Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology

Abstract

An estimated 4–5 million CT scans are performed in the USA every year to investigate nephrourological diseases such as urinary stones and renal masses. Despite the clinical benefits of CT imaging, concerns remain regarding the potential risks associated with exposure to ionizing radiation. To assess the potential risk of harmful biological effects from exposure to ionizing radiation, understanding the mechanisms by which radiation damage and repair occur is essential. Although radiation level and cancer risk follow a linear association at high doses, no strong relationship is apparent below 100 mSv, the doses used in diagnostic imaging. Furthermore, the small theoretical increase in risk of cancer incidence must be considered in the context of the clinical benefit derived from a medically indicated CT and the likelihood of cancer occurrence in the general population. Elimination of unnecessary imaging is the most important method to reduce imaging-related radiation; however, technical aspects of medically justified imaging should also be optimized, such that the required diagnostic information is retained while minimizing the dose of radiation. Despite intensive study, evidence to prove an increased cancer risk associated with radiation doses below ~100 mSv is lacking; however, concerns about ionizing radiation in medical imaging remain and can affect patient care. Overall, the principles of justification and optimization must remain the basis of clinical decision-making regarding the use of ionizing radiation in medicine.

Key points

  • CT scans are commonly performed in nephrourology, for indications including suspected stones and renal masses.

  • Concerns have been raised regarding the potential harmful effects of exposure to radiation associated with CT scans; however, the dose associated with CT is <~100 mSv and no harmful effects have been shown at these low doses.

  • Even taking the very low potential risk of malignancy into account, such a risk must be considered in the context of the clinical benefit of performing the scan, and elimination of unnecessary CT examinations is the first step towards managing risk.

  • Optimization of the scanning technique is essential, so that the necessary clinical information can be gathered with minimization of the radiation dose.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Purchase on Springer Link

Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Illustration of the different models for radiation-related cancer risk as a function of radiation dose in the low-dose (<100 mSv) region.
Fig. 2: Cancer incidence as a function of effective radiation dose for survivors of the atomic bombings in Japan.
Fig. 3: Typical dose levels (in terms of effective dose) for a routine CT examination of the abdomen and pelvis over various time periods.
Fig. 4: Typical effective doses for common imaging examinations that use ionizing radiation.

Similar content being viewed by others

References

  1. Rubin, G. D., Dake, M. D., Napel, S. A., McDonnell, C. H. & Jeffrey, R. B. Jr. Three-dimensional spiral CT angiography of the abdomen: initial clinical experience. Radiology 186, 147–152 (1993).

    CAS  PubMed  Google Scholar 

  2. Miller, J. M. et al. Diagnostic performance of coronary angiography by 64-row CT. N. Engl. J. Med. 359, 2324–2336 (2008).

    CAS  PubMed  Google Scholar 

  3. Biesbroek, J. et al. Diagnostic accuracy of CT perfusion imaging for detecting acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc. Dis. 35, 493–501 (2013).

    CAS  PubMed  Google Scholar 

  4. Ruzsics, B. et al. Images in cardiovascular medicine. Myocardial ischemia diagnosed by dual-energy computed tomography: correlation with single-photon emission computed tomography. Circulation 117, 1244–1245 (2008).

    PubMed  Google Scholar 

  5. American College of Radiology. ACR appropriateness criteria: genitourinary imaging. ACR https://acsearch.acr.org/ (2016).

  6. Smith, R., Verga, M., McCarthy, S. & Rosenfield, A. Diagnosis of acute flank pain: value of unenhanced helical CT. AJR Am. J. Roentgenol 166, 97–101 (1996).

    CAS  PubMed  Google Scholar 

  7. Poletti, P.-A. et al. Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. AJR Am. J. Roentgenol. 188, 927–933 (2007).

    PubMed  Google Scholar 

  8. Mulkens, T. H. et al. Urinary stone disease: comparison of standard-dose and low-dose with 4D MDCT tube current modulation. AJR Am. J. Roentgenol. 188, 553–562 (2007).

