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology I (MP36)1 Apr 2020MP36-15 COMPARISON OF CONVENTIONAL AND TRIPLE BOLUS CT UROGRAPHY PROTOCOLS FOR RADIATION DOSE REDUCTION IN HEMATURIA EVALUATION Rajiv Karani*, John M. Sung, Lillian Xie, Raphael Arada, Egor Parkhomenko, Daniel J. Lama, Francis Jefferson, Sonia Lee, Chandana Lall, Roshan M. Patel, Zhamshid Okhunov, Shlomi Tapiero, Ralph V. Clayman, and Jaime Landman Rajiv Karani*Rajiv Karani* More articles by this author , John M. SungJohn M. Sung More articles by this author , Lillian XieLillian Xie More articles by this author , Raphael AradaRaphael Arada More articles by this author , Egor ParkhomenkoEgor Parkhomenko More articles by this author , Daniel J. LamaDaniel J. Lama More articles by this author , Francis JeffersonFrancis Jefferson More articles by this author , Sonia LeeSonia Lee More articles by this author , Chandana LallChandana Lall More articles by this author , Roshan M. PatelRoshan M. Patel More articles by this author , Zhamshid OkhunovZhamshid Okhunov More articles by this author , Shlomi TapieroShlomi Tapiero More articles by this author , Ralph V. ClaymanRalph V. Clayman More articles by this author , and Jaime LandmanJaime Landman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000880.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Computed tomography urography (CTU) is the diagnostic tool of choice for evaluating hematuria. In keeping with the ALARA (as low as reasonably achievable) principle, we evaluated a triple bolus computed tomography (TBCT) protocol designed to reduce radiation exposure. METHODS: Patients with macroscopic or microscopic hematuria were prospectively randomized to conventional CTU (n=75) or TBCT (n=75). Conventional CTU protocol requires 4 scans: pre-contrast scan, and 3 post-contrast scans at 35 seconds, 70 seconds, and 10 minutes. The TBCT protocol entails 2 scans: pre-contrast scan followed by 3 injections of contrast at 35 seconds, 70 seconds, and 15 minutes prior to the second scan. Patient demographics, change in creatinine values, CT scan length and urological pathology detection rates were recorded. Total radiation exposure was recorded from the CT machine using the dose length product (DLP). An imaging quality assessment questionnaire (1 = poor to 5 = excellent for 9 items) was completed by a radiologist for each study. RESULTS: There were no differences in patient demographics, CT scan length or change in creatinine between the two groups. The TBCT protocol exposed patients to 35% less radiation (DLP: 1718 vs. 1125 mGy*cm, p<0.001). The TBCT protocol exposed macroscopic hematuria patients to 32% less radiation and microscopic hematuria patients to 37% less radiation (DLP:1792 vs. 1212 mGy*cm, p<0.001; DLP: 1579 vs. 987 mGy*cm, p<0.001, respectively). Urological pathology detection rates were 60% for TBCT and 63% for CTU (p=0.66). For macroscopic hematuria, the detection rates were 65% for TBCT and 71% for CTU (p=0.5). For microscopic hematuria, the detection rates were 52% for TBCT and 46% for CTU (p=0.68); of note, with TBCT there was a significantly higher rate of urologic mass detection (5/29, 17% vs 0/26, 0%, p<0.001). Of these 5 detected urologic masses, 4 were bladder masses and 1 was a kidney mass. The image quality of CTU was 7% superior to TBCT (42.72 vs. 39.90, p <0.001). CONCLUSIONS: Despite a slight decrease in image quality, the TBCT protocol for hematuria evaluation reduced radiation exposure by 35% while providing a similar pathology detection rate to CTU. Of note, microscopic hematuria patients benefitted from the TBCT protocol due to an increased detection of urologic masses. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e528-e528 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajiv Karani* More articles by this author John M. Sung More articles by this author Lillian Xie More articles by this author Raphael Arada More articles by this author Egor Parkhomenko More articles by this author Daniel J. Lama More articles by this author Francis Jefferson More articles by this author Sonia Lee More articles by this author Chandana Lall More articles by this author Roshan M. Patel More articles by this author Zhamshid Okhunov More articles by this author Shlomi Tapiero More articles by this author Ralph V. Clayman More articles by this author Jaime Landman More articles by this author Expand All Advertisement PDF downloadLoading ...