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Bowel preparation for excretory urography is not necessary: a randomized trial
Department of Radiology, Örebro University Hospital, Örebro, Sweden.
Department of Radiology, Örebro University Hospital, Örebro, Sweden.
Department of Radiology, Örebro University Hospital, Örebro, Sweden.
2007 (English)In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 80, no 956, 617-624 p.Article in journal (Refereed) Published
Abstract [en]

Despite the fact that computed tomography is becoming more commonly used to investigate the genitourinary tract, intravenous urography still plays an important role in uroradiology. The aim of this study was to compare bowel purgation and two other preparation methods — dietary restrictions and no preparations at all — in an attempt to find the optimal procedure for uniform practice. 210 consecutive patients were randomised to three preparation groups with 70 in each group. Group 1 received standard bowel purgation, Group 2 was instructed to fast, while Group 3 had no preparation at all. Irrespective of preparation, all patients underwent the same examination procedure. The examining radiographer and evaluating radiologists were unaware of the type of preparation given. Image quality was assessed according to European Commission criteria for excretory urography. The effectiveness of bowel purgation and the amount of residual gas were scored separately. There was no statistically significant difference in the proportions with fulfilled criteria between preparation Groups 1 and 2 and Groups 1 and 3. A criterion was regarded as fulfilled only when all three observers agreed. Assessment of the amount of residual faeces proved the effectiveness of our standard bowel purgation. The results of our study show equality of the evaluated preparation methods and cannot justify further use of bowel purgation before excretory urography.

Place, publisher, year, edition, pages
2007. Vol. 80, no 956, 617-624 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-76719DOI: 10.1259/bjr/78311002ISI: 000249951000005OAI: oai:DiVA.org:liu-76719DiVA: diva2:516369
Available from: 2012-04-18 Created: 2012-04-18 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Aspects on Image Quality in Radiologic Evaluation of the Urinary Tract
Open this publication in new window or tab >>Aspects on Image Quality in Radiologic Evaluation of the Urinary Tract
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The focus of this document is on image quality as one of the factors fundamental for the diagnostic process. With the rising number of procedures and the trend towards more complicated examinations, urinary tract investigations was chosen in this work as a good clinical model for evaluation of the factors influencing image quality and of the ways of evaluating image quality.

In paper I, a method is described for optimisation during the introduction of a new imaging system, with a focus on the maintenance of image quality relative to the older already optimised system. Image quality was assessed using the image criteria of the European guidelines for IVU with visual grading analysis. Equivalent image quality in image pairs was achieved at 30% of the dose. The CDRAD contrast-detail phantom makes it possible to find dose levels that give equal image quality using different imaging systems.

In paper II, the influence of bowel purgation on image quality in urography is questioned. The aim of this study was to compare bowel purgation and two other preparation methods; dietary restrictions and no preparation at all. Image quality was assessed according to European Commission criteria for excretory urography. The effectiveness of bowel purgation and the amount of residual gas were scored separately. The results of our study show that the preparation methods are of equal value and further use of bowel purgation before excretory urography cannot be justified.

In paper III, the image quality of the non-enhanced series is compared to a virtual noncontrast series obtained using two generations of dual-energy CT scanners and taking CT of the urinary tract as a model. The image quality of the VNC images was rated inferior to the single-energy variant for both scanners, the OR range being 11.5–67.3 for the Definition and 2.1–2.8 for the Definition Flash. Visual noise and overall quality were regarded as better with Flash than with Definition. Image quality of VNC images obtained with the new generation of DECT is still slightly inferior compared to native images.

In paper IV, the accuracy of measurement of renal calculi in a dual-energy, virtual, nonenhanced-image series is compared to actual stone size and a single-energy image series in the phantom study. This study shows that detection of small stones is not reliable, despite better image quality, with the new DECT and that small stones will be missed with VNC imaging. With larger stones, the inherent measurement error with CT is magnified with VNC imaging.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 69 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1298
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-76723 (URN)978-91-7519-943-6 (ISBN)
Public defence
2012-05-18, Bohmansonssalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-04-18 Created: 2012-04-18 Last updated: 2013-10-21Bibliographically approved

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