    PubMed  Google Scholar 

  9. Niemann, T., Kollmann, T. & Bongartz, G. Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis. AJR Am. J. Roentgenol. 191, 396–401 (2008).

    PubMed  Google Scholar 

  10. Jin, D. H. et al. Effect of reduced radiation CT protocols on the detection of renal calculi. Radiology 255, 100–107 (2010).

    PubMed  Google Scholar 

  11. Kekelidze, M. et al. Kidney and urinary tract imaging: triple-bolus multidetector CT urography as a one-stop shop—protocol design, opacification, and image quality analysis 1. Radiology 255, 508–516 (2010).

    PubMed  Google Scholar 

  12. Cowan, N. C. CT urography for hematuria. Nat. Rev. Urol. 9, 218–226 (2012).

    CAS  PubMed  Google Scholar 

  13. Stolzmann, P. et al. In vivo identification of uric acid stones with dual-energy CT: diagnostic performance evaluation in patients. Abdom. Imaging 35, 629–635 (2010).

    PubMed  Google Scholar 

  14. Assimos, D. et al. Surgical management of stones: American urological association/endourological society guideline, PART I. J. Urol. 196, 1153–1160 (2016).

    PubMed  Google Scholar 

  15. IMV Medical Information Division. IMV 2015 CT market outlook report (IMV, 2015).

  16. Mettler, F. A. Jr., Huda, W., Yoshizumi, T. T. & Mahesh, M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248, 254–263 (2008).

    PubMed  Google Scholar 

  17. National Research Council. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2 (National Academies Press, 2006).

  18. Brenner, D. J. & Hall, E. J. Computed tomography—an increasing source of radiation exposure. N. Engl. J. Med. 357, 2277–2284 (2007).

    CAS  PubMed  Google Scholar 

  19. Brenner, D., Elliston, C., Hall, E. & Berdon, W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am. J. Roentgenol. 176, 289–296 (2001).

    CAS  PubMed  Google Scholar 

  20. Smith-Bindman, R. et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch. Intern. Med. 169, 2078–2086 (2009).

    PubMed  PubMed Central  Google Scholar 

  21. Pearce, M. S. et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380, 499–505 (2012).

    PubMed  PubMed Central  Google Scholar 

  22. Miglioretti, D. L. et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 167, 700–707 (2013).

    PubMed  PubMed Central  Google Scholar 

  23. Berrington de Gonzalez, A. et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch. Intern. Med. 169, 2071–2077 (2009).

    PubMed  Google Scholar 

  24. The New York Times. Report links increased cancer risk to CT scans. The New York Times http://www.nytimes.com/2007/11/29/us/29scan.html (2007).

  25. Cable News Network (CNN). Could CT scans cause cancer? CNN http://www.cnn.com/2016/01/07/health/ct-scan-radiation-concerns/ (2016).

  26. Larson, D. B., Rader, S. B., Forman, H. P. & Fenton, L. Z. Informing parents about CT radiation exposure in children: it’s OK to tell them. AJR Am. J. Roentgenol. 189, 271–275 (2007).

    PubMed  Google Scholar 

  27. Boutis, K. et al. Parental knowledge of potential cancer risks from exposure to computed tomography. Pediatrics 132, 305–311 (2013).

    PubMed  Google Scholar 

  28. Centers for Disease Control and Prevention. TBI data and statistics. CDC https://www.cdc.gov/traumaticbraininjury/data/index.html (2016).

  29. National Council on Radiation Protection and Measurements. Commentary No. 27. - Implications of Recent Epidemiologic Studies for the Linear Nonthreshold Model and Radiation Protection (NCRP, Bethesda, MD, 2018).

  30. Hall, E. J. & Giaccia, A. J. Radiology for the Radiologist 6th edn (Lippincott Williams & Wilkins, 2006).

  31. Balter, S., Hopewell, J. W., Miller, D. L., Wagner, L. K. & Zelefsky, M. J. Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair. Radiology 254, 326–341 (2010).

    PubMed  Google Scholar 

  32. Wintermark, M. & Lev, M. H. FDA investigates the safety of brain perfusion CT. AJNR Am. J. Neuroradiol 31, 2–3 (2010).

