Radiation Dose Reduction of Unenhanced CT Limited to the Kidneys for Follow-Up of Patients With Known Nephrolithiasis Without Symptoms

The purpose of this study is to identify the landmarks and associated radiation dose reduction for limited CT of the kidneys of patients requiring follow-up for known nephrolithiasis. This retrospective study included all adult patients who underwent CT examination type "CT abdomen + pelvis renal stone" at our institution during 2017. Several exclusion criteria were identified, including scoliosis and congenital renal abnormalities. A total of 299 patients met the inclusion and exclusion criteria. The radiation dose and -axis length associated with the original CT scan were recorded. The upper and lower limits of both kidneys in relation to the vertebral body endplates were recorded, to determine the -axis length for a CT scan limited to the kidneys. A commercially available radiation dose analytics software package was used to provide estimates of whole-body-and individual organ-equivalent doses for the original CT scan and the limited range CT scan. The superior endplate of T11 and the inferior endplate of L5 are landmarks that will include both kidneys on almost all scans. A limited -axis range leads to a mean scan length reduction of 50%. The whole-body mean effective dose is reduced by 41.5%, and the doses to the breast and the gonadal and bladder organs are reduced by 71.7%, 73.8%, and 81.8%, respectively. For patients without symptoms who are undergoing CT surveillance to evaluate renal calculi growth, new stone formation, or both, a limited-range scan extending from the superior endplate of T11 to the inferior endplate of L5 results in a significant reduction in radiation dose.