Choosing Wisely:

Don’t routinely use CT to screen pediatric patients with suspected nephrolithiasis.

Rationale and Comments: Given the link between radiation exposure from CT in children and increased cancer risk, imaging test selection should adhere to the principle of ALARA (as low as reasonably achievable) to minimize radiation exposure. Ultrasonography is sufficiently sensitive and specific as an initial imaging test in pediatric patients with suspected urolithiasis. When ultrasound results are negative or indeterminate despite strong clinical suspicion or when proceeding with perioperative planning, CT using a low-dose protocol is an appropriate next step.
Sponsoring Organizations:
  • American Urological Association
  • Sources:
  • American Urological Association guidelines
  • Disciplines:
  • Urologic
  • Pediatric
  • References: • Clinical Effectiveness Protocols for Imaging in the Management of Ureteral Calculous Disease: American Urological Association Technology Assessment, 2012; J Urol; April 2013;189(4):1203-1213; DOI: dx.doi.org/10.1016/j.juro.2012.10.031. Available from: www.jurology.com/article/S0022-5347(12)05259-7/fulltext.
    • Assimos, Dean et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, 2016; J Urol 196(4)1153-60. DOI: dx.doi.org/10.1016/j.juro.2016.05.090; www.jurology.com/article/S0022-5347(16)30531-6/abstract; www.auanet.org/common/pdf/education/clinical-guidance/Surgical-Management-of-Stones.pdf; www.guideline.gov/summaries/summary/50408.

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