    CAS  PubMed  Google Scholar 

  33. Furukawa, K. et al. Long-term trend of thyroid cancer risk among Japanese atomic-bomb survivors: 60 years after exposure. Int. J. Cancer 132, 1222–1226 (2013).

    CAS  PubMed  Google Scholar 

  34. Hsu, W. L. et al. The incidence of leukemia, lymphoma and multiple myeloma among atomic bomb survivors: 1950–2001. Radiat. Res. 179, 361–382 (2013).

    CAS  PubMed  Google Scholar 

  35. Preston, D. L. et al. Solid cancer incidence in atomic bomb survivors exposed in utero or as young children. J. Natl Cancer Inst. 100, 428–436 (2008).

    PubMed  Google Scholar 

  36. Preston, D. L. et al. Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat. Res. 168, 1–64 (2007).

    CAS  PubMed  Google Scholar 

  37. Pattison, J. E., Hugtenburg, R. P., Charles, M. W. & Beddoe, A. H. Experimental simulation of A-bomb gamma ray spectra for radiobiology studies. Radiat. Prot. Dosimetry 95, 125–136 (2001).

    CAS  PubMed  Google Scholar 

  38. Johns, H. E. & Cunningham, J. R. The Physics of Radiology (Charles River Media, 1983).

  39. Hendee, W. R. & O’Connor, M. K. Radiation risks of medical imaging: separating fact from fantasy. Radiology 264, 312–321 (2012).

    PubMed  Google Scholar 

  40. Mathews, J. D. et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 346, f2360 (2013).

    PubMed  PubMed Central  Google Scholar 

  41. Phillips, L. E. et al. History of head trauma and risk of intracranial meningioma: population-based case-control study. Neurology 58, 1849–1852 (2002).

    CAS  PubMed  Google Scholar 

  42. Tyagi, V. et al. Traumatic brain injury and subsequent glioblastoma development: review of the literature and case reports. Surg. Neurol. Int. 7, 78 (2016).

    PubMed  PubMed Central  Google Scholar 

  43. Berrington de Gonzalez, A. et al. Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions. Br. J. Cancer 114, 388–394 (2016).

    PubMed  Google Scholar 

  44. Journy, N. et al. Are the studies on cancer risk from CT scans biased by indication? Elements of answer from a large-scale cohort study in France. Br. J. Cancer 112, 185–193 (2015).

    CAS  PubMed  Google Scholar 

  45. Krille, L. et al. Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study. Radiat. Environ. Biophys. 54, 1–12 (2015).

    CAS  PubMed  Google Scholar 

  46. Ahmad, A. S., Ormiston-Smith, N. & Sasieni, P. D. Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. Br. J. Cancer 112, 943–947 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Pandharipande, P. V. et al. CT in the emergency department: a real-time study of changes in physician decision making. Radiology 278, 812–821 (2016).

    PubMed  Google Scholar 

  48. Boice, J. D. The Boice Report #15: low doses in Madison - July 2013 Health Physics Society annual meeting in Madison, Wisconsin. NCRP https://ncrponline.org/wp-content/themes/ncrp/PDFs/BOICE-HPnews/15-HPS_Low-Dose.pdf (2013).

  49. National Council on Radiation Protection and Measurements. Report No. 171 - Uncertainties in the Estimation of Radiation Risks and Probability of Disease Causation (NCRP, Bethesda, MD, 2012).

  50. Walsh, L., Shore, R., Auvinen, A., Jung, T. & Wakeford, R. Risks from CT scans—what do recent studies tell us? J. Radiol. Prot. 34, E1–E5 (2014).

    PubMed  Google Scholar 

  51. Löbrich, M. et al. In vivo formation and repair of DNA double-strand breaks after computed tomography examinations. Proc. Natl Acad. Sci. USA 102, 8984–8989 (2005).

    PubMed  Google Scholar 

  52. National Council on Radiation Protection and Measurements. Report No. 160 - Ionizing Radiation Exposure of the Population of the United States (2009) (NCRP, Bethesda, MD, 2009).

  53. Berrington de González, A. et al. Long-term mortality in 43 763 US radiologists compared with 64 990 US psychiatrists. Radiology 281, 847–857 (2016).

    PubMed  PubMed Central  Google Scholar 

  54. United Nations Scientific Committee on the Effects of Atomic Radiation. Report of the United Nations Scientific Committee on the Effects of Atomic Radiation 2010. Fifty-seventh session, includes scientific report: summary of low-dose radiation effects on health. unscear http://www.unscear.org/docs/publications/2010/UNSCEAR_2010_Report.pdf (2010).

  55. International Commission on Radiological Protection. ICRP publication 103: the 2007 recommendations of the International Commission on Radiological Protection. Ann. ICRP 37, 2–4 (2007).

    Google Scholar 

  56. Health Physics Society. Radiation risk in perspective: position statement of the Health Physics Society. HPS http://hps.org/documents/risk_ps010-3.pdf (1996).

  57. Hendee, W. R. Policy statement of the International Organization for Medical Physics. Radiology 267, 326–327 (2013).

    PubMed  Google Scholar 

  58. American Association of Physicists in Medicine. AAPM position statement on radiation risks from medical imaging procedures. AAPM https://www.aapm.org/org/policies/details.asp?id=318&type=PP&current=true. (2017).

  59. Tubiana, M. Dose–effect relationship and estimation of the carcinogenic effects of low doses of ionizing radiation: the joint report of the Academie des Sciences (Paris) and of the Academie Nationale de Medecine. Int. J. Radiat. Oncol. Biol. Phys. 63, 317–319 (2005).

    PubMed  Google Scholar 

  60. McCollough, C. H., Bushberg, J. T., Fletcher, J. G. & Eckel, L. J. Answers to common questions about the use and safety of CT scans. Mayo Clin. Proc. 90, 1380–1392 (2015).

    PubMed  Google Scholar 

  61. National Safety Council. Injury facts 2016 chart: what are the odds of dying from. NSC http://www.nsc.org/learn/safety-knowledge/Pages/injury-facts-chart.aspx (2016).

  62. Brenner, D. J., Shuryak, I. & Einstein, A. J. Impact of reduced patient life expectancy on potential cancer risks from radiologic imaging. Radiology 261, 193–198 (2011).

    PubMed  Google Scholar 

  63. Lowry, K. P. et al. Projected effects of radiation-induced cancers on life expectancy in patients undergoing CT surveillance for limited-stage Hodgkin lymphoma: a Markov model. AJR Am. J. Roentgenol. 204, 1228–1233 (2015).

    PubMed  Google Scholar 

  64. Pandharipande, P. V. et al. Changes in physician decision making after CT: a prospective multicenter study in primary care settings. Radiology 281, 835–846 (2016).

    PubMed  Google Scholar 

  65. Pandharipande, P. V. et al. Patients with testicular cancer undergoing CT surveillance demonstrate a pitfall of radiation-induced cancer risk estimates: the timing paradox. Radiology 266, 896–904 (2013).

    PubMed  PubMed Central  Google Scholar 

  66. De, P. et al. Trends in incidence, mortality, and survival for kidney cancer in Canada, 1986–2007. Cancer Causes Control 25, 1271–1281 (2014).

    PubMed  PubMed Central  Google Scholar 

  67. Sun, M. et al. Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. Eur. Urol. 59, 135–141 (2011).

    PubMed  Google Scholar 

  68. Rini, B. I. & Campbell, S. C. Renal Cell Carcinoma (People’s Medical Pub. House, 2009).

  69. European Association of Urology. European Association of Urology guidelines (2016 edition). uroweb https://uroweb.org/wp-content/uploads/EAU-Extended-Guidelines-2016-Edn.pdf (2016).

  70. Rosenthal, D. I. et al. Radiology order entry with decision support: initial clinical experience. J. Am. Coll. Radiol. 3, 799–806 (2006).

    PubMed  Google Scholar 

  71. Sistrom, C. L. et al. Effect of computerized order entry with integrated decision support on the growth of outpatient procedure volumes: seven-year time series analysis 1. Radiology 251, 147–155 (2009).

    PubMed  Google Scholar 

  72. Graser, A., Johnson, T. R., Chandarana, H. & Macari, M. Dual energy CT: preliminary observations and potential clinical applications in the abdomen. Eur. Radiol. 19, 13 (2009).

    PubMed  Google Scholar 

  73. Türk, C. et al. EAU guidelines on interventional treatment for urolithiasis. Eur. Urol. 69, 475–482 (2016).

    PubMed  Google Scholar 

  74. Abuelo, J. G. The diagnosis of hematuria. Arch. Intern. Med. 143, 967–970 (1983).

    CAS  PubMed  Google Scholar 

  75. O’Regan, K. N., O’Connor, O. J., McLoughlin, P. & Maher, M. M. The role of imaging in the investigation of painless hematuria in adults. Semin. Ultrasound CT MR 30, 258–270 (2009).

    PubMed  Google Scholar 

  76. American College of Radiology. ACR appropriateness criteria: hematuria. ACR https://acsearch.acr.org/docs/69490/Narrative/ (2014).

  77. Jinzaki, M. et al. Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract. AJR Am. J. Roentgenol. 196, 1102–1109 (2011).

    PubMed  Google Scholar 

  78. Hartman, D. S., Choyke, P. L. & Hartman, M. S. From the RSNA refresher courses: a practical approach to the cystic renal mass. Radiographics 24, S101–S115 (2004).

    PubMed  Google Scholar 

  79. Ozveren, B., Onganer, E. & Turkeri, L. N. Simple renal cysts: prevalence, associated risk factors and follow-up in a health screening cohort. Urol. J. 13, 2569–2575 (2016).

    PubMed  Google Scholar 

  80. Bettmann, M. A. Frequently asked questions: iodinated contrast agents. Radiographics 24 (Suppl. 1), S3–S10 (2004).

    PubMed  Google Scholar 

  81. Maxwell, M. H. & Prozan, G. B. Renovascular hypertension. Prog. Cardiovasc. Dis. 5, 81 (1962).

    CAS  PubMed  Google Scholar 

  82. American College of Radiology. ACR appropriateness criteria: renovascular hypertension. ACR https://acsearch.acr.org/docs/69374/Narrative/ (2014).

  83. Vasbinder, G. B. C. et al. Accuracy of computed tomographic angiography and magnetic resonance angiography for diagnosing renal artery stenosis. Ann. Intern. Med. 141, 674–682 (2004).

    PubMed  Google Scholar 

  84. American College of Radiology. Medicare physician fee schedule. ACR https://www.acr.org/Advocacy-and-Economics/Radiology-Economics/Medicare-Medicaid/MPFS (2018).

  85. Winchester, P., Kapur, S. & Prince, M. R. Noninvasive imaging of living kidney donors. Transplantation 86, 1168–1169 (2008).

    PubMed  Google Scholar 

  86. Gluecker, T. M. et al. Comparison of CT angiography with MR angiography in the preoperative assessment of living kidney donors. Transplantation 86, 1249–1256 (2008).

    PubMed  Google Scholar 

  87. McCollough, C. H. et al. Strategies for reducing radiation dose in CT. Radiol Clin. North Am. 47, 27–40 (2009).

    PubMed  PubMed Central  Google Scholar 

  88. International Commission on Radiological Protection. ICRP publication 87: managing patient dose in computed tomography. Ann. ICRP 30, 7 (2000).

  89. Kalra, M. K. et al. Strategies for CT radiation dose optimization. Radiology 230, 619–628 (2004).

    PubMed  Google Scholar 

  90. United States Nuclear Regulatory Commission. Information for radiation workers. NRC https://www.nrc.gov/about-nrc/radiation/health-effects/info.html (2018).

  91. Guimarães, L. S. et al. Appropriate patient selection at abdominal dual-energy CT using 80 kV: relationship between patient size, image noise, and image quality. Radiology 257, 732–742 (2010).

    PubMed  Google Scholar 

  92. Yu, L. et al. Automatic selection of tube potential for radiation dose reduction in vascular and contrast-enhanced abdominopelvic CT. AJR Am. J. Roentgenol. 201, W297–W306 (2013).

    PubMed  Google Scholar 

  93. Yu, L., Li, H., Fletcher, J. G. & McCollough, C. H. Automatic selection of tube potential for radiation dose reduction in CT: a general strategy. Med. Phys. 37, 234–243 (2010).

    PubMed  Google Scholar 

  94. Pooler, B. D. et al. Prospective trial of the detection of urolithiasis on ultralow dose (sub mSv) noncontrast computerized tomography: direct comparison against routine low dose reference standard. J. Urol. 192, 1433–1439 (2014).

    PubMed  PubMed Central  Google Scholar 

  95. McCollough, C. H. et al. Degradation of CT low-contrast spatial resolution due to the use of iterative reconstruction and reduced dose levels. Radiology 276, 499–506 (2015).

    PubMed  PubMed Central  Google Scholar 

  96. Fletcher, J. G. et al. Dual-energy and dual-source CT: is there a role in the abdomen and pelvis? Radiol. Clin. North Amer. 47, 41–57 (2009).

    Google Scholar 

  97. Vrtiska, T. J. et al. Genitourinary applications of dual-energy CT. AJR Am. J. Roentgenol 194, 1434–1442 (2010).

    PubMed  PubMed Central  Google Scholar 

  98. Takahashi, N. et al. Detectability of urinary stones on virtual nonenhanced images generated at pyelographic-phase dual-energy CT. Radiology 256, 184–190 (2010).

    PubMed  PubMed Central  Google Scholar 

  99. Yu, L., Primak, A. N., Liu, X. & McCollough, C. H. Image quality optimization and evaluation of linearly mixed images in dual-source, dual-energy CT. Med. Phys. 36, 1019–1024 (2009).

    PubMed  PubMed Central  Google Scholar 

  100. Mandal, D., Saha, M. M. & Pal, D. K. Urological disorders and pregnancy: an overall experience. Urol. Ann. 9, 32–36 (2017).

    PubMed  PubMed Central  Google Scholar 

  101. McCollough, C. H. et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics 27, 909–917 (2007).

    PubMed  Google Scholar 

  102. Rossen, L. M., Khan, D. & Schoendorf, K. C. Mapping geographic variation in infant mortality and related Black–White disparities in the US. Epidemiology 27, 690–696 (2016).

    PubMed  PubMed Central  Google Scholar 

  103. Ganesan, V., De, S., Greene, D., Torricelli, F. C. & Monga, M. Accuracy of ultrasonography for renal stone detection and size determination: is it good enough for management decisions? BJU Int. 119, 464–469 (2017).

    PubMed  Google Scholar 

  104. Renard-Penna, R., Martin, A., Conort, P., Mozer, P. & Grenier, P. Kidney stones and imaging: what can your radiologist do for you? World J. Urol. 33, 193–202 (2015).

    PubMed  Google Scholar 

  105. Sternberg, K. M. et al. Ultrasonography significantly overestimates stone size when compared to low-dose, noncontrast computed tomography. Urology 95, 67–71 (2016).

    PubMed  Google Scholar 

Download references

Acknowledgements

The project described was supported by grant number DK 100227 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

Authors

Contributions

C.H.M., A.F. and N.T. researched data for the article. C.H.M., A.F., T.J.V., A.K. and J.C.L. made substantial contributions to discussions of content. C.H.M. and A.F. wrote the manuscript. All authors reviewed and edited the manuscript before submission.

Corresponding author

Correspondence to Cynthia H. McCollough.

Ethics declarations

Competing interests

C.H.M. is the principal investigator of a grant to the authors’ institution from Siemens Healthcare that is unrelated to this work. The other authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferrero, A., Takahashi, N., Vrtiska, T.J. et al. Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology. Nat Rev Urol 16, 231–244 (2019). https://doi.org/10.1038/s41585-019-0148-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41585-019-0148-8

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing